Thomas Breen photo
Testing at Murphy’s former Day Street Park site.
A pandemic-era folk hero who dares to challenge the “illegal and irresponsible” actions of an insurance giant?
Or an “opportunistic medical provider who followed the old adage of never letting a crisis go to waste”?
Those divergent takes on Greenwich-based Dr. Steven Murphy emerge in competing legal briefs newly filed in the ongoing case Murphy Medical Associates LLC v. Cigna Health and Life Insurance Company.
That’s the federal lawsuit filed in the U.S. District Court of Connecticut last November in which a handful of companies controlled by the Fairfield County medical provider allege that the international insurance behemoth cheated him out of reimbursements to the tune of $4.6 million.
How so?
Because Cigna allegedly hasn’t covered the cost of thousands of Covid-19 tests that Murphy’s companies billed them for at upwards of $2,000 a pop. (Click here, here, and here for previous Independent coverage about Murphy’s local testing woes. Similar patient complaints about exorbitant bills sent to insurance providers also made their way last year into the New York Times and the Stamford Advocate.)
A flurry of recent federal court filings in the ongoing lawsuit show Murphy’s companies playing the role of the aggrieved, going after Cigna in what they portray as a noble crusade against a greedy corporate behemoth flouting federal law.
Lawyers for Cigna, meanwhile, painted the Greenwich-based doctor as a pandemic “profiteer” looking for any excuse he can find to cash in on a crisis.
Murphy: Cigna Acts “Above The Law”
Zoom
Dr. Murphy, speaking at virtual city presser in April 2020.
In an amended complaint filed by Murphy’s companies on March 24 and in a May 7 response to Cigna’s motion to dismiss the case, Murphy’s Stamford-based attorneys, John Martin and Michael Keane, argue that the doctor is only going after reimbursements mandated by the federal government.
They write that Murphy was an early “pioneer” in the effort to set up mass, accessible Covid-testing at the onset of the pandemic. His companies ultimately ran testing sites in Greenwich, Stamford, New Canaan, Darien, Fairfield, Bridgeport, New Haven, West Haven, Stratford, and Ridgefield, Connecticut, and Bedford, Brooklyn, and Pound Ridge, N.Y., according to the May 7 filing.
The lawyers also write that Murphy realized early on through research and personal experience that “solely performing a COVID-19 test failed to adhere to the requisite standard of care. To properly treat a patient, other diagnostic testing was required. Patients who presented with symptoms of COVID-19 or who potentially have exposure to COVID-19 need to be tested for COVID-19 and other respiratory viruses and infections that could cause the same or similar symptoms as COVID-19.”
So the clinic obtained a BioFire Frim Array System and started testing walk-up and drive-through patients for Covid. And for “other respiratory viruses” too.
From March 1, 2020 through Dec. 31, 2020, they wrote on May 7, Murphy’s clinics “engaged in over 75,000 encounters with patients and collectively tested and provided medical treatment and care to over 35,000 of those patients. To date, the Murphy Practice has provided COVID-19 testing to approximately 3,000 uninsured patients, without any cost to the patients.”
The problem, those attorneys claim, is that Cigna has refused to cover the costs of such tests performed by Murphy’s clinics on its insurance plan members. And it stonewalled Murphy’s clinics when they’ve tried to find a solution so they can get paid.
“Although a few payments have been made, as of now, the amount owed to the Murphy Practice for this testing totals more than $4 million dollars,” Murphy’s attorneys wrote on May 7. “Cigna has denied reimbursement for COVID-19 testing and testing-related services for thousands of Cigna members or beneficiaries. Cigna has, however, issued hundreds if not thousands of bad faith demands for patients’ entire medical records, doing in virtually every case where the Murphy Practice has sought reimbursement for statutorily covered COVID-19 testing.”
Cigna must pay Murphy’s clinics for the costs of these tests, the lawyers claim, thanks to the federal Families First Coronavirus Response Act (“FFCRA”) and the CARES Act, which require all health insurance plans to cover Covid-19 testing with no out of pocket expenses to patients.
“The Murphy Practice brings this action to hold Cigna responsible for their not only illegal and irresponsible response to the pandemic and to federal efforts to combat it, but for the sheer arrogance of their assertion that Cigna is above the law.”
In the May 7 filing, Murphy’s clinics’ attorneys state that the $4 million-plus owed in reimbursements stem from more than 4,000 Covid-related tests performed on roughly 2,600 Cigna members.
Cigna: Murphy “Exploits National Health Emergency For Profit”
Thomas Breen photo
A sign at Murphy’s former Day Street testing site.
In an April 16 motion to dismiss the lawsuit and in a June 1 filing in support of that motion to dismiss, Cigna’s lawyers take umbrage with Murphy’s clinics’ claims that the insurance giant is the one in the wrong.
It is Murphy’s clinics that are billing too much for tests unrelated to Covid-19, they claim. It is Murphy’s clinics that have, according to the April 16 motion, concocted “an elaborate business enterprise to exploit a national health emergency for profit.”
Cigna’s Hartford-based attorneys — Patrick Begos, Theodore Tucci, and Jean Tomasco — put their case as bluntly in the June 1 filing.
“This case amounts to nothing more than an out-of-network provider’s strained attempt to create a novel independent legal right to obtain payment from Cigna of their exorbitant charges for a battery of unnecessary laboratory tests and services on people who simply wanted to know whether they had COVID.”
The insurance companies’ lawyers argue that the federal Covid-era legislation cited by Murphy’s clinics’ lawyers is designed to protect Americans from the medical, economic, and national security perils of Covid-19, “not (as Plaintiffs baldly assert) to benefit providers by creating new payment rights in place of existing federal or state remedies.”
They argue that the federal Covid legislation clearly does not prohibit insurance companies from ensuring “proper billing for plan benefits and to detect and prevent fraud.”
In fact, they continue, “federal regulators were concerned about the unintended byproduct of the Coronavirus Legislation that this lawsuit presents: the emergency of profiteering providers.” Therefore, regulatory guidance makes clear that in administering claims for Covid testing, health plans “may continue to employ programs designed to detect and address fraud and abuse.”
Which, they argue, is exactly what Cigna is trying to do in thoroughly investigating and at times denying claims submitted by Murphy’s clinics.
A Feb. 12 filing in the case, meanwhile, indicates that this is not the first time that Murphy and Cigna have butted heads around allegations of fraud.
“Cigna had terminated Steven Murphy from its provider network in June 2019,” Cigna’s attorneys wrote, “following investigation of misrepresentation of services.”
“NO COST TO PATIENTS”
In the May 7 filing in opposition to Cigna’s motion to dismiss, Murphy’s clinics’ attorneys also argue that the Fairfield County doctor is in compliance with federal law requiring Covid testing providers to post publicly about how much a test costs. Below is the section of Murphy’s clinic’s website—coronatestct.com—which describes how much a test costs.
The below text, reproduced in full, appears on the site under the headline: “NO COST TO PATIENTS.”
For the COVID-only tests we send to our lab partners, we may bill your insurance company between approximately $200 and $600.
For the BioFire panel tests for 21 respiratory pathogens, including COVID-19, we will bill your insurance $1,500 for running this panel.
For COVID Antibodies bloodwork (depending on your symptoms and medical history), we may bill your insurance between approximately $150 to $2,300.
For telemedicine follow-up (depending on your symptoms and medical conditions), we may bill your insurance between approximately $200 to $480.
You will not be billed for any of these costs regardless of which lab is used to process your test.
Both federal and state laws have mandated insurance companies to pay for COVID Testing and treatment at 100% of the insurances’ contracted rate. Murphy Medical will bill your insurance company for testing and our services.
In medical billing, insurance companies reimburse medical providers for the testing at a rate the insurance company determines, not the price a medical provider bills.
You may get a letter from your insurance company called an Explanation of Benefits or EOB. This letter is to advise you that your insurance company has received a bill from us for the testing services provided.
Even if the EOB says you owe a portion of the bill, under federal and state law, you do not owe anything for COVID testing. You will never receive a bill from Murphy Medical Associates for COVID testing and care and treatment. We will not turn you away, and we will never seek reimbursement from you for the medical services and care provided.