Physicians, Southwest Texas HMO sue to force Texas IPA into bankruptcy

Plaintiffs say the IPA owes them thousands in unpaid claims, but Heritage Southwest Medical Group insists the suit is just a negotiating ploy.

By Julie A. Jacob, AMNews staff. Feb. 5, 2001.

An HMO, two doctors' groups and three physicians have filed a lawsuit against a Dallas-area IPA to try to force it into Chapter 7 bankruptcy.

The plaintiffs -- Southwest Texas HMO Inc., owned by Blue Cross Blue Shield of Texas; Texas Oncology P.A.; Imaging Consultants of Denton; and three individual physicians -- filed the lawsuit Jan. 5 in U.S. Bankruptcy Court, Northern Texas District, in Dallas.

The doctors and physician groups are seeking their share of capitation payments that they claim were made to Heritage Southwest Medical Group and the IPA then failed to distribute to physicians.

Mark Altenau, MD, a Dallas otolaryngologist, said Heritage abruptly stopped paying his claims in April 2000. Heritage owes him about $50,000, he said. When he called to inquire about his claims, "they didn't call me back," Dr. Altenau said. "Finally, someone in the accounting department told me the claims were a figment of my imagination."

Heritage spokeswoman Laura Carabello disagreed with the plaintiffs' claims that they had not been paid, stating that "all bona fide claims have been paid."

The Texas Blues' involvement stems from a long-running dispute over the amount of capitation payments made to Heritage Southwest. The HMO and physicians joined forces because they each believed that putting Heritage Southwest in Chapter 7 liquidation would be the best way to settle their disputes.

The plaintiffs sued because they were concerned that Heritage would shift its assets to another company and then file for bankruptcy, explained Robert Torti, MD, a Plano, Texas, ophthalmologist, leaving the physicians without any recourse to receive payment for their services. [...]