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M&R Partner Andrew Selesnick Argues on Physicians’ Behalf Before CA Supreme Court

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September 9, 2016

On Thursday, September 8, 2016, Michelman & Robinson, LLP (M&R) Health Care Practice Leader, Andrew H. Selesnick, argued before the Supreme Court of California in the matter of California Centinela Freeman Emergency Medical Associates et al. v. Health Net of California Inc. et al.. The case has tremendous significance in the health care industry as the Court’s opinion will directly impact the reimbursement obligations placed on HMO’s throughout California. Our client, Emergency Medical Associates, provided emergency medical services to all patients who entered their emergency departments. In 2010, a risk bearing organization called La Vida, went bankrupt, leaving medical providers unpaid for the services they already provided. M&R filed an action alleging that almost every major health plan in California negligently delegated risk to La Vida and thus should take responsibility and pay for the provided services. The question before the Court is whether emergency physicians can sue HMO's for negligently delegating payment responsibility to an Independent Physicians Association (IPA) when they knew, or should have known, that the IPA was not financially stable.

During oral argument, Andrew Selesnick (part of a team from M&R that also included attorneys Damaris L. Medina and Robin James) urged the state’s high court to uphold the Court of Appeals decision, arguing that there is a “long history” within the judicial system of finding that when an entity can foresee an injury, it holds responsibility for those injuries. He argued that in this case, the health plans knew for years that La Vida was failing but chose not to take corrective action. Mr. Selesnick emphasized the fact that emergency rooms are required by law to provide services, regardless of patients’ ability to pay, and thus there is a strong public policy interest in favor of ensuring that emergency service providers get paid for their work.