The suit alleges nursing staff and non-medical administrators routinely denied medical services, even when approved by the treating physician and their own medical director.
San Luis Obispo, California (PRWEB) April 04, 2013
A San Luis Obispo doctor is suing a medical group who allegedly fired him for his refusal to participate in an unlawful scheme to deny adequate medical care to patients. In the lawsuit, Dr. John S. McGee said the Defendants, the Heritage Provider Network, fired him for approving necessary medical care to patients.
Dr. John S. McGee was the medical director of Coastal Communities Physician Network and Bakersfield Family Medical Center. He explained that he strongly supports managed care, but what these companies are doing is allegedly, “nothing more than managed profits.” The suit further alleges he was fired because he advocated for quality healthcare for his patients and insisted on performing his duties under the law.
The Coastal Communities Physician Network and Bakersfield Family Medical Center- both Heritage affiliates- are medical groups that serve as the intermediary between managed health care plans and physicians. These medical groups make decisions on whether or not to approve, deny, or modify ordered medical services.
According to the lawsuit, case number CV120007, filed in San Luis Obispo Superior Court:
McGee, who practiced internal medicine for 20 years and had, “extensive experience,” in managed health care, began working for the defendants in 2010 and was fired 19 months later. While McGee had a long history of increasing company profits — and helped increased profits for the defendants — allegedly he and his staff were repeatedly undermined and overruled, “seriously jeopardizing the health, safety and lives” of patients. Even company CEO Bob O’Keefe, who had no medical training, allegedly challenged McGee and his staff several times on patient care.
The suit alleges nursing staff and non-medical administrators routinely denied medical services, even when approved by the treating physician and their own medical director. In addition, the lawsuit alleges companies’ managers mandated a 6% rate of denials of all out-patient referrals, without consideration of the patients’ needs and refused to permit more than 3 elective procedures per day, regardless of the urgency of those procedures.
The lawsuit seeks unspecified general and punitive damages, and a court order to prevent the continuation of unlawfully denying medical services in pursuit of profit, potentially affecting hundreds of thousands of patients in central and southern California. The full complaint can be viewed here.
Dr. John S. McGee is represented by the San Luis Obispo Lawyers at the Ernst Law Group. The law firm has been representing clients who have been seriously injured, harmed, or defrauded by large corporations for more than 35 years.