Posts tagged "Therapy"

Therapy Resources Management LLC, et al. v. Whittier Health Network, Inc., et al. (Lawyers Weekly No. 12-120-17)

COMMONWEALTH OF MASSACHUSETTS SUFFOLK, ss. SUPERIOR COURT CIVIL ACTION No. 1784CV0942 BLS 1 THERAPY RESOURCES MANAGEMENT LLC, et al vs. WHITTIER HEALTH NETWORK, INC., et al ORDER ON CROSS-MOTIONS FOR PARTIAL SUMMARY JUDGMENT Count IV of the Amended Complaint seeks a declaratory judgment to the effect that defendants (referred to collectively as “Whittier”) are barred from seeking indemnity from plaintiffs (referred to collectively as “Therapy”). Whittier has not yet answered the amended complaint or asserted a counterclaim, but the record is clear that Whittier believes it has the right to be indemnified by Therapy for litigation costs and a settlement payment incurred by Whittier in connection with an investigation and lawsuit under the False Claims Act (“FCA”), 31 U.S.C. §3729.1 There is an actual controversy between the parties regarding whether, as a matter of law, Whittier can obtain indemnification under its contracts with Therapy which state that “[Therapy] shall indemnify and hold [Whittier] harmless from and against all claims, demands, costs, expenses, liabilities and losses (including reasonable attorney’s fees) which may result against [Whittier] as a consequence of any malfeasance, negligence . . . caused . . . by [Therapy] . . . .” 1 Whittier has effectively obtained some indemnification by refusing to pay invoices for services rendered by Therapy. Thus, Therapy is the plaintiff in this action seeking recovery for non-payment of invoices. The claim for indemnification by Whittier is anticipated because such claim is the stated basis for Whittier’s refusal to pay the invoices. 1 Therapy’s argument for summary judgment on Count IV is based on the following undisputed facts. The losses that Whittier wants indemnification for arise from the fact that Whittier was sued, along with Therapy, for fraud under the FCA. The suit was brought by a former employee of Therapy. There was also another suit by a different former employee of Therapy against Therapy alone. The filing of the suits triggered an investigation by federal officials. The gist of the FCA claims was that Whittier and Therapy knowingly presented false claims for Medicare reimbursement. Both Whittier and Therapy denied the allegations. At some point, the claims against Therapy were dismissed. It is unclear from the record whether the dismissal was a result of a settlement or whether it was a dismissal without prejudice. Sometime later, Whittier entered into a settlement with the FCA plaintiffs, including the government, requiring, among other things, payment by Whittier of $ 2.5 million. Therapy was not a party to the settlement. FCA claims against Therapy were not released in the Whittier settlement. The settlement agreement alleges that Whittier failed “to take sufficient steps to prevent [Therapy] from engaging in a pattern and practice of fraudulently inflating the reported amounts […]

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Posted by Massachusetts Legal Resources - September 6, 2017 at 6:26 pm

Categories: News   Tags: , , , , , , , , ,

N.E. Physical Therapy Plus, Inc. v. Liberty Mutual Insurance Company (Lawyers Weekly No. 10-166-13)

NOTICE:  All slip opinions and orders are subject to formal revision and are superseded by the advance sheets and bound volumes of the Official Reports.  If you find a typographical error or other formal error, please notify the Reporter of Decisions, Supreme Judicial Court, John Adams Courthouse, 1 Pemberton Square, Suite 2500, Boston, MA 02108-1750;  (617) 557-1030; SJCReporter@sjc.state.ma.us     SJC‑11284   N.E. PHYSICAL THERAPY PLUS, INC.  vs.  LIBERTY MUTUAL INSURANCE COMPANY. Essex.     May 7, 2013.  ‑  September 10, 2013. Present:  Ireland, C.J., Spina, Cordy, Botsford, Gants, Duffly, & Lenk, JJ.     Evidence, Hearsay, Judicial discretion, Medical bill.  Practice, Civil, Judicial discretion, Motion in limine, Appellate Division:  decision.       Civil action commenced in the Lawrence Division of the District Court Department on June 4, 2008.   The case was heard by Mark A. Sullivan, J.   After review by the Appeals Court, the Supreme Judicial Court granted leave to obtain further appellate review.     Daniel P. Tighe (Douglas R. Tillberg with him) for the defendant. Francis A. Gaimari (Stephen B. Byers with him) for the plaintiff. The following submitted briefs for amici curiae: E. Michael Sloman for Automobile Insurers Bureau. Peter A. Biagetti & Andrew Nathanson for Fair Health, Inc. Paul R.Q. Wolfson, Shirley Cassin Woodward, & Dina B. Mishra, of the District of Columbia, & John J. Regan & Mark C. Fleming for American Insurance Association & others. David L. Arrington & Jodi L. Howick, of Utah, & Todd S. Holbrook & Jeffrey D. Adams for Mitchell International, Inc.     LENK, J.  After being billed by the plaintiff, N.E. Physical Therapy Plus, Inc. (NEPT), for certain medically necessary chiropractic services provided to the passenger of its insured, the defendant, Liberty Mutual Insurance Company (Liberty  Mutual), maintained that the cost of those services was unreasonably high and thus refused to pay the full amount invoiced.  At the ensuing trial on the dispute, Liberty Mutual sought to introduce statistical evidence from a commercial database to show that NEPT’s charges exceeded the eightieth percentile of reported charges for the same procedures and were thus unreasonable.  Liberty Mutual claimed that the statistical evidence was admissible pursuant to G. L. c. 233, § 79B (§ 79B), which creates a limited exception to the hearsay rule for factual statements contained in commercial publications.  Citing a decision of the Appellate Division of the District Court that concluded the same database was unreliable, a District Court judge denied Liberty Mutual’s motion to admit the database evidence. We are asked to determine whether a trial judge has discretion to consider the reliability of evidence offered under  § 79B where the evidence otherwise satisfies the requirements of § 79B, and, if so, whether the judge here abused such discretion […]

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Posted by Massachusetts Legal Resources - September 10, 2013 at 5:15 pm

Categories: News   Tags: , , , , , , , , , , ,