SOURCE: Attorney Ervin A. Gonzalez

May 01, 2007 19:55 ET

Florida HMO Ordered to Pay $1.5 Million to Doctors

Jury Finds Health Options of Florida Liable for Pathologists' Fees

MIAMI, FL -- (MARKET WIRE) -- May 1, 2007 -- Under the Florida HMO Act, when an HMO member is admitted to any Florida hospital, all pathology tests ordered by a physician must be covered by the HMO, including technical and professional clinical pathology laboratory services. The costs of such tests are divided into two components: technical, which includes the hospital's labs and equipment; and professional, which includes the services of the physician supervising and interpreting the tests.

In 1999 Florida's largest health insurer, Blue Cross and Blue Shield of Florida (Health Options HMO), made a statewide business decision to stop paying all hospital pathologists for the professional component of clinical pathology medical services. Their decision would save them $4.1 million per year. In 2005, after years of unsuccessfully attempting to collect their fees from Health Options, Florida Pathology Services filed suit in Miami Dade County 11th Circuit Court on behalf of Palmetto General Hospital and Coral Gables Hospital, citing the Florida HMO Act and the American Medical Association (AMA) guidelines as their source for restitution.

On April 16, 2007, the weeklong "landmark" case began. "This case is really about quality healthcare," said Ervin A. Gonzalez, attorney for the Plaintiffs. "The doctors need to get paid for supervising and interpreting lab results. If they don't get paid, the healthcare system will begin seeing an increase in negligence and a decrease in physicians who are willing to work in Florida. The patient will ultimately be the one that loses." Gonzalez argued that Health Options was required by State law to pay the professional component to the doctors and that in not doing so, it was violating state law. On April 19th Judge Thomas "Tam" Wilson agreed and held that, as a matter of law, Health Options was legally responsible to pay the reasonable value of the professional component of the clinical pathologists' medical services. On April 20th the jury determined the reasonable value to be $1,546,479 and awarded the plaintiffs the entire amount they sought plus interest.

"This is the first case of its kind and is a landmark case," said Gonzalez. "The judge's decision that payment was required by laws will impact all cases in Florida and other states with similar cases." Gonzalez is currently representing 11 other hospital pathology groups around the state -- all individually scheduled for trial in 2007 before Judge Wilson.

Plaintiff's Attorney -- Ervin A. Gonzalez & Patrick Montoya of Colson Hick Eidson

Defendant's Attorney -- Steven Siff, Michael Austin and Justin Uhlemann of McDermott, Will & Emery

About -- Ervin A. Gonzalez is Board Certified in Civil Trial Law and Business Litigation by the Florida Bar and the National Board of Trial Advocacy. He is a partner at the law firm of Colson Hicks Eidson Colson Cooper Matthews Martinez Gonzalez Kalbac and Kane in Miami-Dade County Florida. He is also licensed to practice law in the District of Columbia, Texas, Colorado, and New York. Mr. Gonzalez is currently on the Board of Governors for The Florida Bar, a member of the National Board of Trustees of The National Institute of Trial Advocacy (NITA) and a member of the American Board of Trial Advocates (ABOTA). He is past President of The Dade County Bar Association and Past President of the Dade County Trial Lawyers Association. He is an adjunct professor at The University of Miami School of Law, where he also graduated with honors (JD 1985). His areas of expertise include catastrophic injuries, wrongful death, medical malpractice, aviation accidents, trucking accidents, class action litigation and consumer related commercial litigation. Mr. Gonzalez resides in Coral Gables, Florida.

Ervin A. Gonzalez is available for comments and interviews regarding the case and can be reached at 305-476-7491 or 305-298-1888.

Contact Information

  • Media Contact:
    Janice B. Gonzalez
    JBG Communications
    305-898-1895