A lawsuit against a Medicare Advantage plan contractor over payment denials has been dismissed by a federal court.
The U.S. District Court for the Eastern District of Missouri handed down the ruling Monday against Physicians Home Health Infusion PC, a home health care provider based in Columbia, MO. It had filed suit against private insurance company UnitedHealthcare of the Midwest, Bloomberg Law reported.
United Healthcare is approved by the Centers for Medicare & Medicaid Services to provide Medicare Advantage plans.
The provider alleged that the insurance company “does not consistently approve” its claims for reimbursement of pain management services, court documents stated. They also accused the insurance company of breach of contract, negligent misrepresentation and unjust enrichment and sought reimbursements for its services and denied claims.
The court, however, argued that the provider’s claims fall under the Medicare Act and that the plaintiff did not exhaust all administrative remedies before filing the lawsuit and granted the insurance company’s motion to dismiss.
“Based on the factual allegations in PHHI’s first amended complaint, the court concludes the administrative exhaustion prerequisite to judicial review cannot be waived,” Magistrate Judge Patricia Cohen wrote.
