Damaris L. Medina

Buchalter APC

Los Angeles

Litigation

Medina is a co-chair of Buchalter's life sciences pratice as well as a member of its litigation and health care practice groups. She represents providers in litigation such as reimbursement issues, shareholder and breach of contract disputes, managed care contracting revenue cycle management and risk and compliance matters.

The coronavirus emergency, of course, has been a shock to her medical caregiver clients. "My client hospitals have had to make a lot of changes very fast," she said. "They have cancelled or rescheduled elective procedures, and that's had an impact on revenue. So has the fact that they're going to be seeing a lot more uninsured patients. How are health plans going to handle that? Will there be covid claim denials?

"They're also trying to get enough PPE and ventilators, so we're dealing with potential price gouging and shortages. And there are issues surrounding moving patients through hospitals when they need to be isolated. Following new guidelines and rules from government agencies and professional associations is quite the endeavor."

Despite the chaos, Medina is proceeding with litigation critical to hospital clients concerned with revenues. In March she filed a breach of contract complaint for client hospitals that are part of Prime Healthcare Services, a 42,000-employee hospital network in California and 13 other states.

The hospitals claim that Humana Insurance Co. underpaid them an undetermined but significant amount for covered health care services. North Vista Hospital Inc. v. Humana Insurance Co., 2:20-cv-02305 (C.D. Cal., filed March 10, 2020).

"Courts are still open for filings," Medina said, "and hospitals are going to be in a rough spot after this crisis is over. We need to establish these claims that existed well before the coronavirus came along. Hospitals operate on a very small margin of three to six percent, which is why we have seen a number of them close. The ones still open are going to badly need the reimbursement revenue."

Last year Medina reached a settlement for the same client over nearly identical issues. Prime Healthcare Services Inc. v. Humana Insurance Co., 5:16-cv-01097 (C.D. Cal., filed May 26, 2016). Settlement hinged on Medina's close familiarity with the regulations governing health care, which let her undercut Humana's claims that Prime had made procedural billing errors. So strong were Medina's arguments that a trial judge sanctioned Humana for making frivolous arguments.

The new complaint contends that Humana was "downcoding" her clients' claims, resulting in significant reduction of payments for the services provided.

"In the new case we allege some of the same bad conduct by the defendant that we believe is still ongoing," she said. "So maintaining this litigation and moving it forward is very important to my clients."

-- John Roemer