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Saer v. New Orleans Regional Physician Hospital Organization

Court of Appeal of Louisiana, Fifth Circuit

March 25, 2015

DR. JOHN SAER
v.
NEW ORLEANS REGIONAL PHYSICIAN HOSPITAL ORGANIZATION (D/B/A PEOPLES HEALTH NETWORK)

ON APPEAL FROM THE TWENTY-FOURTH JUDICIAL DISTRICT COURT, PARISH OF JEFFERSON, STATE OF LOUISIANA. NO. 741-279, DIVISION " K" . HONORABLE ELLEN SHIRER KOVACH, JUDGE PRESIDING.

KYLE SCHONEKAS, THOMAS M. MCEACHIN, IAN L. ATKINSON, ATTORNEYS AT LAW, New Orleans, Louisiana, COUNSEL FOR PLAINTIFF/APPELLANT.

ELIZABETH A. ROUSSEL, JANIS VAN MEERVELD, RAYMOND P. WARD, DAVID C. COONS, ATTORNEYS AT LAW, New Orleans, Louisiana, COUNSEL FOR DEFENDANT/APPELLEE.

Panel composed of Judges Jude G. Gravois, Marc E. Johnson, and Robert M. Murphy.

OPINION

Page 618

[14-856 La.App. 5 Cir. 2] JUDE G. GRAVOIS, J.

Plaintiff/appellant, Dr. John Saer, appeals the trial court's denial of his request for a preliminary injunction. For the following reasons, we affirm.

FACTS AND PROCEDURAL HISTORY

Defendant/appellee, New Orleans Regional Physician Hospital Organization, Inc. d/b/a Peoples Health Network[1] (" Peoples Health" ), provides health plans to those who qualify for Medicare benefits. On January 1, 2010, Dr. John Saer, a physician specializing in retinal disease

Page 619

and surgery, a subspecialty of ophthalmology, entered into a Specialty Care Physician Agreement (" the Agreement" ) with Peoples Health to become an Ophthalmology-Retina provider to Peoples Health's members. The Agreement included the following provision regarding termination of the Agreement without cause, to-wit: " This Agreement may be terminated by either Physician or [Peoples Health] at any time, without cause, by the giving to the other party of sixty (60) days prior written notice."

[14-856 La.App. 5 Cir. 3] By letter dated June 30, 2014, Peoples Health notified Dr. Saer that it had decided to terminate the Agreement, effective on August 31, 2014. Dr. Saer appealed Peoples Health's decision. His appeal was presented to a three-person panel of individuals who were not involved in the initial decision to terminate the Agreement. On July 31, 2014, Peoples Health notified Dr. Saer by letter that based on the panel's review, Peoples Health would uphold its decision to terminate the Agreement, that the decision was final, and that there would be no further appeal rights concerning termination of the Agreement. Peoples Health also began notifying Dr. Saer's patients that he no longer would be a health care provider for Peoples Health after August 31, 2014.

On August 15, 2014, Dr. Saer filed a Petition for Declaratory Judgment and Injunctive Relief. In his petition, Dr. Saer alleged that Peoples Health did not comply with the notice and hearing provisions regarding termination of physicians by a Medicare Advantage organization as set forth in 42 C.F.R. § 422.202(d). Further, Dr. Saer alleged that as a result of these actions, his reputation was irreparably harmed and his patients were adversely impacted.

On August 18, 2014, the trial court issued a Temporary Restraining Order restraining Peoples Health from terminating the Agreement and/or excluding Dr. Saer from its plans or network. In said Order, the trial court also set a hearing for ...


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