A woman injured in a 2012 car crash has launched a class action lawsuit against the Evanston-based doctors’ practice which provided her care following the crash, claiming the physicians wrongly slapped a lien on the damages she might be paid by the other driver involved in the crash, and has done the same to others like her in the hope of collecting more than they should under the terms of the contracts the doctors hold with HMO plan providers.
Plaintiff Barbara Niehus, described as a resident of Cook County, filed her complaint in Cook County Circuit Court against NorthShore Physician Associates Inc., a group which formerly did business as NorthShore University Health System Medical Group. State records indicate the president of NPA is Gerald “J.P.” Gallagher. Gallagher serves as chief operating officer at NorthShore University Health System, according to the health system’s website.
Niehus’ lawsuit also named debt collection company First Recovery Group, of St. Peter, Mo., as a defendant in the action.
Niehus is represented in the lawsuit by attorney Daniel A. Edelman, and the firm of Edelman Combs Latturner & Goodwin, of Chicago.
According to the complaint, Niehus is a participant in the HMO Illinois health insurance plan offered through Blue Cross Blue Shield of Illinois. The complaint said she had selected the NorthShore Physician group as her primary care provider, under the terms of her HMO plan.
Further, the complaint said she believes NPA and Blue Cross have a contract, common under such HMO plans, under which Blue Cross pays NPA an agreed set monthly fee, rather than fees for services rendered for patients covered by HMO Illinois.
And Niehus’ complaint said the terms of her plan under HMO Illinois also stipulate that, should she require medical care because she became ill or injured because of the actions or negligence of another person, such as in a car crash, Blue Cross is entitled to collect reimbursements from the other person for expenses paid for their insured’s medical care. Further, the plan’s terms did not allow heath care providers, like NPA, to pursue patients covered by HMO Illinois for further payment beyond what Blue Cross paid them.
In 2012, Niehus said she was involved in a traffic crash, and suffered injuries. She said those injuries were treated at NPA and through other medical specialists not affiliated with NPA, but approved by Blue Cross.
The lawsuit said Niehus said she believed NPA was fully paid for the care she received under the terms of her HMO plan.
However, in January 2016, Niehus said she received a letter from First Recovery Group, asserting it was collecting nearly $13,000 the physicians’ practice claimed it was owed for “medical benefits” provided to Niehus. The letter demanded payment and asserted the debt collector would put a lien on Niehus for a share of whatever she might collect in court from the other driver involved in the crash.
Niehus said that lien is “inconsistent with the HMO Illinois medical benefits plan in which (she) was enrolled at the time of the accident,” as Blue Cross, “and not NPA, had the right to recover medical payments from” the other driver.
The lawsuit said Niehus believes Blue Cross “did recover the amounts it claimed to have paid for medical services provided to treat (Niehus’) injuries.”
Her lawsuit said she believes NPA has similarly routinely placed liens on others like her, “because they believe that they will recover more by placing a lien on the patient’s tort recovery than they received as payments” under agreements with HMO plan providers.
The complaint specifically alleged NPA and First Recovery violated the HMO contract, and committed consumer fraud.
The lawsuit asked the judge to approve two classes of plaintiffs. The first would include all HMO Illinois members who have similarly faced liens brought by NPA in similar cases; the second would include those from whom First Recovery has demanded payment for medical services, which should have been the obligation of a medical group under the terms of a HMO plan. The classes would stretch back 10 years, the lawsuit said.
The complaint said Niehus and her attorneys believe the class could include as many as 50 people.
Niehus has requested the court issue an injunction barring NPA and First Recovery from continuing the alleged activity, and award unspecified compensatory and punitive damages, plus attorney fees.