A Connecticut medical practice is suing Centene for allegedly violating state and federal law by failing to reimburse it for COVID-19 testing services.
In March 2020, Murphy Medical Associates invested hundreds of thousands of dollars in drive-/walk-through COVID-19 testing sites throughout 14 communities in Connecticut and New York, including staffing. The sites provided services to over 35,000 patients, according to court documents filed April 6.
Around May 2020, Murphy began providing testing to Centene members through its health plans or its subsidiaries, Fidelis and WellCare.
To date, Murphy claims it has billed Fidelis and WellCare for a combined total of nearly $2.6 million for over 2,240 claims, but has only been reimbursed $187,029 in total from both.
Murphy says it attempted to communicate with Centene about the claims, but was "either ignored or failed to engage in a meaningful dialogue." Murphy claims that Centene continued to send denials or fractional reimbursement checks.
Through the 2020 Families First Coronavirus Response Act, Congress mandated that health plans cover and reimburse providers for conducting COVID-19 testing without cost-sharing, deductibles, copayments or coinsurance regardless of whether patients were in- or out-of-network.
The lawsuit alleges that Centene is violating FFCRA; the Coronavirus Aid, Relief and Economic Security Act; the Affordable Care Act; the Employee Retirement Income Security Act; the Connecticut Unfair Insurance Practices Act; and the Connecticut Unfair Trade Practices Act.
The plaintiffs are demanding compensatory damages for the unpaid claims, declaratory and injunctive relief, punitive damages, and attorney's fees.