The Supreme Court has ordered the state's largest health insurance company to turn over consultant reports and other materials it relied on when establishing its two-tier OMNIA system to hospitals relegated to the second tier. The justices overturned a decision by the Appellate Division that denied the discovery request, rejecting the panel's conclusion that the broad discovery request was not warranted because the challenge to the OMNIA system lacked merit.
The justices ordered disclosure of a McKinsey & Company report commissioned by Horizon Healthcare Services when it decided which hospitals would be designated Alliance partners, its term for those in the first tier of the OMNIA system. The order also encompasses documents relating to the formulation of Tier 1 criteria, performance scores for all Tier 1 hospitals and communication between Horizon and Tier 1 partners. The OMNIA plan, which offers lower premiums and deductibles to patients who use the seven large hospital systems in Tier 1, is under challenge by hospitals in the second tier.
The ruling doesn't permit the public or the media to view the documents, based on a protective order, but it does allow the plaintiffs to obtain them to challenge their exclusion from Tier 1.
The ruling follows a decision by Superior Court Judge Frank Ciuffani, granting access to the discovery documents in a suit brought by St. Peter's University Hospital in New Brunswick, and a similar ruling by Superior Court Judge Robert Contillo in Bergen County, who granted access to documents sought by Trinitas Regional Medical Center, Holy Name Medical Center and Valley Hospital. But Horizon appealed, and the Appellate Division reversed the two Chancery Division judges' decisions after balancing the right to extensive discovery against what claims that it considered weak.
But the Supreme Court took issue with the Appellate Division's consideration of its own view of the strength of the case.
"We conclude the Appellate Division exceeded the limits imposed by the standard of appellate review both by assessing the information's relevance against the panel's own disapproving view of the merits and by giving no apparent weight or consideration to the protections afforded by the confidentiality orders," Appellate Division Judge Clarkson Fisher, temporarily assigned, wrote for the court. "Having closely examined the record, we reject the Appellate Division's determination that the chancery judges encharged with these matters abused their discretion."
This is a developing story.