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Patient’s Second ‘Injury’ – Medical Billing | Fox Rothschild LLP

According to the Court, the claims do not fall within the doctor-patient relationship, but are also “intertwined” and “directly linked” to the care

Charles McNew was injured in a fall at his home in June 2021, then treated in the emergency room of Fletcher Hospital in Hendersonville, North Carolina. Three months later, he claims to have suffered a different kind of injury when he was billed amounts for that care at rates he says were well above the hospital’s published rates and those of providers. similar.

In McNew v. Fletcher Hosp., Inc., 2022 CNBC 53a so-called class action found that the business court was considering the nature of the patient-biller relationship and whether billing for medical care was part of “professional services rendered by members of a learned profession.” See SNCG § 75-1.1(b).

Justice Bledsoe rejected the claim that a breach of fiduciary duty could lie between a patient and a hospital that arises from its pricing and billing practices. The Court recognized the well-established rule that a physician-patient relationship is among the small list of contexts where “particular reliance has been placed on one who, in equity and good conscience, is bound to act in good faith “. McNew¶ 14 (citing Dallaire v. Bank of Am., NA, 367 NC 363, 367 (2014). In North Carolina, this limited list also includes relationships between attorneys and clients, spouses, business partners, guardians, and wards. Identifier. ¶ 15 (citing Hager v. Smithfield E. Health Holdings, LLC, 264 NC App. 350355 (2019).

However, neither as of right nor on a basis de facto on this basis, the Court concluded that the doctor-patient relationship included that of the issuer of the bill to the patient. The Court noted that the doctor-patient obligation exists because of “special knowledge and skill in the diagnosis and treatment of disease or injury” which is absent when the connection is simply “a connection between debtor and creditor”. . Identifier. ¶ 17.

The Court held that the issuer-patient relationship appears contractual, as opposed to one where the hospital “occupies a position of power and influence” over patients. Identifier. ¶ 23. Thus, he concluded that the traditional rule that “general contractual relationships do not generally rise to the level of fiduciary relationships” should apply. Identifier. ¶ 21 (citing Sykes v. Health Network Sols., Inc., 372 NC 326, 340 (2019). Judge Bledsoe noted that neither Plaintiff nor the Court could locate any authority in North Carolina or elsewhere to support a fiduciary construct in the factual biller-patient model. See for example, Burton v. William Beaumont Hosp., 373 F. Sup. 2d 707723–24 (ED Mich. 2005) (“Although Michigan courts have recognized fiduciary relationships such as…physicians and patients, there is no support for the proposition that a fiduciary relationship exists between a hospital and a patient for what the plaintiffs are complaining about here, namely billing practices.”).

The Court also rejected the plaintiff’s claim that a de facto fiduciary relationship exists in the patient-biller context. The Court noted the high level of a de facto claim in North Carolina as one where “one party figuratively holds all the cards – all the financial power or technical information”. McNew¶ 20 (citing Lockerman v. S.River Elec. Membership Company, 250 NC App. 631, 636 (2016)). Judge Bledsoe pointed to the absence of claims regarding the medical care received by McNew or the “medical knowledge of hospital staff”. Identifier. ¶ 23. Instead, the Court observed (Identifier.):

“[Plaintiff] only disputes the amount he was charged after the services were rendered, and he provides insufficient facts to argue the substantial difference in bargaining power that our courts require to establish that he had a de facto fiduciary relationship with the hospital.

Unfair trade practices

The Court also dismissed Plaintiff’s Chapter 75 claim against the hospital as failing the “in or affecting commerce” prong of the unfair trade practices analysis. The Court’s justification was the statutory exception that “trade[ne comprend pas les services professionnels rendus par un membre d’une profession savante.Identifiant. ¶ 28 (citant SGNC § 75.1.1). La Cour s’est appuyée en grande partie sur Sykeset son avertissement selon lequel “cette exception pour les professionnels de la santé a été interprétée au sens large”. Identifiant. ¶ 30.

La Cour a noté qu’une analyse en deux étapes s’applique pour déterminer si l’exception de la « profession savante » s’applique : (i) l’auteur de l’acte est-il un membre de la profession, et (ii) la conduite est-elle une prestation effective de services professionnels. Identifiant. ¶ 29 (citant Sykes, 372 NC à 334). La Cour a examiné la même situation factuelle qu’elle a qualifiée de simple «débiteur et créancier» aux fins d’une analyse de l’obligation fiduciaire et a conclu qu’elle démontrait néanmoins une conduite qui était «suffisamment liée à la prestation de soins aux patients pour tomber sous le coup de la [learned profession] exemption. Identifier. ¶¶ 17, 33.

In its analysis of Chapter 75, the Court found that the hospital’s charges for medical care “directly relate to the provision of plaintiff’s medical care” and that plaintiff’s claims challenged “the conduct of the hospital in not disclosing these charges in connection with the provision of its emergency and imaging services.” Thus, the Court found that the hospital’s alleged conduct was so closely related to its provision of medical care to the plaintiff that it “is connected and directly related to the provision of medical care to the plaintiff at the emergency room of the hospital”. Identifier. ¶ 33.

Take away food

  • Billing disputes between patients and healthcare providers continue to present opportunities for complex analysis and narrow legal distinctions. Here, the commercial court concludes that the conduct may be so ordinary as to be that of “debtor and creditor” not contained in a doctor-patient relationship, but also so closely “related to” the “provision of patient care to rise from the [learned profession] scope of the exemption.

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