PROSPECT MEDICAL GROUP, INC., et al., Plaintiffs and Appellants,
v.
NORTHRIDGE EMERGENCY MEDICAL GROUP et al., Defendants and Respondents.
PROSPECT HEALTH SOURCE MEDICAL GROUP, Plaintiff and Appellant,
v.
SAINT JOHN'S EMERGENCY MEDICINE SPECIALISTS, INC., et al., Defendants and Respondents.
Supreme Court of California.https://leagle.com/images/logo.png
January 8, 2009.
January 8, 2009.
Attorney(s) appearing for the Case
Bird, Marella, Boxer, Wolpert, Nessim, Drooks & Lincenberg, Thomas R. Freeman; Miller & Holguin, Stephan, Oringher, Richman, Theodora & Miller, Theodora Oringher Miller & Richman, Harry W. R. Chamberlain II, Kenneth E. Johnson, Robert M. Dato and Stacey L. Zill for Plaintiffs and Appellants.
Epstein Becker & Green, William A. Helvestine, Michael T. Horan and Carri L. Becker for California Association of Health Plans as Amicus Curiae on behalf of Plaintiffs and Appellants.
Fulbright & Jaworski, Buchalter, Nemer, Fields & Younger, Buchalter Nemer and Carol K. Lucas for California Association of Physicians Groups as Amicus Curiae on behalf of Plaintiffs and Appellants.
Amy L. Dobberteen, Debra L. Denton, Michael D. McClelland and Drew Brereton for Department of Managed Health Care as Amicus Curiae on behalf of Plaintiffs and Appellants.
Howard Rice Nemerovski Canady Falk & Rabkin, Jerome B. Falk, Jr., Ethan P. Schulman, Steven L. Mayer, Jonas M. Nahoum; Law Offices of Andrew H. Selesnick, Alleguez & Selesnick and Andrew H. Selesnick for Defendants and Respondents.
Catherine I. Hanson for California Medical Association as Amicus Curiae on behalf of Defendants and Respondents.
Astrid G. Meghrigian for American College of Emergency Physicians, California Chapter of the American College of Emergency Physicians and California Chapter, American Academy of Emergency Medicine as Amici Curiae on behalf of Defendants and Respondents.
Physicians' Advocates and Charles Bond for American Medical Association as Amicus Curiae on behalf of Defendants and Respondents.
Hooper, Lundy & Bookman, Lloyd A. Bookman, Suzanne S. Chou and Felicia Y Sze for California Hospital Association as Amicus Curiae on behalf of Defendants and Respondents.
Supreme Court of California.
OPINION
CHIN, J.—
A health maintenance organization (HMO) commonly manages medical care in California. In the typical model, familiar to many, doctors contract to provide medical care to enrolled HMO members. Members generally use the services of one of the contracting doctors. When they do, and except for copayments the members must make when services are rendered, the HMO (or its delegate) pays the doctor under the existing contract...
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