Encompass Office Solutions, a McKinney, Texas-based company that provides equipment and personnel to physicians performing in-office procedures, has filed a lawsuit against BlueCross BlueShield of Texas for allegedly violating the Employee Retirement Income Security Act, according to a Southeast Texas Record report.
Physicians and their patients choose to use Encompass for surgeries or procedures and assign insurance rights and benefits to Encompass. BlueCross, which has been paying for Encompass' services as an out-of-network provider, accused the medical group for misrepresenting itself as an ambulatory surgery center, although Encompass claims it has made every effort to ensure insurance companies knew it was in fact not one, according to the report.
In August, Encompass received a letter from the insurance company stating that it would no longer pay anymore claims filed by Encompass. Encompass consequently filed a lawsuit against the insurer, claiming it breached ERISA by failing to reimburse Encompass for services, primarily gynecological surgeries requiring anesthesia.
BlueCross also allegedly breached its ERISA policy by using "flawed or inadequate data" to determine charges for services, which led to lower payments to Encompass. Encompass is also accusing BlueCross of various other activities, including threatening Encompass with fraud if claims for reimbursement continued to be filed and creating new policies to avoid paying for Encompass' services, according to the report.
Encompass is seeking reimbursement from BlueCross for all unpaid claim and improperly underpaid benefits as well as an award of costs, attorneys' fees and interest. Additionally, Encompass is requesting the court to state the company is not required to reimburse BlueCross, according to the report.
Read the Sourtheast Texas Record report about the Encompass lawsuit against BlueCross BlueShield.
Read other coverage about healthcare fraud:
- Maryland Cardiologist Charged with Healthcare Fraud After Allegedly Implanting Unnecessary Stents
- Former Los Angeles Hospital Executive Sentenced to Two Years in Prison for Healthcare Fraud
- Florida Surgeon, Others Plead Guilty to Involvement in $37M Medicare Fraud Scheme
Physicians and their patients choose to use Encompass for surgeries or procedures and assign insurance rights and benefits to Encompass. BlueCross, which has been paying for Encompass' services as an out-of-network provider, accused the medical group for misrepresenting itself as an ambulatory surgery center, although Encompass claims it has made every effort to ensure insurance companies knew it was in fact not one, according to the report.
In August, Encompass received a letter from the insurance company stating that it would no longer pay anymore claims filed by Encompass. Encompass consequently filed a lawsuit against the insurer, claiming it breached ERISA by failing to reimburse Encompass for services, primarily gynecological surgeries requiring anesthesia.
BlueCross also allegedly breached its ERISA policy by using "flawed or inadequate data" to determine charges for services, which led to lower payments to Encompass. Encompass is also accusing BlueCross of various other activities, including threatening Encompass with fraud if claims for reimbursement continued to be filed and creating new policies to avoid paying for Encompass' services, according to the report.
Encompass is seeking reimbursement from BlueCross for all unpaid claim and improperly underpaid benefits as well as an award of costs, attorneys' fees and interest. Additionally, Encompass is requesting the court to state the company is not required to reimburse BlueCross, according to the report.
Read the Sourtheast Texas Record report about the Encompass lawsuit against BlueCross BlueShield.
Read other coverage about healthcare fraud:
- Maryland Cardiologist Charged with Healthcare Fraud After Allegedly Implanting Unnecessary Stents
- Former Los Angeles Hospital Executive Sentenced to Two Years in Prison for Healthcare Fraud
- Florida Surgeon, Others Plead Guilty to Involvement in $37M Medicare Fraud Scheme