A British insurance underwriters group claims that Navicent Health stonewalled their investigation into a Medicare and Medicaid fraud complaint.
They don't want to pay $2.5 million to the U.S. Department of Justice on behalf of the hospital.
A London-based group of investors, identified as Lloyd's of London Syndicate Nos. 2623 and 623, filed the lawsuit last week in U.S. District Court in Macon.
Under their coverage policy with Navicent, the group agreed to compensate the hospital for any major losses.
But the agreement also says they have the right to work with Navicent to investigate and defend claims and take part in any settlement talks, the lawsuit says.
The Lloyd's group claims Navicent has violated their agreement and last year's settlement never should have happened.
FEDS ACCUSED NAVICENT OF BOGUS BILLING
Last year, the federal government said Navicent billed the federal government for millions of dollars in ambulance transports that were inflated or medically unnecessary.
A whistle-blower's complaint claimed that Navicent managers directed paramedics and EMTs to alter reports so that the hospital could bill the federal government for emergency transports.
The Department of Justice notified the hospital in March 2016 that it was investigating the matter.
But the underwriters' group claims that, for months, Navicent failed to provide their documents and reports on the case, despite several requests.
Without that information, they said, the Lloyd's group couldn't decide whether the federal claim was "reasonable and appropriate."
Among other things, the lawsuit says, the underwriters wanted to know when the bogus billing began and how long Navicent managers knew about it.
Last June, the lawsuit says, they sent Navicent's brokers a draft letter denying the coverage for the claim, "based on Navicent's breach of its duty to cooperate."
The Lloyd's group says Navicent reached its agreement with the Department of Justice without giving them a chance to approve or disapprove.
The U.S. Attorney's office announced the $2.5 million settlement last August. Under the settlement, the whistleblower, former ambulance driver Andre Valentine, would receive more than $140,000 of that.
UNDERWRITERS SAY THEY'RE NOT RESPONSIBLE
The underwriters' lawsuit asks a jury to rule that they should not be obligated to cover the claim because the hospital violated their agreement.
They also argue that they're not obliged to cover the $2.5 million because it involves Navicent returning an overpayment. That's not an insurance loss covered by their contract, the group claims.
The group also wants to be reimbursed by Navicent for damages and costs.
They are asking for a jury trial in Macon's U.S. District Court.
We reached to Navicent, the Macon and to the Lloyd's group's lawyers to find out if Navicent actually paid the $2.5 million settlement yet.
None have returned our messages.
No trial date has been set.
MORE THAN $24 MILLION IN FEDERAL SETTLEMENTS
Last year's settlement marked at least the third time in less than three years that Navicent has paid settlements to the federal government. Those settlements total more than $24 million.
In April 2015, Navicent paid $20 million to settle a dispute over Medicare billing. The hospital said the government accused them of submitting claims for short-term inpatient admissions that should have been billed as outpatient care.
In October 2015, they paid $1.6 million after a federal complaint said Navicent put dozens of cardiac devices in people, and that those procedures violated Medicare rules. That was part of a national settlement involving about 500 hospitals.
