26 Pa. D. & C.5th 49
Pennsylvania Court of Common P...2012Background
- Dr. Ahmad, a cardiovascular/thoracic surgeon, faced state-law defamation and interference claims against Aetna and Dr. Baskin arising from its investigation into alleged fraudulent billing.
- Aetna/Baskin undertook an investigation after noting irregular use of a billing code and directed further inquiry through Aetna’s Special Investigations Unit.
- Berman conducted interviews and reviewed records, concluding misrepresentation by Ahmad and initiating referral to the New Jersey Medical Board and fraud bureau.
- Aetna sent notices to patients denying payment for spider-vein procedures as cosmetic, and demanded reimbursement for overpayments.
- The New Jersey Board investigated and administratively closed the case in 2006 due to an expert-witness conflict of interest.
- The trial court denied Ahmad’s renewed summary-judgment motion and granted summary judgment for Aetna, leading to this appeal.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether NJ privilege immunizes disclosures to the board | Ahmad argues the privilege does not apply due to alleged bad faith/malice. | Aetna contends the statutory privilege shields disclosures made in good faith for disciplinary purposes. | Privilege applied; immunity for statements during investigation; summary judgment for appellees affirmed. |
Key Cases Cited
- Commonwealth v. Otero, 860 A.2d 1052 (Pa. Super. 2004) (rule 1925(b) aids identifying issues; issues not raised may be waived)
- Commonwealth v. Rolan, 964 A.2d 398 (Pa. Super. 2008) (concise statement required; failure to identify issues waives review)
- Commonwealth v. McCree, 857 A.2d 188 (Pa. Super. 2004) (conciseness required; lengthy 1925(b) statements hinder review)
- Kanter v. Epstein, 866 A.2d 394 (Pa. Super. 2004) (conciseness and coherence essential in 1925(b) statements)
- Feit v. Horizon Blue Cross & Blue Shield of N.J., 897 A.2d 1075 (N.J. Super. Ct. App. Div. 2006) (statutory privilege immunity extends when information reasonably believed to indicate misconduct)