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Meyer v. Health Plan of Nev. - 2013 Nev. Dist. LEXIS 572

Rule:

Rule 56(c) of the Nevada Rules of Civil Procedure specifically authorizes the granting of summary judgment upon all or any part of a party's claim, when there is no genuine issue as to any material fact and the moving party is entitled to a judgment as a matter of law. A genuine issue of material fact is one where the evidence is such that a reasonable jury could return, a verdict for the non-moving party. Summary judgment should be granted when it clearly appears that there is no reasonable probability that the party moved against could prevail on that issue.

Facts:

Plaintiffs filed suit against defendant health plans, alleging negligence in selecting and retaining a medical professionals group in their network of medical providers. As a defense, and without articulating what such industry standards might be, defendants suggested that there was some sort of "industry standard" for credentialing or for selecting and retaining medical providers by an HMO with which defendants have complied. Plaintiffs filed a motion for summary judgment. They sought an order establishing that there are no "industry standards" for selecting and retaining or credentialing medical providers and that defendants must be precluded from suggesting that such "industry standards" exist.

 

Issue:

In a negligence action involving credentialing, should the Court grant plaintiffs' motion for summary judgment regarding defendant health plans' "industry standards" defense?

Answer:

Yes

Conclusion:

Granting plaintiffs' motion for summary judgment, the Court held that there was no genuine issue of material fact regarding the "industry standards" defense. The Court found it apparent that no "industry standards" existed during the applicable time period regarding the selection and retention of medical providers by an HMO or regarding credentialing. The National Committee for Quality Assurance ("NCQA") merely provided suggestions regarding how an HMO credentialing committee should be set up, but clearly does not suggest any supposed "industry standards" regarding the implementation of an HMO's own policies or policies and procedures regarding selection and retention of medical providers, as such responsibility rests solely within the HMO. 

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