Healthcare company Centene was sued on Wednesday by a Connecticut medical practice for allegedly violating federal and state laws by failing to reimburse plaintiffs for COVID-19 testing costs.
In response to the coronavirus pandemic in March 2020, plaintiff Murphy Medical Associates LLC invested hundreds of thousands of dollars to set up drive- and walk-through COVID-19 testing sites throughout Connecticut and New York. In May 2020, the Murphy practice began providing COVID-19 testing and related services to members and beneficiaries of Centene administered health plans Fidelis and WellCare. However, Centene has failed to reimburse the Murphy practice for the majority of these services as required under the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act, plaintiffs alleged. As a result, the complaint claims Fidelis and WellCare owe the Murphy practice a combined $2.4 million.
“Defendants…have refused to honor federal law and, instead, have issued outright denials or infinitesimal ‘reimbursement’ of claims submitted by the Murphy Practice. The Murphy Practice has appealed every claim submitted to Fidelis and WellCare, which were summarily denied and later advised to the Murphy Practice that it has exhausted all appeal rights,” the complaint states.
Congress passed the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act in 2020, requiring all fully-insured, level-funded and self-insured health plans to cover COVID-19 tests and related services, regardless of whether they are provided by in-network or out-of-network providers. Coverage must include copayments, deductibles and coinsurance, and limits on coverage are not permitted, according to the complaint. Plaintiffs are suing for violations of both these Acts, as well as violations of the Affordable Care Act, the Employee Retirement Income Security Act, the Connecticut Unfair Insurance Practices Act and the Connecticut Unfair Trade Practices Act, unjust enrichment and breach of contract.
The complaint demands compensatory damages, declaratory and injunctive relief, punitive damages and attorney’s fees.
Plaintiffs are represented by Harris Beach PLLC.