Prominent Pasadena Plastic Surgeon Under Investigation By State
Martello terminated from the emergency department on-call rotation
A well-known plastic surgeon in Pasadena, Dr. Jeanette Martello is now under investigation by the State of California for unfair billing practices, the Los Angeles Times first reported on Saturday.
“Martello’s use of aggressive tactics to collect fees from emergency room patients— including lawsuits, taking out liens on their homes and damaging their credit — prompted an unprecedented court case by state health officials and a judge’s order for Martello to cease the practices.”
The state’s lawsuit against Martello, however, is the first of its kind, according to Marta Green, California Department of Managed Health Care spokeswoman. State officials allege in court papers that Martello collected or attempted to collect more from patients than insurance companies paid, a practice known as balance billing.
Protections against balance billing are strongest in emergency cases because patients have less control over who treats them according to the Times.
The Supreme Court said if the doctor is unhappy with what they are getting paid by the managed care plan, they need to fight it out with the health plan and leave the patient out of it, according to The Los Angeles Times.
California’s managed healthcare regulators investigated Martello after receiving complaints.
Huntington Hospital in Pasadena made this statement regarding the situation involving the plastic surgeon.
“In California, physicians are not employed by hospitals and their actions are monitored by an independent, self-governed medical staff. Any charges brought against a physician are investigated by the medical staff (medical executive committee) based on its bylaws. Hospital administration does not have the power to revoke medical staff privileges.
Some physicians or physician groups are contracted by hospitals to provide services, such as emergency department call. Hospitals do have the right terminate these services and Dr. Jeanette Martello was terminated from the emergency department on-call rotation earlier this year.
In California, any legal action taken against a physician must go through the physician’s private practice and be conducted by the State. Hospitals do not have jurisdiction over private physician practices. Jeanette Martello no longer has privileges at Huntington Hospital and the hospital does not condone patient harassment under any circumstances, ” said Andrea Stradling, Director of Public Relations for Huntington Memorial Hospital.
In 2010, the state issued a cease-and-desist order against her. “When that didn’t stop her, the department sued her in Los Angeles County Superior Court — the first time the state has taken such an action against an individual doctor, officials said. The case alleged Martello’s actions posed a “substantial, irreparable, and unjustified threat to the financial livelihood” of the patients. Officials said that didn’t stop her either, ” according to the Times.
Department of Managed Health Care (DMHC) Director Brent Barnhart in May released a statement regarding the Los Angeles Superior Court ruling granting a preliminary injunction against Dr. Martello to immediately stop her from illegally billing health plan enrollees for the difference between what their health plan paid and her billed charges. The ruling came in the case of the People v. Martello.
“The court’s ruling prevents Dr. Martello from harming health plan enrollees by illegally attempting to collect money from them that they don’t owe,” said Brent Barnhart, Director of the Department of Managed Health Care. “The California Supreme Court has made it clear that patients cannot be placed in the middle of disputes between health plans and providers over payments for emergency care.”
In California, health plans are responsible for the cost of enrollees’ emergency health care services. Occasionally, disputes arise between health plans and emergency providers about the reasonable cost of those services. Under California law, emergency health care providers are prohibited from attempting to collect disputed balances from health plan enrollees – a practice known as balance billing. The California Supreme Court has made it clear that any such dispute is between the health plan and provider; a health plan enrollee cannot be placed in the middle (Prospect v. Northridge).
The order can be found here: http://healthhelp.ca.gov/library/reports/news/orderpi052912.pdf
People v. Martello Background
On December 30, 2010, the DMHC issued a Cease and Desist Order against Jeannette Martello, M.D., a South Pasadena board certified plastic surgeon, to stop her from illegally collecting or attempting to collect payments from health plan enrollees for emergency services. A DMHC investigation found that Dr. Martello had balance-billed multiple health plan enrollees for emergency room services provided at Huntington Memorial Hospital in Pasadena and Providence St. Joseph Medical Center in Burbank. In defiance of the order, Dr. Martello allegedly continued the practice and filed multiple complaints in court against her patients.