A suit was removed to Hawai’i federal court last Friday, after being filed in late December by Scott J. Miscovich, M.D. LLC and Windward Urgent Care Services LLC (collectively known as Premier Medical Group Hawai’i, or PMG) against University Health Alliance (UHA). The complaint alleges that the defendants wrongfully denied thousands of insurance claims that were filed for COVID-19 testing, which the plaintiffs argue is in direct violation of the Families First Coronavirus Response Act (FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (CARES), and other relevant laws.
Dr. Miscovich is a doctor who “has been a regularly featured guest on CNN to discuss the COVID-19 pandemic and is recognized testing expert and consultant throughout the United States.” The defendant is a provider of private medical, drug, and vision insurance in Hawai’i, the state court complaint said.
PMG, a major COVID-19 test provider in Hawai’i, has submitted various claims to the defendant for payment in full of COVID-19 tests. The complaint details that “under the FFCRA, CARES Act, and other relevant, law, UHA must pay claims for diagnostic COVID-19 testing.” Despite this, the defendant has denied the claims made by PMG on the basis that the tests should be paid for by a private facility or under workers’ compensation. In addition to being against federal law, the plaintiffs believe that this denial is in violation of the defendant’s own policies.
After the plaintiffs engaged in a lengthy dispute with UHA over the alleged wrongful denial of the COVID-19 testing claims by the defendant, UHA terminated the plaintiffs from their capacity as participating providers in UHA’s provider network, a network which they had been a part of since 2003. The plaintiffs believe that this action taken by UHA constitutes retaliatory termination, which they assert is “improper and in bad faith.”
The complaint cites bad faith denial of claims and unjust enrichment. The plaintiffs are seeking declaratory relief, special, general, and punitive damages, litigation fees, and any other relief deemed proper by the court.
The plaintiffs are represented by Bronster Fujichaku Robbins, while the defendants are represented by Goodsill Anderson Quinn & Stifel LLP.
