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Labs Accused of Fraud by UnitedHealthcare Fight Back With Countersuit

NEW YORK (360Dx) – A group of Texas labs sued by UnitedHealthcare earlier this year have fired back with a countersuit, alleging that the insurer's fraud suit against the labs is an attempt to recoup $100 million in claims already paid, and avoid paying $36 million in claims that have been disregarded by the insurer since the summer of 2016.

The countersuit — by Next Health and subsidiaries United Toxicology, Medicus Laboratories, US Toxicology, and American Laboratories — was filed Thursday in US District Court for the Northern District of Texas, Dallas division.

In an emailed statement, UnitedHealthcare called the countersuit "false and ethically improper."

"UnitedHealthcare stands behind the lawsuit filed earlier this year, and we will continue to take action regarding inappropriate and potentially fraudulent laboratory practices," the insurer said.

The countersuit is in response to a lawsuit filed by UnitedHealthcare in January alleging Next Health and its subsidiary labs paid bribes and kickbacks to physicians and other referral sources who ordered tests from the labs. The UnitedHealthcare suit also alleged Next Health and its affiliated labs performed and billed for tests that were not ordered by physicians and improperly billed for services that they did not perform.

One of the codefendants in UnitedHealthcare's original lawsuit, Erik Bugen, a former independent contractor for a Next Health subsidiary, was charged in July by the US Attorney's office with one felony count of submitting false and fraudulent claims for healthcare benefits.

Next Health and its subsidiaries allege that UnitedHealthcare is attempting to use litigation as a "bullying" tactic to force the labs out of business. In their countersuit, the labs are seeking lost profits, contractual damages, compensatory damages, restitution for reimbursements improperly withheld, attorney fees, and other compensation.