Saint Peter's Files Suit Against Horizon - Court Grants Hearing
Release date: 11/10/2015
Saint Peter’s Healthcare System announced today that on Friday, November 6, 2015, it filed suit against Horizon Health Services, Inc. over its wrongful exclusion of Saint Peter’s from its preferred Tier 1 network of the health insurer’s newly launched OMNIA Health Alliance, which was publicly announced in early September.
NEW BRUNSWICK, N.J. – Saint Peter’s Healthcare System announced today that on Friday, November 6, 2015, it filed suit against Horizon Health Services, Inc. over its wrongful exclusion of Saint Peter’s from its preferred Tier 1 network of the health insurer’s newly launched OMNIA Health Alliance, which was publicly announced in early September. Today, we moved before the court to get a hearing on whether we were improperly denied Tier 1 status and, pending discovery and the conducting of that hearing, we wanted the court to halt the program. Superior Court Judge Frank M. Ciufanni did not halt the program because he decided to give us accelerated discovery and a hearing before January 1 when the OMNIA program goes into effect. The Court also made clear that Saint Peter’s was entitled to full disclosure of the criteria and standards established by Horizon, their weightings and how they were applied to Saint Peter’s. The Court also rejected the argument of Horizon that judicial review of its determinations was not available.
The OMNIA Health Alliance divides New Jersey’s hospitals into “Tier 1” and “Tier 2” groupings. OMNIA customers would be steered by Horizon toward Tier 1 hospitals through lower rates despite higher quality rankings among many Tier 2 hospitals, including Saint Peter’s, a leading care provider in Central Jersey. All Catholic hospitals except Saint Joseph’s in Paterson were excluded from Tier 1 status.
“As set forth in our papers, Saint Peter’s believes it was wrongfully excluded from the preferred Tier 1 status through a secret process, without a fair opportunity to be considered, in a manner that was contrary to Saint Peter’s rights and the interests of all citizens of New Jersey who want cost-efficient access to top quality health care, and to those who want faith-based care,” said lawyer Jeffrey J. Greenbaum of Sills Cummis & Gross P.C., Newark, the lead representative for Saint Peter’s in the suit. “We are gratified that we will finally have our day in Court to demonstrate that Saint Peter’s meets all objective criteria as a top quality New Jersey hospital and is entitled to Tier 1 status” Greenbaum said, “and that we will obtain full access to the secret criteria used by Horizon to make its decisions.” “We are also delighted that the Court rejected Horizon’s arguments that its decisions on Tier 1 status were not subject to Court review,” said Greenbaum.
The Saint Peter’s lawsuit alleges:
Breach of contract and the duty of good faith and fair dealing;
Wrongful interference with Saint Peter’s relations with its patients and physicians;
Breach of fiduciary duty by Horizon to Saint Peter’s by failing to act in the best interest of New Jersey hospitals and the healthcare public; and
Consumer fraud arising from its false representation that Tier 2 hospitals are of inferior quality to Tier 1 hospitals.
The schedule and date for a hearing in December will be set later this week.