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$9.5 Million Settlement Victory for ASCs Approved by Court in Class Action  Filed by HLB 
May 17, 2016

On behalf of out-of-network California Ambulatory Surgery Centers (ASCs), Hooper, Lundy and Bookman, PC, (HLB) is pleased to announce that the court has given final approval for a $9.5 million settlement with United Health Services, ending a class action that was filed over six years ago.

The class of approximately 270 California ASCs alleged that United Healthcare and a number of its corporate subsidiaries, including Optum, Inc. (formerly known as Ingenix) improperly calculated the reasonable and customary amounts for out-of-network ASCs, which resulted in underpayments in the millions of dollars.  Some of the ASCs participating in the settlement will receive payments in excess of $400,000.

“This is an important victory for out-of-network surgery centers,” said lead attorney, Daron Tooch. “We are pleased that the court has approved a settlement that will adequately compensate California surgery centers whose claims were underpaid.  We would particularly like to thank our class representatives, Downey Surgical Clinic and Tarzana Surgery Center, for their patience, persistence and willingness to stand up for their rights in this litigation.”

ASCs are health care facilities that provide surgical procedures such as orthopedic surgery, podiatry, endoscopy, and ophthalmology in an outpatient setting.  Where such ASCs are out-of-network with an insurer, they are commonly entitled to be paid based a reasonable and customary amount.  This case challenged the defendants’ calculations of those reasonable and customary amounts under employer-provided healthcare benefit plans and health insurance policies that are governed by the Employee Retirement Income Security Act (ERISA). 

For more information about this case, the settlement or related issues, please contact Daron Tooch, Glenn Solomon or Eric Chan  (310.551.8111)– who formed the team of attorneys representing the providers.

For media inquiries, please contact Barrett McBride at bmcbride@health-law.com or 916.456.5855.