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Hands Off, Cigna: Mahendru, PC Files Suit to Stop Cigna’s Demand for a $3 Million COVID-Care Clawback

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Insurance company accused of attempting to bilk clinic to recoup COVID expenses 

Mahendru, PC recently filed a lawsuit against Cigna Healthcare of Texas, alleging that Cigna is trying to strong-arm its client, Genesis Medical Group, into paying back more than $3 million that Genesis received for testing and treating patients exposed to COVID.  

According to the lawsuit, Genesis – a group medical practice – provided vital diagnostic COVID testing services to several large Houston employers that continued in-office operations throughout the COVID pandemic. The filing says Genesis’s timely and efficient testing of exposed and symptomatic employees helped stem the spread of COVID.  

But now, Cigna has privately demanded Genesis repay more than $3 million it received for this testing and treatment, claiming, among other things, that Genesis was not entitled to payment because Genesis failed to establish that there was a COVID “outbreak” that necessitated testing in the first place. 

Cigna also demanded Genesis repay funds because it used cutting-edge COVID testing technology that, in Cigna’s view, should have resulted in lower reimbursement. Cigna also disputed the billing codes Genesis used. In response, Genesis says Cigna’s allegations are directly contrary to federal and state government guidance, which urged health care providers to enact aggressive COVID testing protocols to combat the spread of COVID.  

“With the COVID pandemic waning, it looks like insurance companies are now targeting the heroic healthcare providers who navigated the nation through perhaps the worst pandemic in recent history,” said Ashish Mahendru of Mahendru, PC, who represents Genesis. “These providers battled through layoffs, furloughs, salary cuts, and the constant threat of exposure to test and treat COVID patients and did so under rapidly evolving guidance from the government and from insurance companies.” 

“It’s a slap in the face for Cigna to accuse Genesis of unfairly profiting off the pandemic,” said Mr. Mahendru. “While health care providers like Genesis were furloughing employees and cutting salaries to survive, Cigna was posting enormous multibillion-dollar profits. And with the pandemic’s pressure easing, Cigna is looking to pad those profits a little more.” 

The lawsuit seeks a judicial declaration that Genesis provided COVID-related medical services in accordance with then-existing Cigna government guidance and Cigna policies, and further seeks a declaration Cigna waited too long under Texas law to seek repayment from Genesis. Genesis also is seeking attorney’s fees.  

The case is David P. Ellent, P.L.L.C., d/b/a Genesis Medical Group v. Cigna Healthcare of Texas, Inc., Cause No. 22-08-11287, before the 457th District Court of Montgomery County, Texas. 

Mahendru PC is a boutique commercial litigation firm whose attorneys are known for their tenacity, intelligence, and experience. Founded in 2001, the firm has a simple philosophy: Your problem is our problem. We adopt it, understand it, and solve it. Our objective is to resolve every case in the best, fastest, and most cost-efficient manner possible. We never wait for our opponent’s next move, which means we spend a lot of time at the courthouse and are well-known there. 

To learn more, visit http://www.thelitigationgroup.com.