Questionable lab billing practices threatens the health of the Prague Hospital. Blue Cross Blue Shield dropped the hospital and three others in Oklahoma out of network over the billing issues. Now, two lawsuits have been filed, one alleging illegal activity.
Earlier this year, a CBS News investigation uncovered questionable lab billing practices by Empower group and owner Joe Perez. The investigation revealed Perez and his labs in Florida made millions by billing lab tests through smaller rural hospitals that insurance companies reimburse at dramatically higher rates.
Perez also has an ownership share in the Prague Hospital and three other Oklahoma hospitals. In February, Blue Cross Blue Shield of Oklahoma said they were dropping coverage of the hospitals because of the billing practices.
Now a lawsuit filed by the hospital’s original owners against Perez and co-owners Health Acquisition Company, alleges they used the Oklahoma Hospitals in an "illegal billing scheme" and some samples were never even sent to the labs.
HAC filed its own lawsuit and spokesperson Michael Murtha told News 9, creating an outreach lab in rural hospitals is a legal business model used to keep rural hospitals open.
Last year, as the hospital was negotiating a contract with Blue Cross Blue Shield, hospital officials told News 9 they were concerned that without a deal with BCBSOK they may have to close.
Today, Murtha said the hospital is staying open.
Blue Cross Blue Shield says their members represent three percent of their total volume at the Prague Hospital. And although one lawsuit calls for the end of the lab billing practices, Blue Cross Blue Shield says it's “difficult to speculate if they would contract with the hospital again since they have been out of network for nearly six months.”
Blue Cross Blue Shield still has doctors in-network at the hospital, they just don’t cover hospital and lab costs.