The U.S. District Court for the District of New Jersey is allowing a lawsuit to proceed against Cigna that alleges the payer has illegally refused to reimburse a radiology lab for $1.5 million spent on COVID-19 testing, violating the Employee Retirement Income Security Act.
The plaintiff, Rochelle Park, N.J.-based Open MRI, claims that Cigna violated COVID-19 testing coverage requirements included in the Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security Act. Because patients received the covered services through their Cigna policies, Open MRI is suing for violating the ERISA.
The lab filed the original lawsuit and an amended complaint in 2020, but the case was dismissed in 2021 because Open MRI did not prove that patients had been assigned their rights to coverage through their health plans. A second affirmative constructive from the plaintiff submitted a revised claim for improper denial of benefits, which Cigna appealed in September. The second amendment clarified that Open MRI patients had given the provider permission to file a lawsuit on their behalf.
The judge, Kevin McNulty, wrote May 18 that though the Families First Act didn't amend the ERISA, it "is intended to work in tandem" with it.
"Cigna's quibbling with how and whether the acts can be said to be part of the ERISA status is not entirely the point," he wrote. "What matters is that these acts impose legal requirements on ERISA plans." The judge continued, saying "it is thus no great leap to find that, for an ERISA plan to accord with the statute, the COVID coverage requirement must be deemed a part of the plan."
The judge concluded that if a patient gives their provider permission to sue on their behalf, the provider can take legal action if it has not received reimbursement for COVID-19 services covered under the ERISA.