Balance Billing Doctor Keeps License
An administrative law judge has stayed the revocation of South Pasadena reconstructive plastic surgeon Jeannette Y. Martello, M.D.'s medical license, instead opting to place her on five years of probation after finding she engaged in unprofessional conduct for inappropriately balance billing her patients and dunning them for the sums.
The decision by Administrative Law Judge Eric Sawyer was handed down last week, according to Cindy Lopez, the deputy state attorney general who prosecuted the case on behalf of the Medical Board of California.
Although the 33-page decision exonerated Martello for incompetence and negligence connected to a breast augmentation procedure she performed that went awry in 2007, it concluded she had acted unprofessionally by balance billing patients she treated at Los Angeles-area hospital emergency rooms and attempting to collect the amounts she thought were owed. Sawyer also concluded her testimony regarding the balance billing matters was false and evasive.
Sawyer also expressed concern regarding Martello's lack of remorse for her conduct, and noted that if punishment was not meted out, she would likely balance bill and attempt to collect those amounts from her patients in the future.
Under the terms of the probation, Martello must dismiss any litigation against the five patients he had determined she had improperly balance billed, take an educational course in medical professionalism, and have another physician monitor her billing practices. The monitoring physician is required to make quarterly reports to the board. Martello's license may be revoked by the Medical Board if the terms of the probation are not followed.
Despite imposing the penalty, Sawyer also concluded that Martello was a competent physician who had obtained good results for her patients. He cited her prior lack of a prior disciplinary history as a factor in not imposing a greater punishment.
A 2012 Payers & Providers investigation concluded that Martello had sued dozens of her former patients and their family members in Los Angeles County Superior and Small Claims Courts over amounts alleged she owed them for care, including many not mentioned in Sawyer's decision.
The Department of Managed Health Care sued Martello in 2011 for balance billing patients and ignoring a cease and desist order issued by the agency. It is the first and only time the DMHC has taken such actions against an individual provider.
In May 2012, the DMHC received a legal injunction against Martello for balance billing any patients whose insurance policies it regulates.
Court records indicated that the DMHC recently sought a contempt citation against Martello for continuing to press an appeal in one case that the agency had sought to dismiss. It is unknown whether sanctions have been issued.
A verdict regarding the DMHC lawsuit had been expected this week, but was postponed until mid-September, according to an agency spokesperson.
