“The decision by the Supreme Court makes the Appellate Court’s decision on the case the highest authority in the state of New Jersey on these issues. Ambulatory surgical centers will rely on the Appellate Court’s Garcia decision as a precedent establishing that surgeon ownership and not collecting co-insurance cannot constitute insurance fraud,” says Thomas Gentile, partner at Lampf, Lipkind, Prupis and Petigrow, who argued Garcia v. Health Net on behalf of WSC and its physician-owners in front of the Appellate Court.
Other ASC advocates in the state caution that the win does not mean difficulties for out-of-networks centers will lessen. “While the N.J. Supreme Court decision to not hear the Garcia case is indeed a victory for us, we must always remember at what cost,” says Jeffrey Shanton, director of business management at Journal Square Surgical Center in Jersey City, N.J., “Keep in mind that all of the major insurance carriers and the state of New Jersey joined Healthnet against us at the Superior Court/Appellate level. Insurance carriers are not dissuaded, or scared away by our ‘victory.'”
Contact Lindsey Dunn at lindsey@beckersasc.com.
