ACS Primary Care Physicians Southwest, PA et. al v. Molina Healthcare, Inc. and Molina Healthcare of Texas Inc.
June 21, 2021

A Harris County jury awarded $19.1 million to a group of emergency room doctors in June 2021 in the first case in the nation to litigate emergency room physicians’ out-of-network pay from private insurance companies under the Affordable Care Act. 

The jury awarded physician groups ACS Primary Care Physicians Southwest PA and Emergency Services of Texas, affiliates of non-party physician led TeamHealth, $1.58 million in actual damages and $17.5 million in punitive damages from Molina Healthcare of Texas Inc. The  verdict found Molina routinely underpaid claims and failed to follow insurance laws that require they pay the usual and customary rates for the geographic area.  

Jurors were told that the case was being watched nationally by emergency room doctors and nurses and by insurance companies elsewhere who have tried to get around paying the going rate. 

The Texas Insurance Code requires private insurance companies like Molina to pay doctors the “usual and customary rate” for a geographic area. According to trial testimony, the rate from other private insurers is $1,042 per claim, but Molina was paying the ER doctors only $151 per claim. The plaintiffs showed the defendants violated the Texas Insurance Code and were deceptive in breaching their promises. 

AZA tried the case with Collin Kennedy of Hanshaw Kennedy Hafen.  

AZA lawyers: John Zavitsanos, Sammy Ford IVJane Langdell Robinson,  Michael KillingsworthLouis Liao 

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