Jackson Jambalaya

 An FBI raid always gets attention and Wednesday's raid on Advanced Infusion Systems facitilies in Ridgeland and Chunky were no exception.  The Fibbies are as tight-lipped as usual so it will probably be awhile before more is known about the raids.  However, two federal court cases might - repeat, might - provide some clues. 

Randy Denning sued AIS in Louisiana.  The company filled his prescription for medication administered through a pain pump.  She discovered in 2021 that "AIS was billing her insurer at a rate of $120 per day for allegedly unauthorized services."  

The court fight wound up at the Fifth Circuit Court of Appeals.  The Court ruled the unauthorized billings were indeed a breach of contract but Denning lacked standing to sue AIS as she was not the injured party.   Case closed.  

Blue Cross/Blue Shield and AIS went to war in federal court in Mississippi.  AIS sued the insurer for failure to pay claims.  Blue Cross counterclaimed, accusing AIS of committing insurance fraud by allegedly including per diem charges for each day medication is administered through a pain pump.  However, AIS argued the practice is an industry standard.  The two sides skirmished for a while before settling the case and issuing a joint statement: 

Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company ("BCBSMS") and the Blue Cross Blue Shield Association ("BCBSA") have evaluated the billings by Bond Pharmacy dba AIS Healthcare ("AIS") that included per diems, and have now concluded, after further evaluation that all of AIS' bills to BCBSMS, including without limitation AIS' bills using HCPCS Code S9328 for per diems, did not constitute fraud, and made no finding of waste or abuse.

AIS, BCBSMS, BCBSA, and Advanced Health Systems, Inc. ("AHS") have settled all disputes arising out of, relating to, or concerning the claims and issues asserted by the parties to the legal proceedings in the lawsuit known as Bond Pharmacy d/b/a Advanced Infusion Solutions v. Advanced Health Systems, Inc. and Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company, United States District Court for the Southern District of Mississippi, Civil Action No. 3:21-cv-123-KHJ-MTP. The settlement includes an arm's length negotiated resolution on mutually acceptable terms by which a confidential amount will be paid to AIS for past services.

There will be a new participation agreement going forward between AIS and BCBSMS that will allow enrollees of the Federal Employee Health Benefits Plan ("FEP") co-administered by BCBSA and its licensee Blue Cross and Blue Shield companies to receive services from AIS as a participating provider for FEP. The settlement does not require an admission of wrongdoing by anyone. The rest of the terms of the settlement are confidential except that (a) AIS can provide this Written Settlement Statement to anyone, and (b) BCBSMS, BCBSA and AHS will and hereby do confirm the authenticity and accuracy of this Settlement Statement. The parties to the confidential settlement agreement have approved this Settlement Statement.

Agreed on October 14, 2022 between Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company, the Blue Cross Blue Shield Association, and Bond Pharmacy dba AIS Healthcare.

U.S. District Judge Kristi Johnson dismissed the case in November.