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Underpaid ASCs File Lawsuit

Mon, 05/10/2010 - 7:22am

A recently filed class action complaint against United Health and other health care plan administrators has been filed on behalf of Ambulatory Surgery Centers (ASCs) across the country, citing that these ASCs have been underpaid by millions of dollars.

The suit centers on improper calculations that have produced low reimbursement amounts for ASCs, effectively leaving patients on the hook for larger amounts than they should owe, argue attorneys from Hooper, Lundy & Bookman.

The firm states that United often did not use the Ingenix database at all for ASC claims, even when representing that Ingenix had been used. Instead, United simply used its in-network or Medicare rates as a baseline, coupled with what appears to be an arbitrary multiplier, when paying out-of-network claims to ASCs.

In court hearings since that class action complaint filing, United also has asserted that it cannot be sued for ERISA violations committed by its plan clients, as it allegedly is not the formal plan or plan administrator, but merely the claims processor for plan clients. In other words, United has said that the firm must sue United's clients.

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