HDL labs is being accused of fraud to the tune of $84 million dollars by Cigna healthcare.
Healthcare fraud comes with a hefty bill for any healthcare organisation but lets get some nice excerpts out of the article, “HDL sued for $84 million, accused of fraud” by Burl Rolett for RichmondBizSense.com.
Cigna, a Connecticut-based insurer, claims HDL extracted more than $84 million in fraudulent payments in what it alleges as scheme that involved waiving out-of-pocket fees for patients and then billing inflated rates to the insurance company. “HDL has developed a business model designed to game the healthcare system by submitting grossly inflated, phantom charges to Cigna that do not reflect the actual amount HDL bills patients,” the suit reads. “The effect of HDL’s scheme is to deceive health benefit plans into paying far more for services than the plans are obligated to pay.” Cigna filed the case in federal court in Connecticut on Oct. 15, after what it called an independent investigation of HDL’s dealing with Cigna customers. The company claims it sent out questionnaires to members who had used HDL’s services and received 27 responses. The lawsuit claims that HDL advertised its services as free to patients and did not bill any of those 27 Cigna members. Cigna claims it wasn’t aware of the cost waive to patients until after it launched its investigation. “Cigna was only able to confirm HDL’s fraudulent billing practices through a special investigation of HDL, after which Cigna began reducing or denying payment for its claims submitted by HDL,” the suit reads. Because HDL is outside of Cigna’s network, the suit claims, patients should have to pitch in for their services. That’s a vital part of the insurance pool process that incentivizes customers to seek in-network healthcare, it argues. The suit accuses HDL of a “fraudulent ‘fee forgiving’ scheme” that undermines the insurance system by unfairly promising free services to out-of-network patients. Cigna further argues that “fee forgiving” is a recognized variety of medical billing fraud. Cigna alleges that by not billing the customer for its service, HDL drove patient demand for its product at the expense of the insurance company. The suit, which was first reported by The Richmond Times-Dispatch, makes claims under eight counts, including unjust enrichment, fraud and negligent misrepresentation. In addition to seeking reimbursement for the alleged fraudulent charges, Cigna asked the court to prevent HDL from making similar charges going forward. Cigna seeks the return of all of $84 million it claims to have paid HDL as well as exemplary and punitive damages, court costs and attorneys’ fees. Cigna is also going after healthcare firms Texas Spine and Joint Hospital and a group of about 20 Maryland surgery centers for alleged fee forgiving campaigns, according to lawsuits filed in federal district courts for those two states. Cigna cited internal investigations in their complaints in each of those cases as well.
From our standpoint we see that the threat is real to clinics and healthcare organisations that regularly waive fees or have unspoken dual fee schedules are in the cross hairs of insurance companies to get their payments back. That is why we are free for every patient. Our service allows you to legally discount for your cash patients and other protections to your office. Patient Options is here for you at any time.
Information contained in this article is from RichmondBizSense.com contributed by Burl Rolett. Original article here.