Issue link: https://beckershealthcare.uberflip.com/i/572638
91 Coding, Billing & Collections C igna Health and Life Insurance Co. filed a billing fraud suit in fed- eral court attempting to recoup millions paid to 11 Indiana-based surgical centers allegedly participating in a "fee forgiveness" model to attract Cigna's out-of-network patients, according to a Law 360 report. Here are five things to know about the suit: 1. Cigna claims the surgery centers attracted out-of-network members by re- ducing the members' copays and other fees but charging Cigna inflated prices to recoup losses, according to the report. 2. Cigna allegedly paid the 11 surgery centers more than $6.5 million in claims before realizing the centers were allegedly using the "fee-forgiving" model for out-of-network patients. 3. e insurance company stopped paying those ASCs and now requests the money be returned and an injunction against attempts at similar "fee-forgiv- ing" models in the future. 4. Cigna has gone to court in the past to stop out-of-network provid- ers from attracting patients through fee forgiveness and is currently en- gaged in a suit with Health Diagnostic Laboratory in Virginia for similar reasons. Health Diagnostic Laboratory filed a $66 million counterclaim claiming Cigna refusing to pay until after members pay out-of-pocket is illegal. 5. e American Medical Association has warned against "fee-forgiving" and some states have laws against the practice. Cigna alleges the model violates the Employee Retirement Income Security and Racketeer Influenced and Corrupt Organizations Acts. 6. e 11 surgery centers asked for more time to respond to the lawsuit in early August. e surgery centers were served the lawsuit at separate times and rep- resentatives from the centers requested an extension from the judge to respond as a group. 7. e ASCs also planned to file a motion to dismiss the lawsuit. If the request for extension is granted, the centers will have to file for a motion of dismissal by Sept. 14. n Cigna Files Multimillion-Dollar Suit Against 11 ASCs for OON Fee-Forgiveness Model: 7 Things to Know By Laura Dyrda 900 Airport Road, Ste. 3B, West Chester, PA 19380 T: 484.887.8810 F: 800.493.0966 cs@centinelspine.com www.centinelspine.com LBL124 rev 2 Centinel Spine's STALIF® family continues to lead the Integrated Interbody™ market it created over 25 years ago. 25+ YEARS OF FIRSTS 1 st Stand-Alone Integrated Interbody™ Device with FDA Allogeneic Clearance 1 st Stand-Alone Cervical Integrated Interbody™ Device with Multilevel* & Allogeneic Indication MIDLINE II ™ STALIF C® 1 st Stand-Alone Lumbar Integrated Interbody™ Device 1987 Hartshill Horseshoe 1 st US Stand-Alone Lumbar Integrated Interbody™ Device 2004 STALIF TT™ 1 st Ti-ACTIVE™ Titanium-Coated Integrated Interbody™ Device 2014 STALIF C-Ti™ 1 st US Stand-Alone Cervical Integrated Interbody™ Device 2008 STALIF C® NOW... Make STALIF® your FIRST choice for all your spinal fusion procedures. * Multilevel indicates for 1-2 contiguous levels. To learn more, please visit: CENTINELSPINE.COM CENT_BeckersASC_Ad_08-15_v2.indd 1 8/4/15 10:28 AM