Bellaire, Texas-based Harris Health System filed a lawsuit against Elevance’s Wellpoint Texas, formerly Amerigroup Texas, due to alleged payment failures for Medicare Advantage beneficiaries, according to a March complaint.
Harris Health began flagging payment delays in 2020. Following an escalation in 2021, the complaint said Wellpoint Texas wanted to update the parties’ agreement, “replacing it with an entirely new contract.” When Harris Health declined, Wellpoint said their contract would end in March 2022, but members continued to show up for care after. Wellpoint underpaid or did not pay for these services.
“In effect, Amerigroup is pocketing the federal funds it receives for enrolling Medicare Advantage beneficiaries while shifting the cost of providing their medical care to Harris Health and, ultimately, the residents and taxpayers of Harris County,” the lawsuit said. Harris Health said thousands of claims were involved and millions of dollars were at stake.
The lawsuit also took aim at third parties IntegraNet Health and Van Lang IPA.
Harris Health’s allegations include breach of contract, unjust enrichment and negligent misrepresentation. The system asked for damages determined at trial, interest and other fees and costs.
Wellpoint is having the case moved from a state district court in Harris County to federal court this month.
Wellpoint Texas told Becker’s it does not comment on ongoing litigation.
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