Cigna Sues New Jersey's Roseland Ambulatory Surgery Center for Waiving Patient Costs
North Jersey report.
The insurer wants Roseland ASC to repay more than $6.6 million, the entire amount the center received for 1,400 claims for which the patients were allegedly not billed their share. Waiving the patient's share of treatment costs is a common practice at out-of-network surgery centers in New Jersey, because it gives patients an incentive to choose out-of-network facilities despite pressure from payors.
"There are a number of facilities and doctors in New Jersey that pursue an out-of-network business model," said Phil Mann, a Cigna spokesman. That strategy is responsible for "driving up claim costs, with significantly higher charges than those billed by in-network doctors and facilities," he said. "The waiver of cost-sharing as a routine business practice is deceptive and fraudulent. Providers who engage in this are driving higher costs for all New Jersey consumers."
According to William J. Maer, a spokesman for ASC owner and anesthesiologist Richard Lipsky, the case was filed in the midst of a settlement negotiation and was done for "strategic purposes." Mr. Maer said the surgery center demanded Cigna pay "overdue and unpaid claims" prior to the lawsuit.
Related Articles on Coding, Billing and Collections:
5 Challenges for Coding & Billing Compliance
AHA Seeks Federal Help to Stop Medicare Billing Abuse
10 Leading Payors by Dollars Collected
© Copyright ASC COMMUNICATIONS 2014. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.
New From Becker's ASC Review
6 things to know about medical coder career earning potentialRead Now
- Medicare inspections & survey readiness: Key concepts for success
- Streamlining the Life Safety Code® Survey
- International Anesthesia Research Society to issue $1.3M+ in research awards in 2015
- Top 10 common physician credentialing mistakes ASCs make
- Financial leadership playbook: The essential skills for a CFO in gastroenterology