The doctors, who are a part of the Inland Pulmonary Medical Group with offices in Upland and Montclair, allege they are being blackballed because they won't participate with what they call a scheme to overadmit and overbill patients, according to information from the complaint, filed Wednesday in San Bernardino County Superior Court.
"In a nutshell, Chino Valley is accused of devising and implementing a wrongful scheme that games California's managed care system by, among other things, wrongfully encouraging managed care providers to needlessly diagnose and/or document conditions that gamer higher Medicare reimbursements," according to the complaint.
Chino Valley Medical Center is a subsidiary of the Prime Healthcare hospital chain, one of the largest hospital chains in California. According to the complaint, it "operates according to the profit-based model that at times places an emphasis on maximizing profits at the expense of patient care."
Edward Barrera, communications director for Prime Healthcare, said in an emailed statement that the "baseless" lawsuit filed this week by the Inland Pulmonary Group is repetitive of a lawsuit filed by another group of doctors a few years ago.
In his statement, Barrera said the lawsuit "has no merit and is a regurgitation of unproven allegations voiced by critics over the past three years."
The doctors claim Chino Valley Medical Center should be contacting them when one of their patients is admitted to the hospital.
Chino Valley Medical Center also complies with its obligations under Health and Safety Code section 1262.8 to contact a patient's HMO after the treating physician determines that their emergency medical condition has been stabilized, Barrera said. There is no requirement to contact the HMO's contracted physician.
"Plaintiff's lawsuit attempts to rewrite 1262.8 so as to require a hospital to contact a HMO and the HMO's contracted physician," Barrera said in the statement.
Attempts to reach doctors at Inland Pulmonary Medical Group's Montclair office were unsuccessful. An assistant, who answered the phone, said the doctors had left for the day at both the Montclair and Upland office.
A hearing is set for April 19 at West Valley Superior Court in Rancho Cucamonga. While the case is being considered, Inland Pulmonary plans to ask a judge to temporarily instruct the Chino Valley Medical Center, Lally, and the emergency physicians group hired by the hospital to notify the doctors that their patients are at the hospital.