Houston Jury Sends U.S. Insurance Companies a Strong Message on Behalf of Emergency Room Doctors June 26, 2021
HOUSTON – A Harris County jury awarded $19.1 million to a group of emergency room doctors 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 June 24 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.
“This company is evil, and I don’t use that word lightly,” Law360 wrote that AZA co-founding partner John Zavitsanos told the jurors. Along with Mr. Zavitsanos, the AZA trial team included firm partners Sammy Ford IV and Jane Langdell Robinson and associates Michael Killingsworth, Louis Liao, and Joshua Harris.
“What they have done to the government, what they have done to their members and what they have done to us … there’s been no consequence for their actions, until now,” Mr. Zavitsanos told jurors in closing argument quoted by Law360. “You are the tip of the spear. You have the ability to tell every one of these insurance companies watching, ‘Not here. Not in Texas. We don’t treat each other like this.'”
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.
The case is No. 2017-77084 ACS Primary Care Physicians Southwest, PA and Emergency Services of Texas, PA, Plaintiffs v. Molina Healthcare, Inc. and Molina Healthcare of Texas Inc., Defendants in the 113th Harris County District Court.
The case was covered in the media by Texas Lawyer in ‘Designate a Villain’: The Legal Strategy That Led a Houston Jury to Award $19M to ER Docs in Insurance Dispute (subscription required), by Law 360 in Jury Awards $19M To Doc Staffing Co. In Reimbursement Row and Texas Jury Weighs Doctors’ $117M Ask In Insurance Rate Row (subscription required) and by Texas Lawbook in Houston Jury Awards TeamHealth $19.1M in Trial Over ER Doc Pay (subscription required).
AZA tried the case with Collin Kennedy of Hanshaw Kennedy Hafen.
AZA, or Ahmad, Zavitsanos & Mensing, is a Houston-based law firm that is home to true courtroom lawyers with a formidable track record in complex commercial litigation, including energy, healthcare, intellectual property, and business dispute cases. AZA is recognized by Chambers USA 2021 among the best in Texas commercial law and intellectual property; by U.S. News – Best Lawyers’ Best Law Firms as one of the country’s best commercial litigation firms for nine years running; has been named Litigation Department of the Year by Texas Lawyer; and was previously dubbed by Law360 a Texas Powerhouse law firm. National corporate counsel named AZA one of the country’s best in client service among law firms serving the Fortune 500.