Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Sanjiv Goel, M.D., Inc. v. Regal Medical Group, Inc.

California Court of Appeals, Second District, First Division

May 23, 2017

SANJIV GOEL, M.D., INC., Plaintiff and Appellant,
v.
REGAL MEDICAL GROUP, INC., Defendant and Respondent.

         APPEAL from a judgment of the Superior Court of Los Angeles County No. BC 543227 Rolf M. Treu, Judge. Affirmed.

          Pick & Boydston and Brian D. Boydston for Plaintiff and Appellant.

          Doll Amir & Eley, Michael M. Amir and Lloyd Vu for Defendant and Respondent.

          Manatt, Phelps & Phillips, Gregory N. Pimstone, Joanna S. McCallum and Jeffrey J. Maurer for California Physicians' Service dba Blue Shield of California as Amicus Curiae on behalf of Defendant and Respondent.

          LUI, J.

         Appellant Sanjiv Goel, M.D., Inc.[1] appeals from a judgment following a court trial on his quantum meruit claim for fees for emergency treatment rendered to four patients as an interventional cardiologist. The trial court found that the fees paid by Respondent Regal Medical Group, Inc. (Regal) for this treatment reflected the reasonable value of the services that Goel provided.

         The sole issue presented on appeal is whether the trial court employed the correct legal standard in determining the reasonable value of Goel's services. We conclude that the court did use the correct standard, and we therefore affirm.

         BACKGROUND

         1. Goel's Patient Treatments and Billing

         Goel is a board certified interventional cardiologist. Interventional cardiology is a specialized branch of cardiology that, as its name suggests, involves procedures to intervene in preventing cardiovascular problems. Goel has been in private practice since 1992.

         Goel performed the emergency intervention procedures at issue in this case on four different patients at Los Robles Hospital in Thousand Oaks, California (Patients 1-4). The procedures included diagnosis of cardiac conditions with angiograms, removal of blood clots, and placement of stents in cardiac arteries.

         Patients 1-4 were each covered by a medical plan for which Regal was responsible. Goel does not have a contract with Regal for the services he provides. Goel therefore billed Regal for the procedures he performed on Patients 1-4 using prices that he unilaterally set. Goel testified that he based his prices on various factors, including the “value of the service that was given to the patient”; his “skill set”; his training and experience; and the personal risk he undertook from exposure to radiation and the repeated use of heavy lead gowns. His prices were incorporated into a database of charges, or a “chargemaster, ” with standard rates he charged for each procedure listed by “CPT” code.[2] For procedures that he deemed to involve an “extreme degree of complexity” he sometimes increased the charges in particular cases.

         Goel updated his fees periodically. In doing so, he did not consult with others and did not take any steps to determine what other cardiologists in Ventura or Los Angeles counties were charging. He also did not consider what Medicare pays for the same procedures. Medicare rates are fixed and nonnegotiable.

         Goel terminated all his contracts with insurance companies in 2010 because he did not want to be “under anyone else's thumb.” However, he did have a contract with Medicare to treat nonemergency patients. The Medicare rates for the procedures Goel performed on Patients 1-4 totaled $6, 413.36.

         Goel's bills to Regal identified each procedure separately by CPT code with a price for each procedure. The amounts that he received from Regal for each procedure were above the Medicare rates but were well below what he billed. Goel's bills for all of the procedures he performed on Patients 1-4 totaled $275, 383.16. Regal paid $9, 660.86.

         Goel filed suit against Regal to collect the difference between what he billed and what Regal paid.

         2. Tria ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.