United Healthcare Services has sued Saratoga-based Bay Area Surgical Management and its five surgery centers, claiming the company submitted inflated and fraudulent bills, according to a San Jose Mercury News report.
The suit echoes allegations made in a $20 million suit filed earlier this year by Aetna. Aetna alleged that Bay Area Surgical Management is making millions of dollars and enriching local physicians by sidestepping state and federal laws intended to protect patients and control costs.
Bay Area Surgical Management strongly denies the allegations, saying they represent a strategy by the two insurers to force the company to sign an unprofitable contract for the surgery centers. The company said it receives a fraction of the payment that insurers pay surgery centers affiliated with large health systems.
The suit, filed in Santa Clara County Superior Court, claims that Bay Area Surgical Management and its five facilities violated California law by submitting inflated and fraudulent bills, failing to disclose waivers of patient co-pays, and creating incentives for physicians to refer payments and paying physicians "kickbacks" at above-market rates.
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The suit echoes allegations made in a $20 million suit filed earlier this year by Aetna. Aetna alleged that Bay Area Surgical Management is making millions of dollars and enriching local physicians by sidestepping state and federal laws intended to protect patients and control costs.
Bay Area Surgical Management strongly denies the allegations, saying they represent a strategy by the two insurers to force the company to sign an unprofitable contract for the surgery centers. The company said it receives a fraction of the payment that insurers pay surgery centers affiliated with large health systems.
The suit, filed in Santa Clara County Superior Court, claims that Bay Area Surgical Management and its five facilities violated California law by submitting inflated and fraudulent bills, failing to disclose waivers of patient co-pays, and creating incentives for physicians to refer payments and paying physicians "kickbacks" at above-market rates.
Related Articles on Coding, Billing & Collections:
How ASCs Can Build Process Improvement and Lean Principles Into Billing
16 Tips for Optimizing an ASC's Revenue Cycle
15 CPT and Coding Issues for Orthopedics and Spine