Law360 (November 6, 2020, 10:13 PM EST) -- A Connecticut medical practice chain is seeking $9.3 million in damages from Cigna for not paying for policyholders' COVID-19 testing, alleging Friday that the insurer falsely called it a "fraudulent" practice.
Dr. Steven A.R. Murphy of Murphy Medical Associates LLC told a Connecticut federal judge that Cigna has wrongfully refused to reimburse over 4,400 of its patients, allegedly telling health plan holders that Murphy offers fraudulent testing sites and that the patients need to pay out of pocket if they go to his sites.
Murphy, who owns four health care practices, said he set up drive-thru and walk-in COVID-19 testing sites across southwestern Connecticut and the Hudson Valley in the spring. The sites have tested over 28,000 people, including 3,000 uninsured patients from March to October, he added.
The primary care doctor said Cigna has denied claims and claim appeals before his practice was able to respond with Cigna's requests for medical records. Murphy is accusing Cigna of violating the Families First Coronavirus Response Act, the Coronavirus Aid, Relief and Economic Security Act, the Affordable Care Act, and various Employee Retirement Income Security Act provisions.
"While it is virtually impossible in this polarized political environment for our federal elected officials to agree on anything, they did agree on payment for COVID-19 testing and related services," the physician said.
In the complaint, Murphy said Congress mandated plan carriers like Cigna to reimburse providers for COVID-19-related tests even if the provider is out of network. And the Affordable Care Act requires carriers to cover all emergency services, such as COVID-19 testing, without the need for prior authorization, he added.
But Cigna failed to honor its obligation, and his practice only received a "token" amount of reimbursement for the COVD-19-related services, Murphy said. The carrier engaged in "a paperwork war of attrition" by demanding hundreds of thousands of pages of documents to delay and avoid its payment obligations, he alleged.
In the complaint, the physician said he learned from patients and testing site sponsors that Cigna told them Murphy's practice is a "fraudulent enterprise," and that people are on their own for costs if they test at his sites. As a result of Cigna's malicious efforts, Murphy said, some cities and towns have refused to allow his practice to offer COVID-19 testing.
Murphy, who is also an assistant professor at New York Medical College in Valhalla, New York, said his practice "developed a comprehensive approach" to COVID-19 testing, which involves testing of other respiratory infections, offering preventative medical counseling, and scheduling further appointments and blood tests in addition to the swab testing.
The practice books virtual appointments with patients before the COVID-19 result arrives to "check on their conditions," and it asks patients to do a full blood panel test and schedule further appointments if they test positive, according to the complaint.
In the suit, Murphy said he has every reason to expect Cigna, which experienced increased yearly net income and achieved $39.2 billion in total revenue in the second quarter, to fulfill its duty to pay reimbursement.
The doctor said his practice invested hundreds of thousands of dollars to erect the testing sites, pay for staff and prepare testing supplies. Murphy is demanding a jury trial and over $9.3 million in damages, plus attorney fees.
Counsel for Murphy declined to comment, and calls to Cigna were not answered on Friday.
Murphy is represented by Roy W. Breitenbach, Barry B. Cepelewicz, and Michael J. Keane, Jr. of Garfunkel Wild PC.
Counsel information for Cigna was not immediately available.
The case is Murphy Medical Associates LLC et al. v. Cigna Health and Life Insurance Co. et al., case number 3:20-cv-01675, in the U.S. District Court for the District of Connecticut.
--Editing by Haylee Pearl.
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