On Monday a case was removed from the Los Angeles County Superior Court to the Central District of California. The case was filed by Dedicated Sleep, LLC against Cigna Health and Life Insurance and its subsidiaries and regards the processing and payment of claims in a manner that the plaintiff argues was fraudulent and a breach of contract.
According to the complaint, the plaintiff is a medical group that has a contract with Cigna for the payment of claims of insureds at a particular contracted rate. The plaintiff states that despite providing the standard billing, with medical records and standard proof of service and coding, the defendants refused to pay the routine billing and has redirected all of these claims to a “special investigations unit” within Cigna which has made no payments.
The plaintiff, in the complaint, indicates that they have received no explanation as to what is being investigated or why the set of claims have been directed to this unit. They also note that it is not consistent as to which claims are directed to the unit as other claims with the exact same billing and procedures were paid within the same time period. Finally, the plaintiffs also argue that the explanations of benefits that the patients receive that indicate that the bill has gone to the unit is defamatory as it implies that the plaintiffs have done something wrong in their billing, when there is no explanation from Cigna as to why the bills are in the unit.
The plaintiffs are suing for quantum meruit, breach of contract, fraudulent misrepresentation, and declaratory relief. They are represented by Alan Nesbit. The defendants are represented by Cole Pedroza.
