Channel Sponsor - Coding/Billing/Collections

Sponsored by National Medical Billing Services | info@nationalASCbilling.com | (636) 273-6711

Indiana surgery centers file lawsuits against UnitedHealthcare for overpayments — 6 things to know

Various Indiana surgery centers are filing lawsuits against UnitedHealthcare for allegedly failing to pay for services the center's physicians rendered to patients, thereby violating state and federal law, according to Indiana Business Journal.

Here are six things to know:

1. In the suit, the surgery centers claim UnitedHealthcare deducted what the payer considered past overpayments from current patients' bills. The centers filed nearly two dozen suits against UnitedHealthcare, which were consolidated earlier this month before Judge Jane Magnus-Stinson in the U.S. Court for the Southern District of Indiana.

2. On behalf of Carmel (Ind.) Specialty Surgery Center, Jefferson-based Metro Specialty Surgery Center and Rockport-based Riverview Surgery Center, Pismo Beach, Calif.,-based SurgCenter Development sued UnitedHealthcare. Munster (Ind.) Specialty Surgery Center also filed a suit against the payer which may be consolidated into this litigation.

3. SurgCenter's associate general counsel said the suits allege UnitedHealthcare owes the surgery centers and their physicians hundreds of thousands of dollars. The physicians treated out-of-network patients, which UnitedHealthcare insurance plans covered, according to the suit.

4. UnitedHealthcare maintains it complied with all the appropriate state and ERISA laws and regulations, and utilized "cooperative overpayment recoveries."

5. In one of the dozen pending litigation suits, Carmel Specialty Surgery Center LLC, et al. v. United Healthcare Services Inc., UnitedHealth alleged it overpaid the surgery center $39,663.94 for 16 covered patients' services more than two years ago, and thus did not pay anything on the patient's current bill. Carmel Specialty Surgery Center alleges UnitedHealthcare used a cross-plan offsetting scheme to recoup alleged, prior overpayments. The payer countered it requested overpayments' return from the Carmel Specialty Surgery Center, but the center denied the overpayment.

6. In a complaint, Metro Specialty Surgery Center alleges the payer recouped payments from new bills based on 24 previous claims UnitedHealthcare says were overpaid by $95,759.11. Similarly, Riverview alleges UnitedHealthcare took recoupments on new bills of $66,225.48 for 29 claims the payer claimed were overpaid years earlier.

More healthcare news:
7 key findings on physicians not understanding medical test & procedure costs
Donald Trump, GOP agree ACA issue to emerge before 2016 presidential elections — 5 takeaways
Payer losses may double on ACA exchange in 2015, but market may remain viable — 5 things to know

© Copyright ASC COMMUNICATIONS 2019. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Top 40 Articles from the Past 6 Months