College of American Pathologists
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  In Palmetto, Fla. Supreme Court declines appeal


CAP Today




January 2009
Feature Story

In another court action that pathologists can celebrate, on Oct. 15 the Florida Supreme Court declined to review the decision of the appellate court in the case of Palmetto Pathology Services v. Health Options Inc. “This represents the judicial conclusion of the suit filed against Health Options” in 2005, says Michael Abels, MD, a member of the Palmetto group. “We collectively have changed the paradigm for future HMO direct payments to pathologists for PC-CP under current Florida law. The result is everything we wanted when we started down this road to take on the 800-pound gorilla.”

Palmetto’s attorneys have already collected the judgment and Health Options has paid Palmetto approximately $1.5 million in damages, including interest, that the pathology group was awarded in the case last spring. However, Dr. Abels says, “We must remain doubly vigilant in the upcoming Florida legislative session. We anticipate the insurance industry will actively attempt to pass or initiate new legislative changes to negate our accomplishments.”

The action doesn’t herald the end of the battle over professional component billing by any means, says Jack Bierig of Sidley Austin LLP, “but there was some concern that the Florida Supreme Court might take the appeal, and this action does mean the plaintiffs in Palmetto have won their case.” The Palmetto case’s impact is limited to Florida HMOs that are covered under the state HMO Act and it does not apply to pathologists who have contracted away their right to bill for PC-CP services, Dr. Abels says. “But,” says Bierig, “it’s a very favorable decision for pathologists in Florida, and it has good language about PC billing in general.”

Anne Paxton

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