HOUSTON – A state court of appeals has upheld the ruling of a trial court in a legal dispute between insurance companies and off-site emergency rooms.
The Court of Appeals for the 1st District of Texas stated in its Nov. 29 decision that the 269th District Court of Harris County did not err in its decision to grant summary judgment to the defendants.
“Because United did not file suit within four years of being put on inquiry notice, or even four years plus a tolling period for possible fraudulent concealment through First Hospital’s letters written between June and September 2014, the defendants were entitled to summary judgment on limitations grounds. The trial court did not err in granting summary judgment on that basis,” Justice Harvey Brown wrote in the court decision.
The lawsuit was the result of insurance companies trying to recoup facility fees they paid out to customers who were billed medical fees because they attended an emergency room.
According to the court opinion, plaintiffs United Healthcare Services, United Healthcare Insurance Co., et al. argued they were “defrauded into paying facility fees
to entities not entitled to receive them.”
However, the defendants First Street Hospital, First Surgical Partners, et al. claimed they were entitled to the money for two reasons: "that the Insurance Code defines ‘emergency care’ to include health care services at a ‘comparable emergency facility,’ which the off-site ERs claim to be;" and that a Department of Insurance letter issued in January 2008, which was used by insurers to avoid paying facility fees to off-site emergency centers, had no legal effect, the ruling states.
“United contends that the trial court erred by granting summary judgment, including on limitations and federal preemption grounds. The defendants raise several cross-appellate issues as well. Because the statutes of limitations bar United’s claims, we affirm without reaching the cross-appellate issues,” Brown wrote.
“We conclude that the submission of bills under an earlier-represented claim of a legal right to recover facility-fee payments did not create separate fraud claims and had no effect on the accrual of United’s fraud cause of action,” he added.