Dive Brief:
- A group of Indiana surgery centers have filed suit against UnitedHealthcare over a policy they say violated state and federal law by not paying for care rendered to patients, The Indiana Lawyer reported.
- A related lawsuit against UnitedHealthcare has argued over the definition of payment.
- Both lawsuits argue the insurer improperly used what it deemed as past overpayments, some of which were years old, to justify deducting those amounts from payments for current patients.
Dive Insight:
The debate is whether UnitedHealthcare was within its rights to withhold payments based on perceived prior overpayments.
“There are several legal issues with that, as you can imagine,” Ian Friedman, general counsel of SurgCenter Development, told The Indiana Lawyer. The center is suing UnitedHealthcare along with Carmel Specialty Surgery Center, Metro Specialty Surgery Center and Riverview Surgery Center. The current case is built on the recent consolidation of what were previously about two dozen lawsuits filed separately by those centers. A related lawsuit from another surgery center also may be consolidated into this case.
The lawsuits have alleged UnitedHealthcare owes hundreds of thousands to the surgery centers and their physicians for treatment of out-of-network patients with UnitedHealthcare coverage. By not paying for current patients' service, UnitedHealthcare could be leaving those patients on the hook for those bills, attorney Shannon Melton, associate general counsel for SurgCenter, argued.
The litigants described UnitedHealthcare's practice as “a cross-plan offsetting scheme” that uses money recouped from one plan to cover another, and argue the practice is barred by state and federal law.
Meanwhile, UnitedHealthcare defended the practice as “cooperative overpayment recoveries” and said it has complied with all appropriate regulations.