The lawsuit, filed in federal court, names Wellpoint Texas, formerly known as Amerigroup Texas, as the primary defendant. IntegraNet Health Network and independent physician association Van Lang are also named in the suit for their alleged role in the disputed claims.
Harris Health, which operates Ben Taub Hospital and LBJ Hospital, alleges the defendants delayed payments, underpaid claims, or refused to pay for medical services provided to thousands of Medicare patients under a 2004 agreement for in-network care.
According to court filings, Harris Health began noticing a pattern of delayed payments and denials in 2020. The hospital system alleges that Wellpoint continued to receive fixed Medicare payments from the federal government for those patients while shifting unreimbursed costs onto county taxpayers.
In the lawsuit, Harris Health claims the defendants "have unjustifiably delayed payment, refused to pay, or underpaid Harris Health, causing Harris Health injury and damages."
Attorney Jonathan Wu of The Weaver Law Firm, who is not involved in the case, told ABC13 that disputes between healthcare providers and insurers are common.
"They are always at odds because healthcare insurance companies are looking at it like, 'I want to make sure they're not billing for services that were never provided, overbilling, or using incorrect coding for billing,'" Wu said.
Wu said both parties have a financial incentive to resolve the dispute and added that patients should not expect disruptions to their healthcare coverage or treatment while the case proceeds.
"Even if it turns out one side wins, or the other side wins, it's not going to affect any current enrollees because it's all about services that are already provided," Wu said. "That doesn't change Harris Health's obligation to see people whether they're insured or not."
The other defendants named in the lawsuit declined to comment, citing ongoing litigation.