Melbourne, Fla.-based Surgery Center of Viera filed a lawsuit Jan. 20 in Florida Middle District Court in Orlando against Cigna and Strategic Enterprise Solutions.
The ASC is seeking $434,000 for reimbursement of spinal surgery to treat a patient with "chronic (and progressively worsening) debilitating back pain," according to court documents. The center alleges Cigna determined the surgery medically necessary but only reimbursed about $75,000 on a billed amount of $405,373.
Surgery Center of Viera said Cigna allegedly used a "mystery re-pricing program" in calculating the reimbursement amount, rather than a previously established re-pricing contract the center says should have resulted in an 80 percent reimbursement rate, or $350,693.
The ASC also alleges Cigna shirked a legal responsibility to produce applicable records related to the reimbursement and its calculation.
If true, the center said Cigna would be on the hook for a $110 per day penalty from the federal government beginning Feb. 12, 2018, totaling $158,180 as of Jan. 20, when the lawsuit was filed.