Florida health system sues Department of Bill Sharing for non-payment information

Diving Brief:

  • Orlando Health, a system of 16 hospitals working in central Florida, filed a lawsuit against Liberty HealthShare, accusing the faith-based cost-sharing group of failing to pay medical providers offered to its members.
  • The lawsuit, filed Thursday in U.S. District Court in Orlando, alleges that Liberty notified the hospital system in August 2021 that it owed approximately $1.1 million for a “large block of claims,” ​​but that it then failed to provide information that would allow Orlando Health to confirm the excellent account balances.
  • Orlando Health accuses Liberty, which also operates as Gospel Light Mennonite Church Medical Aid Plan, of asking patients not to disclose the group as an outside funding source in an effort to ‘illegitimately secure’ the charity rate “reduced for medical care”. Services, pursuant to the grievance.

Overview of the dive:

Shared Health Care Ministries are faith-based organizations that have recently been recognized as a less expensive alternative to health insurance. Prior to the repeal of the Affordable Care Act’s insurance mandate, HCSM members were also exempt from the uncovered tax penalty.

But cost-sharing claims, which raise funds from members, are generally not subject to the minimum protection requirements and other necessities that apply to insurers below the ACA. HCSMs have caught the attention of state regulators who have raised concerns that some organizations might mislead customers into believing that protection is provided for claims.

California Attorney General Rob Bonta sued Atlanta-based Aliera Companies in January, accusing the company of defrauding customers by promoting health plans not authorized by Sharity Ministries and raising dozens millions of dollars in monthly premiums while declining. pay members’ medical expenses. Sharity Ministries filed for a Security Chapter in 2021.

In its grievance against Liberty HealthShare, Orlando Health said it received a letter from Liberty in August 2021 stating that the HCSM owed the hospital system approximately $1.1 million. But Liberty offered no affected person names, procedures, vendors, dates, account numbers or other information to substantiate the claims, and it did not respond to a later request from the Hospital System for a list of accounts to confirm. excellent account balances.

Liberty said the discrepancies with the claims relate to the band’s 90-day availability window, “when health insurance is primary,” and that lifestyle situations and “other moral choices that are outside the values ​​and beliefs of our program”, according to it goes well with.

Orlando Health said it was not aware of any Liberty member patients and even that the HCSM owed it money when it received the August 2021 letter, but later realized that Liberty ordered patients to “intentionally withhold information” from the hospital operator. Orlando Health said there were no reports of patients recognizing Liberty as an outside source of funding for medical costs during the patient intake and registration process.

The hospital system asked the court for a full account of all the medical providers it provided to Liberty members and the discrepancies mentioned in the group’s letter, as well as all amounts owed for the care it provided to those members. patients.

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