Surgical service provider sues insurer for breach of contract

Michelle Massey Mar. 11, 2010, 3:37am

SHERMAN -- After receiving a demand to return more than $2 million received from insurance payments, Encompass Office Solutions Inc. filed a breach of contract lawsuit against Ingenix Inc., UnitedHealth Group Inc., United Healthcare Services Inc. on March 5, in the Sherman Division of the Eastern District of Texas.

Encompass Office Solutions states that it offers a safe surgical environment at a low costs by providing equipment and nurses to allow a physician to perform procedures in their own offices. Patients who have used Encompass for surgeries or procedures have directly assigned their insurance rights and benefits to Encompass.

UnitedHealthcare is questioning the charges for outpatient benign gynecological surgeries, such as hysteroscopy/biopsy or endometrial ablation.

The insurance company claims the medical group represented itself as an ambulatory surgery center. However, Encompass states it took "painstaking efforts" to ensure all insurance companies knew it was not an ambulatory center.

United is demanding that Encompass reimburse more than $2 million because it allegedly misrepresented that it was an ambulatory center.

Encompass, in the meantime, also wants UnitedHealth to stop claiming the charges are a duplicate billing of services.

According to court documents, "United claims that it has already paid for the services to the physician billing the global procedure and Encompass is not entitled to repayment for its services as well."

United has refused to pay, demanded return of money, stalled discussions and criticized the level of treatment provided by Encompass, the complaint states.

The plaintiff is represented by Dallas attorneys Greg Curry, William Banowsky and Jill Penn of the law firm Thompson and Knight LLP.

U.S. District Judge Richard A. Schell is assigned to the litigation.

Case No 4:10cv00096

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