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January 27, 2012

Ambulance industry lawsuit dismissal upheld in Pa.

By Brian Bowling
Pittsburgh Tribune Review

PITTSBURGH — A federal appeals court on Wednesday upheld a district's judge's dismissal of a lawsuit brought by the ambulance industry against health insurers.

The Ambulance Association of Pennsylvania, which represents about 200 companies and 16 individual services, including Pittsburgh's Bureau of Emergency Medical Services, claimed Highmark Inc. and six other insurance companies conspired in a racketeering scheme to force them into discounts.

A three-judge panel of the 3rd U.S. Circuit Court of Appeals disagreed. Charles Kelly, one of the attorneys representing the association, 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.

Insurers send payments directly to health care providers but will only send them to ambulance services that sign contracts with the insurance companies. Without a contract, insurers send 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

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