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Federal Court Ruling Deals Another Blow to Cigna?ÇÖs Attempts at Overpayment Recoupment

On March 8, 2017, the U.S. District Court for the District of Connecticut (the ?Ç£Connecticut Court?Ç¥) ruled, in Connecticut General Life Insurance Company v. True View Surgery Center One, LP, that Connecticut General Life Insurance Company (?Ç£Cigna?Ç¥) was barred from pursuing recoupment from True View and other affiliated surgery centers (collectively, the ?Ç£Surgery Centers?Ç¥) for reported overpayments attributable to the Surgery Centers?ÇÖ alleged fee-forgiving billing practices. Cigna served as a health benefits insurer and/or a third-party claims administrator for 316 health plans, 293 of which were subject to ERISA (collectively, the ?Ç£ERISA Plans?Ç¥). The Surgery Centers were out-of-network medical care providers that rendered services to participants in the ERISA Plans. With respect to the ERISA Plans, Cigna brought this case in its capacity as claims administrator and plan fiduciary of the plans, alleging that the Surgery Centers (i) lured participants to their facilities by offering services at less than normal… Continue Reading

March 2017
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