Anthem Blue Cross accused 11 Prime Healthcare hospitals of fraud in a lawsuit filed this week in a California federal court. The defendants submitted and were compensated for thousands of claims for independent dispute resolution under the No Surprises Act despite knowing they were false, the insurer alleged.
“We are holding billing companies and out-of-network providers accountable for what we believe are fraudulent and abusive practices that result in excessive health care costs, burden consumers and undermine the integrity of our health care system,” an Anthem spokesperson told Becker’s Hospital Review. “This legal action is another powerful step in our efforts to shield consumers from these harmful practices and restore trust.”
Beginning two years ago, the hospitals submitted more than 6,000 disputes that resulted in more than $15 million in improper awards, according to Anthem. Despite more than three-quarters of these claims not being eligible for the resolution process, the lawsuit said, the average award was more than six times what a contracted provider would receive from Anthem for the same service. The alleged scheme cost the insurer more than $2 million in related fees, it said.
The lawsuit further alleges that the hospitals also knowingly made false claims for disputes over services covered by the state’s Knox-Keene Act; services not covered by the patient’s health plan; disputes in which the hospitals failed to start required open negotiations; and services...
Earlier today, the New York Department of Consumer and Worker Protection issued a report claiming DoorDash is tricking consumers to reduce tips. The report gets a lot wrong. Here are the facts. My...