In a rare case, a California judge has ordered a South Pasadena plastic surgeon to spend five days in jail and pay $562,500 in penalties for improper billing of emergency-room patients. California healthcare regulators said they sued Jeannette Martello in 2011 to stop her from illegally billing insured patients for emergency-room care. Officials said Martello collected or tried to collect more from patients beyond the discounted rates their insurance companies had already paid, a practice known as balance billing. Martello aggressively pursued payment from patients by filing numerous lawsuits and taking out liens on their homes.