Justices grill both sides in IU Health case

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The five justices on the Indiana Supreme Court asked feisty questions of both sides in the case in which two Indiana University Health patients have argued that hospital “chargemaster” rates are unreasonable.

Much of the nearly 45 minutes of arguments and questioning on May 10 involved the justices and the lawyers for both parties trying unsuccessfully to apply various scenarios from the retail world of commerce to health care pricing.

Car dealerships, landscape crews and other retailers were invoked hypothetically to try to reason through why IU Health could claim that uninsured patients Abby Allen and Walter Moore had contractually agreed to pay any and all charges it assessed them – even without naming a price or referring to a price guide.

“Where in the world can a patient know what standard is going to be applied?” acting Chief Justice Brent Dickson asked Jon Laramore, the attorney representing IU Health.

But Laramore said in the world of health care, those models don’t really apply because hospitals constantly use profitable lines of service to support unprofitable ones, such as neonatal intensive care units. Also, hospitals face unfunded federal mandates, such as the requirement to stabilize all patients – regardless of their ability to pay – before transferring them to any other medical facility.

“Providers have to think of their prices in a different way [than retailers],” Laramore told the justices. He added, “It’s a complicated process.”

Meanwhile, Jerry Garau, the attorney representing Allen and Moore, had the difficult case of arguing how his clients had not breached their contracts with IU Health by failing to pay any of their bills. Allen was billed more than $15,600; Moore was billed $1,138.

The justices pressed him on how IU Health could name a price in its contracts with Allen and Moore – both of whom came to the IU Health North emergency room in Carmel – when it could not know in advance what treatment they would require or even their insurance status.

“What would you suggest that the hospital do when somebody checks in and they’re uninsured,” asked the court’s newest justice, Mark Massa. “Are they to give them the manual of every possible, conceivable operation or procedure that might befall them?”

Garau’s answer? IU Health’s billing of Allen and Moore was invalid because their contracts failed to disclose a price, but even more so because IU Health failed to assess a reasonable price.

“There had to be something in the contract that would allow a reasonable consumer to ascertain the price,” Garau said, adding later, “If the price isn’t going to be disclosed, there is an obligation that the price be reasonable.”

Laramore countered that IU Health charged Allen and Moore standard prices, based on IU Health’s “chargemaster” price list. They just were not given the discounts the hospital system has negotiated with health insurance companies.

The trouble is that hospitals have aggressively hiked those chargemaster rates over the past decade more as a negotiating tactic with health insurers than to reflect the true costs of providing care.

Therefore, Garau argued, Allen and Moore should be given the chance to have a jury compare their bills against the typical payments for the services they received, to determine if they were indeed reasonable.

“What a hospital charges to 90 percent of its patients is certainly relevant,” Garau said.

IU Health won the first round in this 2-year-old fight when a Marion Superior judge dismissed the patients’ lawsuit. But after the state appeals court reversed that decision in October, remanding the case, IU Health appealed to the state’s highest court.

If Allen’s and Moore’s case is allowed to go to trial, it will be significant because their attorneys have promised to seek class-action status on behalf of all uninsured IU Health patients back to the year 2000. And they have their eyes on the patients of other Indiana hospitals, too.

IU Health now gives a standard 40 percent discount off its chargemaster prices to uninsured patients, but the discount was 20 percent until last year.

IU Health’s 20 hospitals around the state provide a significant amount of unpaid care each year, noted its spokeswoman Lauren Cislak. In 2011, it cared for 50,000 patients who could not or did not pay their entire bills, which resulted in unpaid costs of nearly $200 million. IU Health also provided nearly $122 million in free care to low-income patients.

IU Health’s revenue in 2011 totaled more than $4 billion.

It is unclear when the Indiana Supreme Court will make a ruling in the case.•


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  1. I think the cops are doing a great job locking up criminals. The Murder rates in the inner cities are skyrocketing and you think that too any people are being incarcerated. Maybe we need to lock up more of them. We have the ACLU, BLM, NAACP, Civil right Division of the DOJ, the innocent Project etc. We have court system with an appeal process that can go on for years, with attorneys supplied by the government. I'm confused as to how that translates into the idea that the defendants are not being represented properly. Maybe the attorneys need to do more Pro-Bono work

  2. We do not have 10% of our population (which would mean about 32 million) incarcerated. It's closer to 2%.

  3. If a class action suit or other manner of retribution is possible, count me in. I have email and voicemail from the man. He colluded with opposing counsel, I am certain. My case was damaged so severely it nearly lost me everything and I am still paying dearly.

  4. There's probably a lot of blame that can be cast around for Indiana Tech's abysmal bar passage rate this last February. The folks who decided that Indiana, a state with roughly 16,000 to 18,000 attorneys, needs a fifth law school need to question the motives that drove their support of this project. Others, who have been "strong supporters" of the law school, should likewise ask themselves why they believe this institution should be supported. Is it because it fills some real need in the state? Or is it, instead, nothing more than a resume builder for those who teach there part-time? And others who make excuses for the students' poor performance, especially those who offer nothing more than conspiracy theories to back up their claims--who are they helping? What evidence do they have to support their posturing? Ultimately, though, like most everything in life, whether one succeeds or fails is entirely within one's own hands. At least one student from Indiana Tech proved this when he/she took and passed the February bar. A second Indiana Tech student proved this when they took the bar in another state and passed. As for the remaining 9 who took the bar and didn't pass (apparently, one of the students successfully appealed his/her original score), it's now up to them (and nobody else) to ensure that they pass on their second attempt. These folks should feel no shame; many currently successful practicing attorneys failed the bar exam on their first try. These same attorneys picked themselves up, dusted themselves off, and got back to the rigorous study needed to ensure they would pass on their second go 'round. This is what the Indiana Tech students who didn't pass the first time need to do. Of course, none of this answers such questions as whether Indiana Tech should be accredited by the ABA, whether the school should keep its doors open, or, most importantly, whether it should have even opened its doors in the first place. Those who promoted the idea of a fifth law school in Indiana need to do a lot of soul-searching regarding their decisions. These same people should never be allowed, again, to have a say about the future of legal education in this state or anywhere else. Indiana already has four law schools. That's probably one more than it really needs. But it's more than enough.

  5. This man Steve Hubbard goes on any online post or forum he can find and tries to push his company. He said court reporters would be obsolete a few years ago, yet here we are. How does he have time to search out every single post about court reporters and even spy in private court reporting forums if his company is so successful???? Dude, get a life. And back to what this post was about, I agree that some national firms cause a huge problem.