Becker's ASC Review

62 ORTHOPEDICS Aetna illegally refused to pay $75,200 for emergency spine procedure, practice alleges By Angie Stewart S an Jose Neurospine is battling Aetna Health California in court, alleg- ing that the insurer illegally refused to pay for emergency medical services performed by spine surgeon Adebukola Onibokun, MD, the practice's owner. What you should know: 1. e case centers on a two-level lumbar microdiscectomy that Dr. Onibokun per- formed in April 2017. San Jose Neurospine submitted two claims to Aetna for reim- bursement — one for emergency medi- cal services and one for nonemergency surgery. Aetna only provided payment for the latter. 2. San Jose Neurospine filed a civil action against Aetna two months aer appealing Aetna's denial. e practice alleged that Aetna owed $75,200 for emergency medi- cal services covered under the patient's healthcare plan. 3. Aetna filed a motion for a summary judgment, claiming that San Jose Neu- rospine used incorrect codes and therefore wasn't entitled to payment for emergency services. Aetna was granted the summary judgment, meaning it showed that one or more elements of the plaintiff 's case were missing or that it was entirely defensible, rendering a trial unnecessary. 4. San Jose Neurospine appealed the ruling. On Feb. 27, the California Court of Appeal in the Second District concluded "there are triable issues of fact whether SJN provided and billed for emergency services and was entitled to reimbursement from Aetna." e court reversed the summary judgment and remanded the case for further proceed- ings. n Dr. Rick Sasso sues Medtronic over royalties for 2 spine surgery products in ongoing battle By Angie Stewart A royalties dispute between Medtronic and Carmel-based Indiana Spine Group founder Rick Sasso, MD, was returned to a state court March 4, The Indiana Lawyer reported. Dr. Sasso alleges that Medtronic owes him royalties related to two spine sur- gery products he invented and licensed to the company in 1999 and 2001. He first sued Medtronic for breach of agreements involving a screw delivery system and the Vertex Reconstruction System in 2013 and was awarded a $112 million verdict in November 2018. In March 2019, Dr. Sasso filed another lawsuit requesting an audit to deter- mine whether Medtronic should be required to pay royalties on continued sales of those products under the agreements. Medtronic countersued, alleging that Dr. Sasso wasn't entitled to an audit or further royalties and requesting that the case be removed to federal court. Indiana Northern District Judge Jon DeGuilio denied Medtronic's request for removal to federal court on the grounds that the case centers on contract interpretation rather than patent law. However, the judge declined to award Dr. Sasso attorney fees, ruling that Medtronic's claims weren't objectively unreasonable. n Alphatec ends plan to buy EOS Imaging for $122M By Alan Condon M edical device company Alphatec said it has ended its agreement to acquire EOS Imaging due to the ongoing impact of COVID-19. "This has been a difficult, disappointing decision," said Alphatec Chairman and CEO Pat Miles. "Both companies have worked so hard and so cooperatively over many months to bring this transaction together. On behalf of the entire ATEC family, I want to personally thank EOS for its commitment and hospitality throughout this process." Alphatec announced the tender offer agreement to purchase EOS imaging for up to $88 million in addition to $33.9 million of debt retirement on Feb. 26. But the business and healthcare landscape has changed considerably since then due to the coronavirus pandemic. After undertaking an analysis of the market effects of COVID-19, Alphatec said it concluded that a material adverse effect, as defined in the terms of agreement, had occurred, and the company decided to terminate its offer. Alphatec sent a letter dated April 24 to EOS to terminate the offer. Alphatec and Perceptive Credit Holdings agreed to terminate the commitment letter for up to $160 million in secured debt financing as well, which would have allowed the company to complete the transaction. Alpahtec's current credit facilities remain in place. Even though the acquisition was terminated, Mr. Miles hinted that the companies may continue to work together in strategic collaboration. n

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