Indiana surgery centers sue UnitedHealthcare over offsetting scheme

Three Indiana surgical centers have accused UnitedHealthcare of violating state and federal laws by deducting old overpayments from new bills submitted for patient services, according to the Indiana Business Journal.

Nearly two dozen claims filed by SurgCenter Development on behalf of three surgical clinics were consolidated into one earlier this month. The providers claim UnitedHealthcare recouped alleged overpayments from patient bills, occasionally subtracting overpayments associated with one plan from a patient's bill on a different plan.

In some cases, the recoupments totaled tens of thousands of dollars. For example, Carmel Specialty Surgery Center cites one instance in which United declined to pay the balance of a patient's bill because the insurer claimed it overpaid nearly $40,000 on 16 claims more than two years ago.

SurgCenter's attorneys call it a "cross-plan offsetting scheme" and argues the providers had no recourse to contest the overpayments, according to the IBJ. United labels the approach "cooperative overpayment recoveries," and contends it has not broken any state or federal laws.

 Although the Centers for Medicare & Medicaid Services announced new rules requiring providers to return overpayments within 60 days, private insurers don't have the same recourse. Last year, United paid $11.5 million to settle allegations that the insurer programmed its software to down-code claims, penalizing doctors with treatment costs that weren't within a certain range, and in 2012, physician groups sued Aetna for allegedly terminating physicians who referred patients outside of the insurer's network.

To learn more:
- read the Indiana Business Journal article

Related Articles:
Docs claim Aetna booted them from network in retaliation for lawsuit
Hospital group sues Aetna for allegedly denying out-of-network access
UnitedHealth agrees to $11.5M settlement over claims payment
CMS clarifies 60-day rule, lookback period for overpayments

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