The lawsuit involved reimbursement that Horizon paid and then recouped from the surgery centers for spinal manipulation under anesthesia. The surgery centers argued that Horizon altered its reimbursement policy without notice and without an opportunity for the surgery centers to object. The alteration was made nearly two years after payment was received.
The centers stipulated in the lawsuit that they sought protection from further reimbursement recoupment from Horizon and that the prior recoupments were fraudulent.
The appeals court found that the surgery centers did not show sufficient need for protection against further payment recoveries by the insurer. The appeals court also ruled that Horizon’s actions were not “at the level of the criminal activity.” The lawsuit will be sent back to trial court for further hearings.
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