California Court of Appeals, Second District, First Division
from a judgment of the Superior Court of Los Angeles County
No. BC 543227 Rolf M. Treu, Judge. Affirmed.
& Boydston and Brian D. Boydston for Plaintiff and
Amir & Eley, Michael M. Amir and Lloyd Vu for Defendant
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.
Sanjiv Goel, M.D., Inc. 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.
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.
Goel's Patient Treatments and Billing
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
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
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. For procedures that he deemed to
involve an “extreme degree of complexity” he
sometimes increased the charges in particular cases.
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
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.
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.
filed suit against Regal to collect the difference between
what he billed and what Regal paid.