CarePoint Health and McCabe Ambulance Services filed a five-count lawsuit against the Jersey City Medical Center in Hudson County Superior Court last week, alleging that their competitor violated an ambulance transport agreement reached in 2016.
By John Heinis/Hudson County View
” … Beginning in at least in 2019, JCMC began redirecting, diverting and/or steering EMS patient transports … particularly those patients having private medical insurance or otherwise had the financial wherewithal to pay the fees and costs associated with the EMS transport and any resultant emergency or in-patient services,” the 28-page suit, filed on August 8th, says.
“Conversely, upon information and belief, beginning in 2019, JCMC began redirecting, diverting or steering patients who relied on Medicare or Medicaid, government sponsored healthcare, and charity, and patients who otherwise are unable to pay such fees, to CarePoint facilities.”
After roughly a year-and-a-half of litigation, the three parties in this case reached a settlement that created a grid protocol that established six different geographic zones that would determined if Jersey City residents would be transported to Christ Hospital in Jersey City, the Bayonne Medical Center, or the Jersey City Medical Center, as HCV first reported.
As part of the settlement, “when an EMS patient transport originates in the North Borderline or South Borderline Zones of the Grid Protocol, where the distance to JCMC and Christ are approximately equal, JCMC must transport such patients to JCMC and a CarePoint facility equally,” the new suit contends.
For example, if there are 100 EMS patient transports originating in the North Borderline Zone, 50 are supposed to be transported to a CarePoint facility (they own the BMC and Christ Hospital) and 50 to the JCMC.
The lawsuit also asserts that CarePoint and McCabe received “significant financial harm” by receiving “a disproportionately high share of patients without private insurance coverage or who are otherwise unable to pay” and that the settlement/grid protocol was supposed to prevent this from happening.
Data outlined in the lawsuit says CarePoint and McCabe lost out on at least $122,615,600 in expected patient revenue from Christ Hospital and at least $34,770,120 for the same figure related to the Bayonne Medical Center.
Furthermore, the lawsuit alleges breach of contract, breach of covenant of good faith and fair dealing, tortious interference with prospective economic advantage, monopolization, and attempted monopolization – both in violations of the New Jersey Antitrust Act.
As a result, the plaintiffs are seeking damages, punitive damages, treble damages, attorney’s fees, an order preventing JCMC from steering patients away from CarePoint facilities, as well as determining at trial how much money JCMC should have to forfeit in profits derived from the ambulance transports.
“This complaint commits a misrepresentation of actions by Jersey City Medical Center (JCMC) to revisit an issue that was resolved among the parties years ago. The evidence will show that JCMC has been and continues to be forthright in adhering to the terms of that settlement, as well as all state and federal regulations on the delivery of these services,” a JCMS spokesperson said in a statement.
“The complaint also ignores one of the most critical factors in determining where patients are taken when transported by EMS personnel – namely, patient preference. The plain fact is that the residents of Jersey City and beyond recognize that JCMC is the premier destination for emergency, inpatient and ambulatory care in Hudson County and ask to be taken here, when clinically appropriate, not those facilities initiating this suit.”
Back in December 2013, Jersey City’s request for proposals (RFP) committee recommended that the Basic Life Support Emergency Ambulance Services (BLS EMS) contract be awarded to CarePoint.
However, the proposal was allegedly pulled for “legal reasons” and sent to the Office of the Inspector General for review.
Rather than waiting for the review to be complete, the city rejected all bids and started the process over in June 2014.
The Jersey City Medical Center was ultimately awarded the BLS EMS contract in a unanimous vote of the city council in November 2014.
The process faced further scrutiny in July 2016 when CarePoint Co-Founder Vivek Garipalli was identified as a $1 million donor to a super PAC linked to Mayor Steven Fulop.
Editor’s note: This story was updated on Wednesday afternoon with a statement from a Jersey City Medical Center spokesperson.