DMHC Cites Doctors For Balance Billing
The Department of Managed Health Care has issued a rare cease and desist order to two Riverside County physicians and their affiliated medical groups for balance billing insured patients, suing them and referring them to collections agencies.
The order, issued on Dec. 16 against Southwest Trauma Medical Associates in Murrieta and Festus B. Dada, M.D., and Bolaji A. Nafiu, M.D., is the first such action taken by the DMHC in nearly three years, and only the second one taken against individual physicians in the agency's history.
“The DMHC will continue to take aggressive action against healthcare providers that illegally balance bill health plan enrollees,” said DMHC Director Shelley Rouillard.
According to the DMHC, Dada and Nafiu balance billed insured patients who were treated at Inland Valley Medical Center in Wildomar. They then sent bills to the patients for the amount not covered by their insurers and referred them to collections agencies or sued them in Riverside County Small Claims Court if they did not pay up.
In one case involving a child covered by Kaiser Foundation Health Plan who sustained head trauma after being hit by a car in 2009, Dada sued the child's parents in small claims court. Southwest Trauma withdrew the suit after the parents complained to the DMHC. However, the matter was later referred to a collections agency, which sought nearly $2,200 plus interest from the parents, according to DMHC documentation. The DMHC sent a letter of admonishment to Dada in August 2012.
That did not deter Nafiu and Southwest Trauma from dunning patients for payments well into the latter half of 2013, according to DMHC documents.
A 2009 California Supreme Court decision, Prospect Medical Group v. Northridge Emergency Medical Group, outlawed the balance billing of insured patients for services rendered in hospital emergency departments
A search of Riverside County court records indicate that Dada and Nafiu, both Nigerian immigrants who received their medical training abroad, have been involved in dozens of lawsuits. A media report indicated that Dada also sued former major league baseball player Lenny Dykstra over a business deal that went sour. However, many of the suits involving the doctors are small claims actions, which are limited to disputes of less than $10,000.
Although attorneys are not allowed to argue such cases, basic contract law would presuppose the patients owe the physicians the sums they demand, and the patients are unlikely to be aware of the Prospect case to cite in their defense.
The DMHC order named only six lawsuits specifically, and officials said the investigation of the two physicians was ongoing.
In 2010, the DMHC issued a cease and desist order against South Pasadena plastic surgeon Jeannette Y. Martello, M.D., who had sued dozens of her patients in Los Angeles County Superior Court and Small Claims Court. Martello sued patients even after receiving the order, prompting the DMHC to sue her in order to halt her legal actions. Last November, the DMHC won a $562,000 judgment against her, and a Superior Court judge also sentenced her to five days in jail for apparently violating an injunction against taking legal action against her patients.
DMHC spokesperson Rodger Butler said he did not expect such extreme action would be required to keep the two physicians in check.
Neither Dada nor Nafiu returned phone calls seeking comment.
