backAIS Healthcare (AIS), through its counsel King & Spalding, secured a settlement and new network contract following a lawsuit with Blue Cross Blue Shield of Mississippi (Blue Cross) over home infusion therapy per diem billing. AIS is a leader in the healthcare industry for these services.
AIS sued Blue Cross for breach of contract for non-payment. Blue Cross counterclaimed, alleging that AIS had misrepresented its bills by including per diem charges for each day the therapy is administered via an implanted pain pump - i.e., billing code S9328. AIS showed during the course of the lawsuit that the way it bills is appropriate and industry standard for these services.
After a full investigation and evaluation of AIS billing per diems, Blue Cross, as well as the Blue Cross Blue Shield Association, both acknowledged, in a written settlement statement, there was in fact no fraud by AIS, and no finding of waste or abuse by AIS.
In agreeing to end their litigation, Blue Cross and the Association also confirmed, in the written settlement statement, that the parties have reached an agreement for Blue Cross to pay for past AIS services, and an agreement for AIS to be in-network again for the Federal Employee Benefits Program (FEP).
AIS was represented by King & Spalding healthcare and litigation partner Glenn Solomon along with trial partner Peter Strotz, who is also managing partner of the firm's Los Angeles office, and experienced healthcare counsel Jonathan Shin. Overseeing the King & Spalding legal team that handled the lawsuit and negotiations was AIS Chief Legal Officer John Finley.
See link to a full copy of the Written Settlement Statement. The lawsuit was venued in federal court in the U.S. District Court for the Southern District of Mississippi. The court entered dismissal of the lawsuit earlier this November.