Defense attorneys for United Healthcare Insurance the country’s largest health insurance company appeared to have their work cut out for them in a lawsuit launched by Fremont Emergency Services.
The trial being conducted in the Clark County, Nevada Eighth Judicial District Court in Las Vegas is a potential landmark because of the impact it could have on the amount of reimbursement rates emergency room doctors receive. A federal law the Emergency Medical Treatment and Labor Act currently mandates that doctors treat emergency room patients regardless of their insurance or ability to pay.
According to Dolcefino Consulting, a media consulting firm, insurance companies have been lowering reimbursement rates for emergency room medical staffers.
Fremont Emergency Services is a Las Vegas emergency medical service provider. The company is suing United Healthcare and several affiliates including Sierra Health Services also of Las Vegas, claiming underpayments of reimbursements.
The case will hinge on whether attorneys for the plaintiff (Fremont) can meet the burden of proof showing a scam in that United Healthcare sought loopholes to avoid payment of reimbursements for emergency services; violating a contract that is implied, not a written contract.
During jury selection on Monday (after a five-day process) a majority of prospective jurors said they believed corporations put profits ahead of people. But most also said they didn’t believe insurance companies looked for loopholes to deliberately avoid paying legitimate medical claims.
“Corporations are more worried about profits,” a prospective juror told United Healthcare lead defense attorney D. Lee Roberts with the law firm of Weinberg Wheeler Hudgins Gunn & Dial.
“Yeah,” another prospective juror agreed, “they (corporations) have more power than the individual.”
“Of course,” a third said. “Nobody wants to be a whistleblower and lose their job. Regulations need to be enforced. Money, that’s what makes the world go around.”
Most of the possible jurors appeared to agree that corporations put profits ahead of safety, but also said there are good and bad corporations.
“Do you think corporations in the health industry are just as bad,” Roberts asked the assembled group.
No hands were raised.
“Do you think companies look for loopholes?” Roberts asked.
“I don’t have enough information,” one prospective juror said.
“Not necessarily, but that doesn’t mean it doesn’t happen,” another told Roberts.
Roberts’ questions were directed at each of the approximate 25 would-be jurors individually, asking them if they had been scammed by any companies in any businesses. He also asked each about their personal work histories.
Most agreed they felt health companies should be held to a higher standard of behavior than other companies because people’s lives were at stake.
A question from Roberts asking if the jurors could make a valid judgement in the case based on a contract implied (not written out) brought objection from plaintiff attorneys, contending that it was vague and unclear.
Judge Nancy L. Allf sustained the objection.
In the afternoon before jury selection resumed Colby Balkenbush, an attorney for the defendant, asked Allf to restrict media access to documents he said were sensitive because they revealed trade secrets (insurance rates) to competitors. He said both parties had agreed to the protections from the media and the public in a court order adopted last June.
“It’s unfair for competitors to see, to expose these attorney-eye-only documents,” Balkenbush said. “The plaintiffs agreed (in June). It protected their material as well.”
Balkenbush indicated the idea that a courtroom must always be open to the public is a fallacy.
“This is to protect trade secrets,” he said of the request.
However, Patricia Lundvall, attorney for Fremont Emergency Services with the Las Vegas law firm McDonald Carano, urged Allf to keep the process open.
“We ask the court to allow people to see the people’s business,” she said. “To have a private trial doesn’t allow the public to see what’s going on.”
Balkenbush indicated that his request did not mean the trial would be secret, only some of the exhibits.
“Just attorney-eyes-only material,” he repeated.
Allf said the exhibits would not be sealed.
“It isn’t going to happen,” she said. “It’s in the public domain.”
With the return of prospective jury members Roberts asked them if the burden was on the plaintiffs to prove the amounts reimbursed if they were less, were unreasonable, not on the defendants to prove otherwise.
“I would want to know why (less was paid),” one juror said.
Members of the jury pool not needed were dismissed and a 12-member jury was impaneled during the afternoon session.
The trial is expected to conclude on Nov. 23.