Molina will pay the ED staffing company $ 19 million for underpaid claims
A Texas state court judge on Thursday awarded two emergency department companies more than $ 19 million in damages from Texas’s Molina Healthcare for underpaid claims.
ACS Southwest PA Primary Care Physicians and Texas Emergency Services will receive $ 1.5 million in actual damages and $ 17.5 million in punitive damages. The Houston jury found Molina Healthcare “engaged in unfair or deceptive practices” in paying for the emergency department’s claims.
Staffing companies ’lawyer, John Zavitsanos, said this was the first trial that assessed how ACA plans would reimburse ED claims. ACS and the Emergency Services cited Molina for the first time in 2017.
During the trial, the plaintiffs asked the jury for $ 17.4 million toward off-net reimbursement for 13,600 claims underpaid by ED doctors, as well as $ 100 million in punitive damages, said Zavitsanos, Ahmad’s fellow administrator. Zavitsanos Anaipakos Alavi & Mensing PC.
Staffing companies had charged Molina of 900% of the Medicare rate for emergency department requests. Zavitsanos said the insurer has reimbursed doctors less than $ 200 in some cases for ED treatment.
Molina argued that he did not pay subject to the claims since he set his usual rate as 100% of Medicare costs with a reasonable margin after calculating the actual costs of care. Molina said he would have increased the premiums if he had paid the bills of staffing companies, which would lead consumers to abandon more expensive health coverage.
In a statement, a Molina Healthcare spokesperson said the insurer works to provide low-income members with reliable and affordable health care and pays doctors fair, regular, and affordable prices, which are online or offline.
“In this case, Molina believes the fee she paid to the plaintiff’s doctors was unfair and unfair, and it is clear that the jury rejected the plaintiff’s exorbitant claims,” the spokesman said.
“This idea that they’re going to break is just absurd,” Zavitsanos said. “It is denied by their financial documents.”
Other Texas-based groups are currently petitioning the Texas Supreme Court to reopen a lawsuit against Molina Insurance claiming the company grossly underpaid doctors, leaving them without financial resources.
“We are pleased that the jury has held Molina Healthcare responsible for its abusive reimbursement practices,” the plaintiffs said in a joint statement. “Evidence has shown that Molina, like many insurance companies in the United States, has refused to negotiate an equitable reimbursement with emergency physicians, coercively underestimating doctors and exposing its members to their balances. underpaid “.