Over the last two months, several lawsuits over healthcare companies' billing and reimbursement practices have made headlines.
Here is a breakdown of seven of the cases:
Louisiana Municipal Risk Management Agency v. TeamHealth
The self-funded employer in Louisiana is suing Knoxville, Tenn.-based TeamHealth over what it considers inappropriate billing and "systematic overcharges." The lawsuit was filed March 21 and alleges TeamHealth deliberately upcoded claims to boost its profit. TeamHealth said it engages professional coders and the lawsuit is similar to one that was "quickly dismissed."
Cottage Health v. Kaiser Permanente
Santa Barbara, Calif.-based Cottage Health sued Oakland, Calif.-based Kaiser Permanente, alleging the insurer underpaid "on thousands of occasions," costing it "tens of millions" of dollars. Kaiser said it is confident it will prevail in the dispute over reimbursement and that it is committed to "paying fair and reasonable rates for emergency services provided to our members by non-Kaiser Permanente hospitals."
Justice Department v. Methodist Le Bonheur
The Justice Department can now intervene in a lawsuit accusing Methodist Le Bonheur of orchestrating a kickback scheme and submitting $800 million in false claims to Medicare. Methodist called the Justice Department's intervention "belated" but says the case is without merit and it will defend itself vigorously.
Lisa French v. St. Anthony North Health Campus
The Colorado Supreme Court heard oral arguments in a lawsuit in March centering on whether Lisa French, a patient who expected to pay $1,337 for a surgery, will be on the hook for more of a bill that reached $303,709. Attorneys representing Ms. French argued that a hospital representative mistakenly told her the insurance was in network and that a contract she signed saying she would be responsible for "all charges of the hospital" was ambiguous and that she should not be responsible for the disputed portion of the bill. The hospital is arguing the contract was not ambiguous and it should be reimbursed more.
Beverly Williams and Amy Johnson, et.al. v. Steward Health Care
Dallas-based Steward Health Care will face a class-action lawsuit alleging the system overbilled patients or demanded payments from third parties not responsible for the bills that resulted from treatments after a motor vehicle accident, a federal court ruled Feb. 25. Beverly Williams and Amy Johnson, the plaintiffs who brought the lawsuit, allege Steward deceptively collected "unauthorized and illegal payments" for hospital treatment related to their injuries. Steward said it "strongly disagrees with plaintiffs' contentions and believes it appropriately pursued the amounts owed."
Washington state Attorney General Bob Ferguson v. Providence
Washington state Attorney General Bob Ferguson sued Renton, Wash.-based Providence, alleging 14 of its hospitals engaged in aggressive tactics to collect payment, failed to ensure discounts for eligible low-income patients and steered poor patients to debt collectors. Providence expressed disappointment with the lawsuit but said it looks forward to defending itself in court.
George Cansler v. Vidant Health
A patient has filed a lawsuit against Greenville, N.C.-based Vidant Health, alleging the 1,477-bed system engaged in deceptive billing and debt collection practices. Specifically, Mr. Cansler alleges Vidant Health and FirstPoint "used and continue to use an unfair, deceptive scheme designed to extract undisclosed and unreasonably high prices from patients."
"The narrative presented in the press release promoting a class action lawsuit is inconsistent with Vidant Health's values as a patient-centered, mission-driven, not-for-profit organization," Vidant Health said in a statement. "Importantly, all Vidant hospitals are fully compliant with all federal pricing transparency regulations as confirmed by the North Carolina Attorney General’s Office. Vidant is confident that its policies, consistent with all state and federal rules and regulations, were appropriately followed in this instance. Vidant is committed to partnering with patients to ensure they have the support they need to successfully navigate their health care journeys. In addition to a dedicated team of case managers who help patients understand their bills, set up payment plans and provide charity care in all applicable cases, Vidant has transparent pricing resources available online for any patient or prospective patient to reference.”
Editor's note: This article was updated at 3:08 p.m. on March 24 with Vidant's comment. An earlier version stated that Vidant didn't respond.