Conspiracy lawsuit seeks more than $500K in reimbursement for medications

By John Suayan | Apr 18, 2019

PITTSBURGH – Elite Care RX has filed a conspiracy lawsuit against several entities, alleging it has not received payment for certain prescriptions.

In the 17-page suit filed in the Court of Common Pleas of Allegheny County, Elite Care states that it served as a bill payer for the quintet of defendants, but has not received payment for medical prescriptions where “(it) has acted as the agent of the Licensed Health Care Providers.”

The defendants are Premier Comp Solutions, LLC; Laundry Owners’ Mutual Liability Insurance Association; UPMC Benefit Management Services, Inc., doing business as UPMC Work Partners; Lackawanna Casualty Co.; and BrickStreet Mutual Insurance Co.

“There is no dispute that each insured’s injured employee has received his or her prescriptions in the claims pertinent to this case,” the lawsuit says. 

“However, these Defendants have refused to pay the bills for these prescriptions, and are thus purposefully and wrongfully receiving the financial benefit of not paying for the medications that have been provided to their insureds’ injured employees, and for which payment is due and owed.”

The suit countered the respondents’ allegations that they are not required to pay “because the billing entity (Elite Care) was allegedly not a Health Care Provider as defined by the Pennsylvania Worker’s Compensation Act.”

“The Defendants have represented they are concerned that if they pay Elite Care, some other unidentified entity may also request payment in the future, resulting in the defendants being double-billed,” court papers said.

Elite Care asserts that the defendants “have yet to provide a single example related to (it) where this has taken place, or even a concrete example of where this could occur.”

According to the plaintiff, it has attempted to satisfy the respondents’ concerns.

The defendants face several counts, including, but not limited to: fraud, civil conspiracy, and unjust enrichment.

Elite Care seeks more than $500,000 in damages. It is represented by Aaron H. Weiss with the law firm Zimmer Kunz, PLLC, of Pittsburgh.

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