HOUSTON – Two health care facilities working with health insurance provider Cigna are asking a Texas court to dismiss the insurer's claim that it is entitled to around $8 million in the form of alleged overpayments to the defendants’ ambulatory surgical centers.
Elite Center for Minimally Invasive Surgery LLC, Houston Metro Ortho and Spine Surgery Center and Elite Ambulatory Surgery Centers filed a motion for partial summary judgment April 23 in the Houston Division of the Southern District of Texas.
Cigna Health and Life Insurance Co.'s Employee Retirement Income Security Act (ERISA) claim has resulted in over a year of discovery, and the defendants contend that there has been no support found for Cigna's claim.
“Cigna’s plan interpretation is legally incorrect and cannot be enforced under ERISA § 502(a)(3), ” the motion states.
Counsel for the defendants maintains that no further discovery will support Cigna's efforts to secure the contested money.
“The evidence developed during discovery shows Cigna cannot come forward with any evidence to support either equitable theory of recovery Cigna pleaded,” the motion states. “Defendants are therefore entitled to judgment as a matter of law on Cigna’s ERISA claims.”
In further arguing for the defendants, the defendants cited the “inscrutable language” of Cigna’s overpayment provision and the difficulty of attaching it to relevant case law.
Defendants' counsel also cited the difference between Cigna's rights to collect funds from a plan member versus the company’s rights to recover overpayments from a provider and used extensive expression of party responsibilities and powers to argue against Cigna's ability to collect.
The motion also shows differing court opinions on elements of the case, including equitable lien.
“At the motion to dismiss stage, courts have split on whether the overpayment provision facially creates an equitable lien by agreement,” the motion states, suggesting that court gave Cigna an opportunity to show that an equitable lien applies.
The defendants' motion states courts that allowed Cigna's equitable lien by agreement claim to progress past the pleading stage did not have access to Cigna's agreement.