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Health Plan Sued Again

‘Hostile situation’ turns into second suit against insurer

February 6, 2013
By CASEY JUNKINS - Staff Writer , The Intelligencer / Wheeling News-Register

When Dr. Emil Nardone and attorney Teresa Toriseva went to the Health Plan office last year, they hoped to reach a resolution to the $450,000 billing dispute between the local chiropractor and the health maintenance organization.

However, Toriseva said the meeting turned out to be a "taped interrogation" that she quickly advised Nardone to end. Now, Nardone is suing the health care provider in Marshall County Circuit Court for allegedly breaching the provider contract he signed with the company in 2001.

"They never told him this was going to be any kind of an interrogation. It was a very hostile situation," Toriseva said regarding her experience with the Health Plan in February 2012.

Article Photos

Photo by Casey Junkins
Dr. Emil Nardone is suing the Health Plan for more than $450,000 for allegedly violating a contract between the local chiropractor and the HMO.

This is the second lawsuit filed against the Health Plan within the last few weeks, as RG Steel has a federal case pending against the health care provider seeking $1.45 million for the alleged mismanagement of funds.

Nardone no longer has an active contract to provide service for the Health Plan. He alleges the HMO's actions have cost him 25 percent to 30 percent of the business he once had.

"HMOs have demonstrated themselves to be concerned more and more with making profits than they are with enabling individuals to get the health care they want and need. Time and again, chiropractic patients have been denied the opportunity to obtain treatment through their HMOs ..." Toriseva's complaint states.

An official with The Health Plan said the company does not comment on pending litigation. Toriseva said the HMO has the remainder of February to respond to the complaint.

According to Toriseva, Nardone entered a provider agreement with the Health Plan on Sept. 30, 2001, for chiropractic and related services to members. Nardone claims in early 2011, the defendant began withholding payments.

During this time period, Nardone said he hired an independent consultant and medical auditor, Dr. Tom Necela, to audit the chiropractic business and medical practice.

The complaint alleges that Necela reported that Nardone's practices were all up to or above professional standards for the chiropractic industry.

In an effort to discuss the dispute, Nardone and Toriseva went to the Health Plan office in St. Clairsville in February 2012. He and Toriseva allege that upon arriving at the office, they were taken to a conference room.

The HMO's medical director, head nurse, fraud investigator, general counsel and several claims reviewers were convened, while a voice recorder was in place. Toriseva and Nardone then left the meeting.

A mailing on the Health Plan's letterhead allegedly sent to one of Nardone's patients on Oct. 17 notifies the patient that Nardone is "no longer a participating provider."

"The actions of the defendant are improper, unethical, overreaching and unfit for a health insurance company," Toriseva said.

 
 

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