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January 26, 2012

Appeals court upholds dismissal of Pa. ambulance industry lawsuit

By Brian Bowling
Pittsburgh Tribune Review

PITTSBURGH — The numerous arguments the ambulance industry offered for why it should ignore the "plain language" of a state law dealing with health insurance payments only resulted in a federal appeals court quoting William Shakespeare`s "The Merchant of Venice" today.

"'The devil can cite scripture for his purpose,'" a three-judge panel of the 3rd U.S. Circuit Court of Appeals noted in rejecting the industry`s appeal of a district judge`s dismissal of its lawsuit against Highmark Inc. and six other insurance companies.

Charles Kelly, one of the attorneys representing the Ambulance Association of Pennsylvania, said the industry has 14 days to decide whether to ask for a new hearing before the entire 3rd Circuit bench.

"We think we're right and we're not happy with the results," he said.

Highmark spokesman Michael Weinstein said the company is happy with the ruling."We would encourage these ambulance providers to contract directly with Highmark as virtually all of the health care providers do in Western Pennsylvania and Pennsylvania as a whole," he said.

The association, which represents about 200 ambulance companies and 16 individual ambulance services, including Pittsburgh's Bureau of Emergency Medical Services, claimed the insurers conspired in a racketeering scheme to force them into discounts.

The insurers send payments directly to other health care providers but will only send them to ambulance services that sign contracts with the insurance companies. Instead, they send the payments to people who received the service and the ambulance companies then have to try to collect the money from them.

U.S. District Judge David Cercone dismissed the lawsuit in June, ruling that state law doesn't define the ambulance companies as health care providers who are entitled to direct payments.

The appeals court ruling notes that the main purpose of the law is to encourage providers to enter into contracts with insurers to slow down spiraling health care costs.

Copyright 2012 Tribune Review Publishing Company
All Rights Reserved


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