IN THE CIRCUIT COURT OF THE STATE OF OREGON COUNTY OF MULTNOMAH NO. I. INTRODUCTION

Transcription

1 // :0:1 PM CV 1 IN THE CIRCUIT COURT OF THE STATE OF OREGON COUNTY OF MULTNOMAH 1 CLAIRE AMOS, on behalf of herself and all others similarly situated, v. Plaintiff, OREGON HEALTH & SCIENCE UNIVERSITY; and DOES 1 through, inclusive, Defendants. NO. CLASS ACTION COMPLAINT FOR DECLARATORY JUDGMENT, NEGLIGENT CONCEALMENT, AND INTENTIONAL CONCEALMENT Not Subject to Mandatory Arbitration Jury Trial Demand Amount in Controversy $,000,000 Filing fee per ORS.0(1)(e) I. INTRODUCTION 1. Plaintiff Claire Amos brings this class action complaint against defendant Oregon Health & Science University (hereinafter Defendant or OSHU ), challenging the unreasonable, unconscionable, and unlawful charges that OHSU billed to her and similarly situated self-pay patients for care arising out of emergency visits to OHSU.. Plaintiff is informed and believes, and thereon alleges, that all patients seeking emergency care at an OHSU facility are required to sign a standard form contract entitled INTENTIONAL CONCEALMENT - 1 TEL...0 FAX.0.

2 Terms and Conditions of Service (the Contract ). The Contract contains a Financial Agreement provision purporting to impose financial liability for all services provided to the patient. All patients, including Medicare, Medicaid, commercially insured, and self-pay patients, are required to sign the same Contract.. The Financial Agreement provision is generic and fails to specify any pricing or rate structure for any of the services OHSU provides. Plaintiff is informed and believes, and thereon alleges, that OHSU has engaged, and continues to engage, in a pattern and practice of billing and seeking to collect unreasonable, unconscionable, and inflated prices for the emergency care it provides to self-pay patients. 1 In particular, OHSU bills self-pay patients at artificially 1 developed rates (i.e., Chargemaster rates), which are dramatically higher than the amount OHSU accepts as full payment for the same treatment provided to other categories of patients. This is particularly troubling in the context of care arising out of an emergency, where patients do not have the opportunity to investigate or negotiate the rates they will pay prior to obtaining medical treatment.. Plaintiff respectfully seeks a declaratory judgment establishing the rights of self-pay patients under the Contract. In particular, Plaintiff asks the Court to rule that the Contract does not specify any price list or schedule for self-pay patients and thus entitles OHSU to bill and 1 Emergency care includes all services provided to a self-pay patient in relation to the patient s emergency visit to OHSU, regardless of whether the patient receives the services in the emergency department or in another hospital department to which the patient is transferred. INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

3 1 collect from self-pay patients only the reasonable value of its services. Such a declaratory judgment is necessary to resolve ongoing uncertainty and disagreement as to the proper interpretation of the Financial Agreement contained in the Contract and to determine whether the Contract authorizes OHSU to bill and collect payment from Plaintiff and other self-pay patients based on a rate schedule that is not described, referenced, or even mentioned in the Financial Agreement.. Further, the Contract terms are inherently false and deceptive, in that they imply all emergency care patients presenting at the same facilities, being provided with the same agreement for signature, and agreeing to pay for the same hospital services will be billed the same amount. The Contract s Financial Agreement does not distinguish between Medicare, Medicaid, commercially insured, and self-pay patients. The discrepancy between the Chargemaster rates that OHSU charges to self-pay patients and the actual payment rates for its other patients is extreme and is not disclosed by OHSU to self-pay patients.. Plaintiff Claire Amos brings this class action on behalf of herself and all similarly situated individuals who (a) were treated at an emergency care facility operated by OHSU in the state of Oregon, (b) were billed at OHSU s full Chargemaster rates for emergency care medical treatment, and (c) did not have payments made on their behalf by an insurer or governmental entity (the Class ). Excluded from the Class are those patients who paid nothing on their account and whose balances have been written off in full. INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

4 1 II. PARTIES. Representative Plaintiff Claire Amos is a citizen and resident of Auburn, California. Plaintiff was provided emergency medical treatment at OHSU in Portland, Oregon from April, to May,.. Plaintiff is informed and believes, and thereon alleges, that Defendant OHSU is a public corporation in the state of Oregon. Plaintiff is informed and believes, and thereon alleges, that OHSU operates an emergency care facility at its Marquam Hill campus in Portland, Oregon. Federal jurisdiction is inappropriate under the Class Action Fairness Act because two-thirds or more of the members of the proposed plaintiff class in the aggregate are citizens of Oregon.. The true names and capacities of Defendant Does 1 through, inclusive, are unknown to Plaintiff and, therefore, they are sued by such fictitious names. Plaintiff will seek leave of court to amend this complaint to allege the true names and capacities of the Doe Defendants when they have been ascertained. Plaintiff is informed and believes, and thereon alleges, that each Doe Defendant is in some manner responsible and liable for the actions herein alleged. III. AGENCY ALLEGATIONS. Plaintiff is informed and believes, and thereon alleges, that Defendant OHSU exercises control over its constituent medical facilities (including hospital campuses and other medical centers) by developing and controlling the form adhesion agreements those facilities present to their patients, as well as their policies, including policies relating to pricing for self-pay INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

5 emergency care patients. 1. Plaintiff is informed and believes, and thereon alleges, that at OHSU s direction and with its approval, each of the OHSU hospitals and other medical facilities represents itself, in its written and online materials and elsewhere, as being part of the OHSU system.. At all relevant times, each and every individual OHSU facility was and is the agent of OHSU. In committing the acts alleged herein, each and every OHSU facility acted in the course and scope of its agency, acted with the consent, permission, authorization, satisfaction and knowledge of OHSU, and perpetrated and/or aided and abetted the wrongdoings described herein. Plaintiff is informed and believes, and thereon alleges, that all actions of each OHSU facility as alleged herein were ratified and approved by OHSU or its officers, directors, regents, trustees, controlling persons, agents, partners, or joint venturers. IV. GENERAL ALLEGATIONS 1. Plaintiff is informed and believes, and thereon alleges, that OHSU has at all relevant times used a form adhesion contract, drafted by OHSU and utilized at its emergency care facilities, which all emergency care patients (or their agents) are required to sign, under circumstances that by their very nature involve a degree of duress. OHSU s form adhesion contract, entitled Terms and Conditions of Service (and defined herein as the Contract ), includes the following generic, nondescript Financial Agreement, which makes emergency care patients financially liable for the treatment rendered but which fails to identify, describe, explain or specify the pricing terms or financial liability amount for any patient s treatment: INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

6 1 Whether or not I have health insurance, I agree to be financially responsible and pay for the services provided to me by OHSU if the services are not covered or fully paid for by insurance and the law allows OHSU to collect from me the amount owing. I also agree to pay OHSU s reasonable costs for collecting payments if I do not pay on time the amounts I am responsible for paying. These collection costs may include reasonable attorney fees whether or not legal action has been filed or appealed.. The Financial Agreement purports to make each patient financially responsible for the services rendered, but provides no price structure or payment schedule. The pricing terms for patients covered by Medicare, Medicaid, and other governmental bodies are defined by governmental regulations and schedules not contained or referenced within the Contract. Likewise, reimbursement rates for patients insured by commercial insurers (e.g., Blue Cross, Aetna, etc.) are contained within separately negotiated contracts between Defendant and such insurers. For self-pay patients, however, there is no rate structure or price schedule specified or referenced within the Contract. As a result of the Contract s generic Financial Agreement, the Contract fails to explain, describe, quantify, identify, reference, or even mention any rate or rating schedule for any patient.. As a result of OHSU s failure to include any agreement for the pricing of its services within the body of its written Contract, or even to identify the basis on which pricing for self-pay patients will be determined, applicable law in Oregon provides that OHSU is entitled to receive only the reasonable value of its services from self-pay patients under equitable principles such as quantum meruit.. Despite being limited by equitable principles to charging self-pay patients for no more INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

7 1 than the reasonable value of the emergency care provided, OHSU bills and takes action to force self-pay emergency care patients to pay unreasonable, unlawful, and grossly excessive amounts for medical treatment and services. The amounts OHSU charges to self-pay emergency care patients are based on OHSU s Chargemaster rates, which are several times greater than the actual reimbursement rates paid by other patients and/or their third party payors for identical or substantially similar services, and far in excess of the reasonable value for such services.. Further, OHSU fails to inform and/or conceals from self-pay emergency care patients its uniform policy of billing and seeking collection from self-pay patients at Chargemaster rates, which are typically several times the reimbursement rates from other patients and/or their thirdparty payors.. OHSU s Chargemaster rates are not the amounts OHSU expects any category of patients to pay, and a patient s agreement to be financially responsible for emergency care, based on OHSU s written contract with its open pricing term, is not an agreement by self-pay patients to pay in accordance with any specific undefined and unmentioned rate schedule, and certainly not an agreement to pay at the hospital s grossly inflated Chargemaster rates. As a result, OHSU cannot reasonably construe that by signing OHSU s adhesive Contract, self-pay patients have obligated themselves to pay for emergency care at OHSU s artificially inflated and grossly excessive Chargemaster rates.. OHSU further acts egregiously by failing to inform and/or concealing from self-pay patients its uniform policy to bill and require payment from self-pay patients at rates vastly INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

8 1 higher than the average reimbursement rates paid by other patients. This failure to inform and/or concealment is shown by the fact that (1) OHSU s adhesive agreements make no mention of gross billing charges or Chargemaster rates; () emergency care patients have no opportunity to review OHSU s Chargemaster rates in advance of seeking emergency care; () the Financial Agreement fails to differentiate between self-pay patients and any other group or category of patient presenting at the same premises and receiving the same level of treatment; () OHSU fails to warn self-pay patients that they will be required to pay at Chargemaster rates that are vastly higher than the reimbursement rates paid by or on behalf of other patients who sign the exact same contractual agreement and receive the same level of emergency care; and () the Chargemaster rates OHSU bills to self-pay patients are grossly higher than the reasonable value of Defendant s treatment/services. V. THE REPRESENTATIVE PLAINTIFF S CLAIMS. On or about April,, Plaintiff Claire Amos was admitted to the emergency department at OHSU s hospital in Portland, Oregon. Plaintiff had no health insurance at the time.. Plaintiff was presented with and signed OHSU s standard admissions Contract. In obtaining emergency care from OHSU, Plaintiff reasonably expected to be billed at the same rates as the rest of the emergency care patients presenting at the same facilities, signing the same Financial Agreement, and receiving the same level of care. Plaintiff was not informed that she would be charged and required to pay substantially more than other patients for the same level of treatment and services, and Plaintiff certainly had no reason to believe she would be billed for INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

9 1 more than the reasonable value of such services.. OHSU subsequently billed Plaintiff a total of $1,1. for the emergency care she received at OHSU on April, through May,. Upon information and belief, such amount was based on 0 percent of OHSU s Chargemaster rates. Plaintiff is informed and believes, and thereon alleges, that $1,1. is far more than the reimbursement rates received from the vast majority of OHSU s patients for similar services and is consequently substantially greater than anything that could be considered to be OHSU s regular charges for such services. Plaintiff is further informed and believes that the amount of $1,1. is grossly excessive, unreasonable, and unconscionable for the services provided, grossly out of proportion to OHSU s actual costs in providing such services, and far beyond the reasonable value of such services. VI. CLASS ACTION ALLEGATIONS. Plaintiff brings this action on behalf of herself and a class of all other persons similarly situated (the Class ), defined as follows: All individuals (or their guardians or representatives) who (a) presented at an emergency care facility operated by OHSU in the state of Oregon, (b) were billed at OHSU s full Chargemaster rates for emergency care medical treatment, and (c) did not have payments made on their behalf by an insurer or government health care program. Excluded from the Class are those patients who paid nothing on their account and had their balances written off in full. Further excluded from the Class are Defendant, any officers or directors thereof, together with the legal representatives, heirs, successors, or assigns of any Defendant, and any judicial officer assigned to this matter and his or her immediate family. INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

10 . This action has been brought and may properly be maintained as a class action, satisfying the numerosity, commonality, typicality, adequacy, and superiority requirements. Plaintiff seeks to represent an ascertainable class with a well-defined community of interest in the questions of law and fact involved in this matter.. The members of the Class are so numerous that joinder of all such members is impractical. Plaintiff is informed and believes, and thereon alleges, that the Class consists of at least hundreds of persons.. There are questions of law and fact common to the Class, including, but not limited to: (a). The proper meaning and interpretation of the Contract s Financial Agreement, and, in 1 particular, the payment obligations of self-pay patients under such agreement; (b). Whether OHSU had a policy and practice of pricing, billing, and seeking collection from self-pay patients at rates substantially higher than the reimbursement rates from other groups and categories of patients; (c). Whether OHSU had a policy and practice of failing to inform and/or concealing from self-pay patients its intention to bill and seek payment for emergency medical care at rates substantially higher than the reimbursement rates for other categories of patients receiving similar emergency care; (d). Whether OHSU s policy and practice of pricing, billing, and seeking payment from selfpay emergency care patients at rates substantially higher than those paid by other patients receiving similar emergency care is unreasonable, unconscionable, and/or unlawful under any of INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

11 the causes of action asserted herein; (e). Whether Defendant s pricing and billing practices as to Plaintiff and the Class are unreasonable, unconscionable, deceptive, and/or illegal; (f). Whether the cost for medical services provided by Defendant is a material factor to a reasonable person in determining whether or not to obtain such services; and (g). Whether the acts and conduct of Defendant described herein render Defendant liable to 1 Plaintiff and the Class for injunctive relief, restitution, and/or damages.. Plaintiff s claims are typical of the claims of the Class, and Plaintiff is a member of the Class as defined. Plaintiff has suffered actual injury and harm and is likely to continue to suffer actual injury and harm due to the excessive, unreasonable, and unconscionable pricing and collection practices of OHSU.. Plaintiff will fairly and adequately represent and protect the interests of the Class. Plaintiff shares the same interests as all Class members because her claims and losses are typical of those of other Class members. Plaintiff has retained competent class counsel who are experienced in class action litigation and who will fairly and adequately protect the interests of the Class members.. Questions of law and/or fact common to the Class, including those identified above, predominate over any questions affecting only individual Class members. 0. At a bare minimum, each self-pay patient visiting an emergency department operated by INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

12 1 OHSU is entitled to know whether he or she is liable, under the Financial Agreement, for payment at OHSU s Chargemaster rates (as OHSU asserts) or for no more than the reasonable value of the medical care received (as Plaintiff asserts). This critical issue, which is essential to every Class member s claim, should be answered the same way for all Class members presenting at OHSU s emergency department. It would be unreasonable and unconscionable to force each self-pay patient to individually confront OHSU s collection department over this critical issue of financial liability or to individually litigate this basic question in a court of law. 1. A class action is superior to other available methods and, indeed, is the only possible method for the fair and efficient adjudication of this litigation, since joinder of all Class members is impracticable. Every self-pay patient is entitled to know whether he or she is financially liable for OHSU s full billing at Chargemaster rates or only for the reasonable value of treatment/services received, but most patient bills are modest in relation to the huge expense of individual litigation necessitated by OHSU s wrongful conduct. Under such circumstances, it would be impossible for Class members to efficiently redress their wrongs on an individual basis or to protect themselves from collection activity. Furthermore, even if some Class members could afford such individual litigation, the court system would substantially benefit from a class action, particularly since medical bills are a frequent source of legal contention, and it is widely recognized that many individuals are forced into bankruptcy as a result of excessive medical bills. Individual litigation would present the potential for inconsistent or contradictory judgments and magnify the delay and expense to all parties and the court system. By contrast, the class action device presents far fewer management difficulties and provides the benefit of comprehensive supervision by a single court, as well as economy of scale and expense. INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

13 1. OHSU has acted or refused to act on grounds generally applicable to all members of the Class, particularly with its system-wide policy of pricing, billing, and seeking collection from self-pay patients at its Chargemaster rates, thereby making final injunctive and declaratory relief concerning the Class as a whole appropriate. FIRST CAUSE OF ACTION For Declaratory Judgment. Plaintiff herein repeats, reiterates, and realleges each and every allegation contained in the preceding paragraphs, with the same force and effect as though the same were set forth at length herein.. OHSU contends that self-pay patients, under its current Contract terms, are obligated to pay the facility s billed charges as contained in OHSU s Charge Description Master. Plaintiff, on the other hand, contends that this interpretation of the Contract terms is invalid and that the Contract requires self-pay patients to pay only for the reasonable value of the treatment and services provided. Specifically, Plaintiff contends that the Contract, due to its vague and ambiguous payment liability provisions, leaves the price term open, and therefore OHSU is entitled to receive payment for no more than the reasonable value of the treatment/services rendered.. Plaintiff requests this Court to determine the proper construction of OHSU s Financial Agreement pursuant to Oregon Revised Statutes.0, which authorizes this Court to determine such construction of contracts. INTENTIONAL CONCEALMENT - 1 TEL...0 FAX.0.

14 1. Since the two interpretations of Plaintiff s financial obligation under the Financial Agreement, Chargemaster rates or reasonable rates, are the only logical interpretations of the payment obligations of a self-pay patient, and the financial liability of every self-pay patient is a substantial factor of critical importance in deciding whether or not to obtain care at OHSU (particularly since the entire bill is the patient s responsibility), a determination as to which contractual interpretation is legally correct can and should be made by this Court, as authorized by Oregon Revised Statutes.0. Such interpretation should be applicable to all self-pay patients, and can undoubtedly be made by this Court in a simple summary proceeding.. Plaintiff and members of the Class are entitled to know their rights, duties, and obligations under the Contract, and an actual dispute exists with regard to the interpretation of the Contract s Financial Agreement provision.. It is unjust and unreasonable for every self-pay patient to face the prospect of either paying for the treatment/services at OHSU s artificial and grossly excessive Chargemaster rates or being required to individually litigate the Contract meaning with OHSU s collection department.. Plaintiff and members of the Class are entitled to a declaration that OHSU s Contract does not permit it to bill and to demand payment from self-pay emergency care patients at its Chargemaster rates. INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

15 1 0. Plaintiff and members of the Class are further entitled to a declaration that they are liable to OHSU, under the Contract, for no more than the reasonable value of the treatment/services OHSU provided to them. 1. Because OHSU s Terms and Conditions of Service is an adhesive contract drafted by OHSU and imposed upon its self-pay emergency care patients, any ambiguity in the Contract, including the Financial Agreement, must be interpreted against OHSU. Further, since the Contract does not describe, define, or identify any pricing schedule in its Financial Agreement, the fact that an ambiguous contract term must be interpreted against the drafter of a contract militates against any argument by OHSU that a self-pay patient, by signing the Contract, has agreed to pay for treatment and services at OHSU s artificially inflated Chargemaster rates.. A Declaratory Judgment as sought herein is necessary and appropriate, since an existing, actual and immediate dispute exists between Plaintiff and OHSU over which of two conflicting interpretations of the Financial Agreement is correct. Such a judgment would terminate the uncertainty and controversy over the proper interpretation of OHSU s Financial Agreement and would allow Plaintiff and the Class members to obtain a determination of their legal rights and obligations under the Contract.. A declaration as sought herein will be of substantial, direct, and immediate benefit to Plaintiff and the Class since they will no longer be subject to OHSU s efforts to bill and/or collect charges in excess of the reasonable value of the services OHSU provided to them. INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

16 1 Furthermore, such declaration will also benefit future self-pay emergency care patients who become subject to the same or a similar Financial Agreement, including existing Class members who seek future emergency care from OHSU. SECOND CAUSE OF ACTION Negligent Concealment. Plaintiff herein repeats, reiterates, and realleges each and every allegation contained in the preceding and subsequent paragraphs, with the same force and effect as though the same were set forth at length herein.. By signing OHSU s standard, adhesive Contract, Plaintiff and Class members reasonably expected they would be billed at the same rates as those applicable to other patients signing the same Contract and receiving similar emergency treatment/services. Plaintiff and Class members also reasonably expected to be billed at rates which reflected no more than the reasonable value of the treatment and services rendered. In signing the Contract, Plaintiff and Class members were certainly not expecting to be billed at the artificial and grossly excessive rates for which they were subsequently billed.. OHSU s conduct constitutes negligent concealment in that OHSU made false and misleading omissions as to material facts regarding a self-pay patient s payment obligations. Specifically, OHSU failed to inform and/or concealed from Plaintiff and Class members OHSU s uniform policy of billing and seeking collection from self-pay patients at rates vastly higher than reimbursement rates from other categories of patients presenting at the same premises and signing the same Contract. Additionally, OHSU failed to inform and/or concealed INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

17 1 from Plaintiff and Class members that OHSU s uniform practice was to bill and demand payment from self-pay patients at rates several times higher than the reasonable value of the treatment and services provided. This practice is particularly egregious since (1) self-pay emergency care patients have no opportunity to view OHSU s Chargemaster rates in advance of receiving emergency care; () OHSU fails to warn self-pay patients that they will be required to pay at rates vastly higher than the reimbursement rates for other patients signing the same Contract and receiving the same level of treatment/services; () the Chargemaster rates OHSU bills to self-pay patients are grossly higher than the reasonable value of the services provided; and () the Contract s Financial Agreement, by misleading self-pay patients and making it appear that OHSU has fixed standards for charging all patients and failing to note any differences in pricing methodology between patients, creates a duty of disclosure as to the pricing disparities between self-pay patients and other emergency care patients.. OHSU s conduct also constitutes negligent concealment in that OHSU made substantial and misleading omissions as to material facts. Specifically: (1) OHSU provides all emergency care patients with an identical Contract that purports to create the same financial liability for all signing patients when, in fact, such is not the case (i.e., insured patient s reimbursement rates are based on separately negotiated contracts between the hospital and the insurer, and Medicare and Medicaid patient s reimbursement rates are based on governmentally approved rates); () OHSU s adhesive Contract, as a result of its lacking a pricing term, conceals the OHSU s intention to bill self-pay patients at its artificially inflated Chargemaster rates; and () OHSU conceals from self-pay patients the dramatic differences in the amounts they will be billed and required to pay in comparison with reimbursement rates for other of patients provided the same INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

18 level of treatment. 1. OHSU made these omissions of material facts when it, and it alone, knew the true state of material facts and knew that the pricing of its services was a substantial factor in a reasonable patient s determination to obtain such services.. The amount of a patient s billings and the costs of treatment are material factors for all patients, including self-pay patients. The pricing for hospital services is a substantial factor in the decision of a reasonable self-pay patient to obtain such services at the hospital or seek treatment elsewhere. 0. OHSU owed Plaintiff and Class members a duty to disclose its billing practices set forth herein based on one or more of the following facts: (a). (b). (c). setting. (d). (e). OHSU bills its emergency care patients at its Chargemaster rates. Chargemaster rates are grossly inflated over OHSU s costs. A list of Chargemaster rates is not reasonably available to patients in an emergency care Virtually no patients actually pay OHSU at its Chargemaster rates. The purpose of ever-expanding Chargemaster rates is to increase third-party reimbursement rates, such as outlier payments from Medicare, or to claim larger community service benefits provided by OHSU, since such benefits are stated at Chargemaster rates. (f). (g). Chargemaster rates are not controlled or regulated. Virtually nobody is expected to pay at Chargemaster rates. INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

19 (h). There is a vast disparity between the reimbursement rates of insured patients and OHSU s Chargemaster rates. (i). OHSU s Financial Agreement is both intentionally and negligently misleading, in that it fails to differentiate between categories of patients and contains the same financial liability provision for all patients, thus implying that all patients are subject to the same payment liability, which is untrue. (j). OHSU s Financial Agreement is both intentionally and negligently misleading in that it conceals that fact that the financial liability for the vast majority of patients, including Medicare, Medicaid, and commercially insured patients, is based on pricing schedules which are not even mentioned in the Contract. (k). OHSU s Financial Agreement is both intentionally and negligently misleading in that it 1 conceals the huge pricing disparity between self-pay patients and the vast majority of patients who are insured. (l). The price a patient will be charged for OHSU s emergency services is clearly material to a reasonable patient who is responsible for the payment of such costs and is a substantial factor in a reasonable patient s utilizing OHSU s services and treatment. (m). The internal billing practices of OSHU, and how the amount of its bills are determined for an emergency care visit, are systematically concealed and virtually unknown to patients. (n). Very few individuals have even the slightest knowledge of what a Chargemaster is, how it operates, when it is used, what it is used for, or where it can be found. (o). OSHU s pricing is kept very secretive. Patients have no basic understanding of how OSHU charges its patients, and this results in a lack of understanding as to the huge pricing disparities between patients. INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

20 1 1. As a direct and proximate result of OHSU s negligent omissions, Plaintiff and Class members have been damaged and are entitled to damages in an amount to be determined at trial. THIRD CAUSE OF ACTION Intentional Concealment. Plaintiff herein repeats, reiterates, and realleges each and every allegation contained in the preceding and subsequent paragraphs, with the same force and effect as though the same were set forth at length herein.. Plaintiff and other self-pay emergency care patients signing OHSU s standard, adhesive Contract reasonably expected that they would be billed at the same rates as those applicable to other patients signing the same Contract and receiving similar emergency treatment/services, and reasonably expected to be billed at rates which reflected no more than the reasonable value of the treatment and services rendered. Additionally, at the time of signing the Contract, Plaintiff and Class members were certainly not expecting to be billed at the artificial and grossly excessive rates for which they were subsequently billed.. OHSU s conduct constitutes intentional concealment in that OHSU made false and misleading omissions as to material facts regarding a self-pay patient s payment obligations. Specifically, OHSU failed to inform and/or concealed from its self-pay emergency care patients OHSU s uniform policy of billing and seeking collection from self-pay patients at rates vastly higher than reimbursement rates from other categories of patients presenting at the same premises and signing the same Contract. Additionally, OHSU failed to inform and/or concealed INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

21 1 from its self-pay emergency care patients that OHSU s uniform practice was to bill and demand payment from self-pay patients at rates several times higher than the reasonable value of the treatment and services provided. This practice is particularly egregious since (1) self-pay emergency care patients have no opportunity to view OHSU s Chargemaster rates in advance of receiving emergency care; () OHSU fails to warn self-pay patients that they will be required to pay at rates that are vastly higher than the reimbursement rates for other patients signing the same Contract and receiving the same level of treatment/services; () the Chargemaster rates OHSU bills to self-pay patients are grossly higher than the reasonable value of the services provided; and () the Contract s Financial Agreement, by misleading self-pay patients and making it appear that OHSU has fixed standards for charging all patients and failing to note any differences in pricing methodology between patients, creates a duty of disclosure as to the pricing disparities between self-pay patients and other emergency care patients.. OHSU s conduct also constitutes intentional concealment in that OHSU made substantial and misleading omissions as to material facts. Specifically: (1) OHSU provides all emergency care patients with an identical Contract that purports to create the same financial liability for all signing patients when, in fact, such is not the case (i.e., insured patient s reimbursement rates are based on separately negotiated contracts between the hospital and the insurer, and Medicare and Medicaid patient s reimbursement rates are based on governmentally approved rates); () OHSU s adhesive Contract, because it lacks a pricing term, conceals the hospital s intention to bill self-pay patients at artificially inflated Chargemaster rates; and () OHSU conceals from self-pay patients the dramatic differences in the amounts they will be billed and required to pay in comparison with reimbursement rates for other of patients provided the same level of INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

22 treatment. 1. OHSU made these omissions of material facts when it, and it alone, knew the true state of material facts, and knew that the pricing of its services was a substantial factor in a reasonable patient s determination to obtain such services.. The amount of a patient s billings and the costs of treatment are material factors for all patients, including self-pay patients. The pricing for hospital services is a substantial factor in the decision of a reasonable self-pay patient to obtain such services at the hospital or seek treatment elsewhere.. OHSU owed Plaintiff and Class members a duty to disclose its billing practices set forth herein based on one or more of the following facts: (a). (b). (c). setting. (d). (e). OHSU bills its emergency care patients at its Chargemaster rates. Chargemaster rates are grossly inflated over OHSU s costs. A list of Chargemaster rates is not reasonably available to patients in an emergency care Virtually no patients actually pay OHSU at its Chargemaster rates. The purpose of ever-expanding Chargemaster rates is to increase third-party reimbursement rates, such as outlier payments from Medicare, or to claim larger community service benefits provided by OHSU, since such benefits are stated at Chargemaster rates. (f). (g). Chargemaster rates are not controlled or regulated. Virtually nobody is expected to pay at Chargemaster rates. INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

23 (h). There is a vast disparity between the reimbursement rates of insured patients and OHSU s Chargemaster rates. (i). OHSU s Financial Agreement is both intentionally and negligently misleading, in that it fails to differentiate between categories of patients and contains the same financial liability provision for all patients, thus implying that all patients are subject to the same payment liability, which is untrue. (j). OHSU s Financial Agreement is both intentionally and negligently misleading in that it conceals that fact that the financial liability for the vast majority of patients, including Medicare, Medicaid, and commercially insured patients, is based on pricing schedules which are not even mentioned in the Contract. (k). OHSU s Financial Agreement is both intentionally and negligently misleading in that it 1 conceals the huge pricing disparity between self-pay patients and the vast majority of patients who are insured. (l). The price a patient will be charged for OHSU s emergency services is clearly material to a reasonable patient who is responsible for the payment of such costs and is a substantial factor in a reasonable patient s utilizing OHSU s services and treatment. (m). The internal billing practices of OSHU, and how the amount of its bills are determined for an emergency care visit, are systematically concealed and virtually unknown to patients. (n). Very few individuals have even the slightest knowledge of what a Chargemaster is, how it operates, when it is used, what it is used for, or where it can be found. (o). OSHU s pricing is kept very secretive. Patients have no basic understanding of how OSHU charges its patients, and this results in a lack of understanding as to the huge pricing disparities between patients. INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

24 1. As a direct and proximate result of OHSU s negligent omissions, Plaintiff and Class members have been damaged and are entitled to damages in an amount to be determined at trial. 0. Because Plaintiff is informed and believes, and thereon alleges, that OHSU acted with oppression, fraud, and/or malice in engaging in the above-described conduct, Plaintiff hereby gives notice of her intent to move the Court for leave to amend this complaint to assert a claim for punitive damages pursuant to ORS 1.. PRAYER FOR RELIEF WHEREFORE, Plaintiff, on her own behalf and on behalf of the Class, prays for the following relief against Defendants and each of them: A. On all causes of action, for an order certifying that this action may be maintained as a class action against OSHU, appointing Plaintiff and her counsel to represent the Class, and directing that reasonable notice of this action be given by OSHU to the members of the Class; B. On the first cause of action, for an order interpreting OHSU s Contract, including the Financial Agreement, and declaring that OHSU s Contract requires payment for treatment/services furnished to self-pay patients at no more than the reasonable value of the services rendered; C. On the first cause of action, for an award of restitution and disgorgement, in accordance with proof at trial; D. On the second and third causes of action, for an award of damages to Plaintiff and the Class in an amount to be proven at trial but presently estimated to be $,000,000; E. On all causes of action, for an order awarding Plaintiff and members of the Class INTENTIONAL CONCEALMENT - TEL...0 FAX.0.

25 1 the costs of their suit, including, but not limited to, reasonable attorneys fees and expert fees; and F. For such other and further relief as may be just and proper. DEMAND FOR JURY TRIAL Plaintiff, on behalf of herself and the Class, respectfully requests trial by jury on all claims so triable. RESPECTFULLY SUBMITTED AND DATED this th day of September,. By: Jennifer Rust Murray, OSB #0 Toby J. Marshall Pro Hac Vice Application Forthcoming Elizabeth A. Adams Pro Hac Vice Application Forthcoming Telephone: () -0 Facsimile: () 0- Barry L. Kramer Pro Hac Vice Application Forthcoming BARRY L. KRAMER LAW OFFICES 0 South Eastern Avenue, Suite Las Vegas, Nevada 1 Telephone: (0) -00 Attorneys for Plaintiff INTENTIONAL CONCEALMENT - TEL...0 FAX.0.