A group of doctors in Fairbanks has filed what could be a multimillion-dollar lawsuit against Tanana Chiefs Conference Inc., a consortium of 42 Interior Alaska tribes.

Golden Heart Emergency Physicians, which provides emergency services at Fairbanks Memorial Hospital, claims TCC has underpaid or refused to pay thousands of emergency room bills even though it takes in money from the Indian Health Service -- as much as $30 million per year, according to the lawsuit -- to pay for the health care needs of its constituents.

The payment disputes often leave TCC members to pay the emergency room tab at their own expense. If those patients can't or don't pay, Golden Heart is stuck with a situation in which it has provided services essentially for free, something it has no intention of doing. Since emergency rooms are required by law to treat patients who come to them in need of emergency care, they don't turn anyone away. Patients are treated without consideration of where payment will come from.

According to Golden Heart, its physicians have provided medical care to thousands of TCC members with little or no payment in return, leaving TCC owing "a substantial sum." The lawsuit does not offer a precise amount Golden Heart seeks from TCC -- only that it wants to recover three times the amount due on each bill or $500, whichever is more, and that it believes punitive damages may also be appropriate.

An attorney for Golden Heart, Clifford Cantor, declined to comment when reached by phone last week at his office in Washington state. Although Alaska Dispatch traded calls over the last week with TCC Chief Jerry Isaac, we were unsuccessful in connecting with him to get the consortium's perspective on the dispute. Peter Partnow, attorney for TCC, said only that his client is aware of the lawsuit and that both sides are "working on it."

It appears some of the payment denials by TCC occur when the consortium determines a patient has unnecessarily sought treatment at the emergency room or after hours when other options may have been available, like a visit to the TCC-run Chief Andrew Isaac Health Center, an outpatient facility also located at Fairbanks Memorial Hospital. TCC members are required to get preapproval before going to a private provider. But members say the protocol for emergency or after hour needs isn't as straightforward.

In one example detailed in the complaint, a TCC member was seen at the emergency room to treat a badly infected hand. The emergency doctors felt without treatment, the joints, tendons and deep tissue in his hand were at great risk and there could be "catastrophic complications." He was treated with intravenous antibiotics until the infection was well enough under control to switch to oral medication. After determining that the services received "did not require the use of an emergency room or private facility," TCC denied payment on the $446 bill.

In another example, TCC refused to pay Golden Heart $691 after it treated a man for severe chest pain, stating that the care received was available during operating hours either at the TCC health clinic or other TCC program.

"Tanana Chiefs refused to pay for services because it believed a potential heart attack was not grounds to go to the Emergency Department," the lawsuit states.

TCC has until June 24 to respond to Golden Heart's claims.

Contact Jill Burke at jill(at)alaskadispatch.com.