MultiCare Health System, a hospital and health care system based in Tacoma, Wash., is suing Optum and Change Healthcare over an alleged $1.2 million in outstanding claims. Change Healthcare "consistently failed to provide the required coding and billing services" for MultiCare's anesthesia operations at its Capital Medical Center in Olympia, Wash., according to the lawsuit.
The lawsuit was filed in King County Superior Court in December but late last month was removed to the U.S. District Court for the Western District of Washington.
"Like many other health systems, clinics and providers, MultiCare contracted with Change -- now owned by Optum -- to assist with billing and reimbursement," the lawsuit said. "Change provides revenue and payment-cycle management services, effectively serving as an intermediary between MultiCare and its patients' insurers and other payors. MultiCare would provide billing information to Change, which would in turn liaise with insurers to secure reimbursement for MultiCare's services. Change would take a percentage of payors' reimbursements to MultiCare for the services rendered as payment for this assistance. But Change repeatedly dropped the ball."
In late 2023, MultiCare began contacting Change with concerns about the timeliness and accuracy of its billing services. By early 2024, according to the company, Change allegedly failed to timely submit or process about $1.6 million in claims. Half of these claims no longer could be recovered because they had passed their submission or payment windows.
"Although MultiCare received repeated assurances from Change that these issues would be addressed, this did not occur," the lawsuit said. MultiCare is seeking a minimum $1.2 million judgment against Optum and Change.
The "defendants do not admit any of the allegations in MultiCare's complaint and do not concede that MultiCare is entitled to any relief," attorneys for Optum and Change said in their notice of removal to federal court.
MultiCare operates more than 300 primary, urgent, pediatric and specialty care locations, as well as 13 hospitals, in Washington, Idaho and Oregon. Earlier this week, it agreed to pay $3.7 million to settle allegations that it knowingly endangered patient safety and falsely and fraudulently billed Medicare, Medicaid and other federal health care programs for unnecessary spinal surgery procedures.
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