Gregory N. Pimstone

Pimstone leads Manatt’s health care litigation practice; he is on the firm’s board of directors and its compensation committees. He’s been at Manatt for 18 years.

He said the pandemic has raised some unresolved legal issues. “Federal and state legislation regarding testing and vaccines and who pays—these are efforts by the government to allocate financial responsibility for new medical burdens that are creating new legal questions. They’re not on our docket yet, but they may be down the road.”

Meanwhile, he added in late October, “it’s still a weird time for everyone. I’m in the office and it’s completely empty. I’m here because there are no dogs barking and it’s a good place to think, but it’s strange to have nobody around.”

Pimstone and colleagues were preparing for oral argument in late October of an appeal of his jury win for Kaiser Foundation Health Plan over millions of dollars sought by hospital plaintiffs seeking to challenge Kaiser’s payment method. Following a four-day trial, the jury found that the $16.4 million Kaiser had paid the hospitals was the reasonable value for its services and declined to require the payment of an additional $14.5 million demanded by the hospital. Long Beach Memorial Medical Center v. Kaiser Foundation Health Plan Inc., NC061310 (L.A. Super. Ct., filed Aug. 4, 2017).

The hospitals appealed, presenting arguments that Pimstone wrote were “shadowboxing” by raising spurious claims about evidence exclusion and other issues. “The plaintiffs are trying to create a new tort of ‘intentional underpayment,’” Pimstone said. “There is no such thing.”

In another case currently on appeal, Pimstone and his colleagues are defending their win on summary judgment in a major tax liability claim in a case that—if the plaintiffs and appellants were to prevail—would upend state tax laws to treat managed care plans as if they were health insurance companies. His client, Blue Shield of California, is not an insurer because “indemnity” or cost reimbursement for medical services is not a significant financial part of its business, he argued, and Los Angeles County Superior Court Judge Maren E. Nelson agreed. Myers v. State Board of Equalization, BS143436 (L.A. Super. Ct., filed July 3, 2013).

The plaintiff and appellant, Southern California family physician Michael D. Myers, contends in his opening brief that four of the state’s largest health plans, including Blue Shield, Blue Shield, Kaiser and Health Net of California, are insurers who must pay a tax applicable to all insurance companies. Currently, the plans are taxed separately in a manner that helps fund the Medi-Cal program.

The appeal is in the briefing stage. Pimstone has pointed out that health spending accounts for more than 12 percent of the California economy, so the stakes are high. “Uncertainty tends to end up in court,” he said.

--John Roemer