AT ISSUE Is UnitedHealthcare's approach a "scheme" or a case of "cooperative recoveries"?

Numerous Indiana surgery centers are suing UnitedHealthcare, accusing the insurance giant of illegally refusing to pay hundreds of thousands of dollars in current claims as a way of recouping what UnitedHealthcare maintains were overpayments it made in previous years, according to news reports.

Nearly 2 dozen suits have been consolidated into one, with the centers saying that UnitedHealthcare's "cross-plan offsetting scheme" violates state and federal laws, while UnitedHealthcare maintains that its "cooperative overpayment recoveries" are proper and legal.

The surgery centers allege breach of contract on both old and current patient claims, unjust enrichment and violation of an Indiana law that limits adjustment claims for overpayments to 2 years. No insurance contracts authorized "such a scheme," according to the suit.

UnitedHealthcare says it undertook the "additional efforts … to recoup the payments," after its request for return of overpayments was denied.

But a lawyer for the surgery centers counters that UnitedHealthcare violated appeal rights under state and federal law by providing "no opportunity to challenge an overpayment that allegedly occurred."

He adds that because UnitedHealthcare hasn't paid current claims, patients could be on the hook for the cost of their services.

Jim Burger