Mass. AG Reaches $260k Settlement With Healthcare Provider Over Billing Practices

The Attorney General of Massachusetts has announced a settlement with a healthcare provider that will see the company pay $260,000 — including a civil penalty of $185,000 — after it was accused of failing to disclose to patients that it was not part of their insurance network and seeking to collect “unfairly high charges.”

The AG’s office received complaints from patients who were treated by South Shore Anesthesia Associates (SSAA) at South Shore Hospital in Boston. While the hospital was part of the patients’ insurance network, SSAA was not and the patients did not learn of this until they received a bill for the services and treatments that were performed. SSAA stopped providing clinical services last June and is in the process of closing its practice, according to the AG’s office. In fact, many of the individuals that were employed by SSAA are now working at the hospital and are part of the same insurance network.

A copy of the settlement is available by clicking here.

Along with paying the fine, SSAA has also agreed to stop collecting on any remaining balances owed by patients who were outside of their insurance network when they were treated by the practice and will forgive those balances. SSAA also agreed to not sell or transfer any of the unpaid debts to a third party. SSAA will also notify any third-party collection agencies working its accounts that the debts have been satisfied, and have the items removed from the patients’ credit reports.

Of the $260,000, $75,000 is being used to repay patients who “incurred financial harm” as a result of SSAA’s billing practices and $185,000 is a civil penalty being paid to the state.

“Massachusetts residents have a right to transparency when it comes to their health care and should not be subjected to surprise billing practices when seeking medical care,” said Maura Healey, the Attorney General of Massachusetts, in a statement. “Health care providers should take the appropriate steps to provide consumers with adequate information to allow them to make informed health care decisions and avoid unexpected charges.”

Surprise billing — which occurs when a patient is treated, usually unknowingly, by a doctor who is outside of the patient’s insurance network — has come under fire in recent years. Congress has been working, as have state legislatures, on bills that would end surprise billing.

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