Lawsuit plan accuses company that owns local hospital of fraud

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TEXARKANA, Texas – A proposed class action lawsuit pending in federal court in Texarkana accuses the company that operates Wadley Hospital and a medical billing company of violating state law and engaging in fraud in cases of injuries caused by car accidents.

The complaint was filed in July by Texarkana attorney Jim Wyly on behalf of Bowie County resident Beverly Williams. in Texarkana, Texas.

The Steward and Billing Contractor Medical Reimburses of America are named as defendants. Neither company responded to email requests for comment on Friday.

The complaint alleges that MRA, acting on Steward’s behalf, seeks to increase hospital revenues by illegally increasing auto claims payments.

According to the complaint, Williams sought treatment at Wadley after being injured on July 5, 2018 on Highway 59 in Cass County, Texas. Williams was a passenger in a car that was struck when another motorist crossed the median and collided with the car she was in.

Williams alleges that she informed Wadley staff that she has health insurance through Blue Cross Blue Shield of Texas.

“However, during the screening process, the defendants had set up their illegal system, which, after identifying the plaintiff as having been involved in a car accident, classified the defendant MRA as“ primary insurance. ”In addition, the defendants’ illegal system omitted the complainant’s health insurance plan as a source of payment, listed her as “self-paid” and further coded her financial situation as “legal,” “the complaint states.

After being treated, Williams’ bill was $ 9,750.79. The complaint alleges that this amount is greater than the total of what Blue Cross would have been required to pay under its contract with the hospital, plus the amount that Williams would have been responsible for the co-payment and deductible disbursements. The complaint alleges that MRA and Steward are guilty of charging for services at a higher price than that permitted by Williams’ coverage under its Blue Cross policy.

The complaint alleges that MRA attempted to collect $ 9,750.79 from insurance company Safeway, which insured the driver of the car that struck the car Williams was in. The letter to Safeway requests that if the company comes to a settlement with Williams, it should send $ 9,750.79 of the settlement to the hospital.

The complaint alleges that MRA’s conduct is illegal for several reasons. First, the complaint alleges that the hospital is required to bill a patient’s health insurance.

“Because she was insured and the defendants refused to bill her insurance company, the defendant’s only claim against the plaintiff was statutorily limited to her quota or deductible amounts,” says the complaint.

The complaint further alleges that MRA, a Tennessee-based company, is required, as a third-party debt collector, to post a bond with the Texas Secretary of State and that without such bond “has no right. to collect a debt in Texas ”.

The complaint alleges that after Williams’ attorney sent a letter to MRA in February 2019 directing them to bill for his health insurance, MRA responded by claiming that the medical coverage “will not be processed” if the services are rendered to following a car accident. The complaint alleges that the response amounts to a total admission of the “deceptive scheme” of falsely stating that Medicare will not cover road accidents, intentionally not billing Medicare plans and asking payment of an inflated bill by the patient or a third party.

“As of the date of filing this lawsuit, the defendants have not submitted the complainant’s medical bills for services at Wadley to her health insurance company,” the complaint states.

The complaint further alleges that Texas law requires hospitals to bill health insurance plans for services within 11 months or within a period specified in the hospital’s contract with the carrier. Because Williams’ health plan was never billed, the complaint alleges that the hospital cannot “recover from the patient any amount that the patient would not otherwise have been obligated to pay (such as a co-payment and / or a franchise) “.

The complaint alleges that the billing system is common to Steward Hospitals in Texarkana, Odessa, Big Springs, San Antonio, Houston and Port Arthur, Texas. The complaint seeks to include as plaintiffs Texas residents who were treated for auto accident-related injuries at hospitals for which health insurance was not billed and a claim for payment was filed “against the patient, the patient’s lawyer, an auto or liability insurer, and / or any third party based on the patient’s third party tort claim. “

The complaint further seeks to include residents of Texas who received treatment at a Texas hospital for injuries caused by a car accident and MRA has asserted a claim against them or against a third party.

The complaint accuses Steward and MRA of violating the Texas Finance Code, the Texas Deceptive Trade Practices Act, and of committing fraud. The lawsuit asks the court to declare that the billing practices violate Texas law, obtain an injunction terminating the conduct, return monies collected in violation of Texas law, compensate and certify as class action lawsuit.

The case is assigned to US District Judge Robert Schroeder III of the Texarkana Division of the Eastern District of Texas. None of the accused filed a response.


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