By GAIL OBER, LACONIA DAILY SUN
LACONIA — LRGHealthcare has filed suit against the Taylor Community and the state's workers compensation insurance company for payment of $127,674 for the work-related surgery they performed on a Taylor Community employee.
Also included in the suit are the legal group hired by the New Hampshire Employers Insurance Company and Qmedworx Services, the mediation team that worked out the final settlement.
According to the pleadings filed in the Belknap County Superior Court, one of the Taylor Community's employees injured his back in 2013 while removing snow in the course of his regular assigned duties.
According to court documents, Qmedworx claims that LRGH grossly overcharged Taylor Community for the services.
The employee was being treated by a neurosurgeon and an orthopedic surgeon, and by February of 2015, they determined that he had a collapsed disc in his back and needed fusion surgery.
The employee had back surgery at the Lakes Region General Hospital on May 12, 2015, and stayed until May 19, 2015. The bill was $233,063 for services.
On Feb. 2, 2016, the state Compensation Appeals Board issued a unanimous decision that the injury sustained by the worker was caused by the snow removal in February 2013 and ordered the Taylor Community, or its insurer, to pay LRGHealthcare the money, "as soon as possible but in no event later than five working days after the effective date of the decision."
The state Employers Insurance Company hired the Lawson Group, who in turn hired Qmedworx to negotiate the medical claim of the worker that would determine the final settlement between LRGH and the Taylor Community.
In those negotiations, LRGH agreed to a final payment of $198,104.23. The agreement was signed by contracting director Herbert Carpenter who agreed to it provided it was overnighted to the hospital because it had not been paid within the five working days set by the state Employers Insurance Company.
He forwarded the agreement to Qmedworx on or about April 4, 2016.
On or about April 18, LRGH received a payment of $70,429.57 but not the agreed amount of $198,104.
Along with the payment, LRGH was told by Qmedworx that in May it has appealed the amount bill to the state Department of Labor, Division of Labor Disputes, who determined the facility charges of $69,255 were about twice as much as the DOL said they should be. Qmedworx reimbursed LRGH $35,229, estimating that LRGH incurred costs of about $30,000.
Additionally, the DOL determination said that LRGH charged $163,808 for implant and supplies. They estimated the costs of these to LRGH was about $22,000 to $32,000, meaning that LRGH charged between five to seven times their costs of the implant and supplies.
Qmedworx determined that they would pay LRGH $35,200 for the implant services, saying the reimbursement was reasonable under state law.
The suit claims that Qmedworx never informed the Carpenter or anyone else from LRGH that it considered the $198,104 agreement null and void and that they are entitled to the negotiated amount.
LRGH claims that the Taylor Community and the others are in breach of their contract for a final payment of $198,104 and that Taylor or their insurer still owes them $127,674.
LRGH also claims that the Taylor Community and the others are being unjustly enriched by not paying LRGH the agreed upon amount.
A third count seeks reasonable legal fees for the attorneys hired by LRGH to file the legal claim and seek what they say is the negotiated final settlement.
The Taylor Community, the Lawson Group, the state Employment Insurance Company and Qmedworx have not yet filed a response to the suit.
- Category: Local News
- Hits: 1927