From Casetext: Smarter Legal Research

Foong v. Empire Blue Cross Blue Shield

Appellate Division of the Supreme Court of New York, First Department
May 29, 2003
305 A.D.2d 330 (N.Y. App. Div. 2003)

Summary

In Foong, the First Department held that a "plaintiff has an implied right of action under Public Health Law § 230(11)(b)...."

Summary of this case from Haar v. Nationwide Mut. Fire Ins. Co.

Opinion

1186

May 29, 2003.

Order, Supreme Court, New York County (Charles Ramos, J.), entered October 1, 2002, which, insofar as appealed from, denied defendant health maintenance organization's motion for summary judgment dismissing plaintiff health care professional's causes of action for violation of Public Health Law § 4406-d and § 230(11)(b), and for breach of contract and breach of the common-law duty of good faith and fair dealing, unanimously affirmed, with costs.

Kenneth L. Kutner, for plaintiffs-respondents.

Randy M. Mastro, for defendants-appellants.

Harold N. Iselin Jay G. Safer, for amici curiae.

Before: Nardelli, J.P., Saxe, Sullivan, Wallach, Gonzalez, JJ.


Plaintiff has an implied right of action under Public Health Law § 4406-d, which gives health care providers a measure of due process, in the form of peer review, against the arbitrary termination of health care plan contracts, but does not provide for any means of enforcement (see Uhr v. East Greenbush Central School Dist., 94 N.Y.2d 32, 38, 39-40). We reject defendant's argument that such a right of action will thwart its statutory right to terminate a provider immediately, without a hearing, in cases of imminent harm to patient care and fraud. Defendant remains free to terminate a provider without a hearing, although its grounds for doing so are subject to judicial review. For similar reasons, plaintiff has an implied right of action under Public Health Law § 230(11)(b), which immunizes from suit insurers and others who make good faith reports to the State Board of Professional Medical Conduct. Here, an issue of fact as to defendant's good faith is raised by evidence that although it terminated plaintiff on the basis of imminent harm to patients, it waited 13 months after first notifying him of his alleged substandard care, and by the finding of the New York County Medical Society that plaintiff had demonstrated sound medical practice. Plaintiff's cause of action for breach of contract was properly sustained based on allegations that defendant withheld payments due for services rendered, and the existence of issues of fact as to imminent harm and fraud. Plaintiff's cause of action for breach of the duty of good faith and fair dealing was properly sustained as it alleges several claims not made under his cause of action for breach of contract, including that he was terminated in retaliation for his having notified the Department of Insurance of defendant's "improper actions."

Motions seeking leave to file amici curiae briefs granted.

THIS CONSTITUTES THE DECISION AND ORDER OF THE SUPREME COURT, APPELLATE DIVISION, FIRST DEPARTMENT.


Summaries of

Foong v. Empire Blue Cross Blue Shield

Appellate Division of the Supreme Court of New York, First Department
May 29, 2003
305 A.D.2d 330 (N.Y. App. Div. 2003)

In Foong, the First Department held that a "plaintiff has an implied right of action under Public Health Law § 230(11)(b)...."

Summary of this case from Haar v. Nationwide Mut. Fire Ins. Co.

In Foong, the First Department held that a "plaintiff has an implied right of action under Public Health Law § 230(11)(b)...." 305 A.D.2d at 330, 762 N.Y.S.2d 348.

Summary of this case from Haar v. Nationwide Mut. Fire Ins. Co.
Case details for

Foong v. Empire Blue Cross Blue Shield

Case Details

Full title:ANTHONY FOONG, M.D., ET AL., Plaintiffs-Respondents, v. EMPIRE BLUE CROSS…

Court:Appellate Division of the Supreme Court of New York, First Department

Date published: May 29, 2003

Citations

305 A.D.2d 330 (N.Y. App. Div. 2003)
762 N.Y.S.2d 348

Citing Cases

Haar v. Nationwide Mut. Fire Ins. Co.

. But the First Department reached the opposite result in Foong v. Empire Blue Cross & Blue Shield , 305…

Haar v. Nationwide Mut. Fire Ins. Co.

Id. (citing Lesesne, 918 F. Supp. 2d at 229). But the First Department reached the opposite result in Foong…