The three Florida labs — West Palm Beach-based BioHealth Laboratories and PB Laboratories, and Riviera Beach-based Epic Reference Labs — accused Cigna of failing to pay $32 million on denied claims. Cigna had already paid the labs $37 million to cover the costs of blood and urine tests.
The labs filed a motion Jan. 14 that would require Cigna to hand over patient claims data and policies related to the denied payments, totalling to 125,000 claims. The payer is contesting the motion, saying the request is too broad.
Cigna countersued Dec. 13, and according to an amended complaint, claimed the three labs and a fourth — Tustin, Calif.-based Epinex Diagnostics Laboratories — engaged in a “fraudulent billing scheme” to “enrich themselves at the expense of Cigna and the health plans that Cigna administers.”
The countersuit alleges the labs forgave patients’ out-of-network fees, instead charging Cigna more to make up for the difference. The payer began to deny potentially-fraudulent charges related to these instances, as well as medically unnecessary services bundled under testing claims.
The payer claimed that the denied payments the labs raised concerns over were a result of these denials.
The parties filed a motion to consolidate both lawsuits Feb. 2.
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