CarePoint Hospitals of New Jersey Sues Cigna for ERISA Violations

On Monday, Hudson Hospitals OPCO, LLC, IJKG PROPCO LLC, and HUMC OPCO, LLC (all formerly known as CarePoint Hospitals) filed a lawsuit against Cigna Health and Life Insurance Company and Connecticut General Life Insurance Company in the New Jersey area. , allegedly “significantly” underpaid and refused to pay hospitals as required by their insurance policies.

Between March 15, 2016 and May 31, 2021, the hospital served 10,650 patients; We either didn’t pay or underpaid for hospital services.” Employee Retirement Income Security Act (ERISA).

The hospital is said to have billed these patients $244,344,882. Plaintiffs allege that to date, Cigna has repaid only $76,155,427 of this sum. Although these patients were out of the network, plaintiffs treated them as required by the Emergency Medical and Labor Act (EMTALA), regardless of whether they were able to pay for the treatment. It relies on commercial insurers to meet their legal obligations and to pay providers timely, fair and reasonable premiums.”

Under the Affordable Care Act (ACA) and the Family First Coronavirus Response Act (FFCRA), providers like Cigna are required to cover all out-of-network fees and COVID-19 testing fees. I have. New Jersey health care law also requires insurance companies to “pay claims within 30 days of receipt of a claim if submitted electronically, or within 40 days if received non-electronically.” I oblige. As such, CarePoint Hospitals is guilty of his three breaches of ERISA, breach of contract, breach of duty of good faith and breach of fair dealing, quantum meritis a violation of the New Jersey Medical Claims Approval, Processing, and Payment Act (HCAPPA), and estoppel of promises.

Plaintiff seeks unpaid profits, a declaration that Cigna has breached its fiduciary duty under ERISA and must conduct a “full and fair review,” contractual damages, general damages, restitution, prejudgment and post-judgment interest, attorneys’ fees and costs. , and other remedies.

CarePoint Hospitals is represented by K&L Gates, LLP.

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