Molina Healthcare Sued for Systemic Claims Denial

On Thursday plaintiff VitaCare Family Practice, PLLC (VitaCare) filed a complaint in the District Court of Texas, Harris County, against defendant Molina Healthcare of Texas Inc. (Molina) for breach of contract.

Per the complaint, healthcare provider VitaCare entered into a contract with insurance provider Molina effective as of January 1, 2016. The defendant publishes insurance polices and guidelines for medical providers to bill their patients for medical services. After the plaintiff provided medical services to the defendant’s patient members, the plaintiff would submit a claim to the defendant for payment. 

VitaCare claimed Molina would refuse to pay some claims completely.  Other claims would only be paid partially.  When the defendant did pay a claim, they allegedly paid it late, per the Prompt Payment of Claims Act provisions of the Texas Insurance Code.  The plaintiff also claims Molina refused to pay the interest owed on these claims.  VitaCare stated they repeatedly request payment for these claims without resolution. 

The instant action is brought for negligent misrepresentation, quantum meruit, fraud, breach of contract, civil conspiracy, promissory estoppel, and unjust enrichment, under the Insurance Code and Deceptive Trade Practices Act and TRCP.

VitaCare is seeking declaratory judgment in their favor; monetary relief between he amounts of $200,000 to $1,000,000, actual damages, exemplary damages, attorney’s fees, prejudgment interest on the actual damages, court fees, post-judgement interest at the highest legal rate, and any other fees the court sees fit.