COUNCIL SUES BC BS FOR ABUSIVE BEHAVIOR
New York, NY (September 11, 2009) The NY Chiropractic Council (the Council)
as well as the Pennsylvania Chiropractic Association (PCA), the Association of
New Jersey Chiropractors (ANJC), fourteen individual chiropractors and one
occupational therapist, located around the country, have sued as the class
representatives of the putative class.
Pomerantz Haudek Grossman & Gross LLP and co-counsel Buttaci & Leardi, LLC,
have filed a class action lawsuit against the Blue Cross Blue Shield
Association (BCBSA) and a number of state BCBS entities. The suit alleges that
BCBSA and its entities violate the Employee Retirement Income Security Act of
1974 ERISA.The suit challenges the Defendants abusive practices in using
post-payment audits and reviews, and improper repayment demands, to pressure
providers to repay substantial sums that have previously properly been paid as
health insurance benefits for services provided to BCBS subscribers.
The action alleges that the post-payment audit and review process as applied
by the various named BCBS Entities violates the Employee Retirement Income
Security Act of 1974 (ERISA), in that its repayment demands are retroactive
determinations that particular services are not covered under the terms of the
BCBS health care plans, but without proper appeal or other protections
otherwise available under ERISA for both self-funded and fully insured health
care plans offered through private employers. The complaint further alleges
that the post-payment audit and review process, as well as the forced
withholds of unrelated benefit payments to offset alleged prior overpayments,
violate the Racketeer Influenced and Corrupt Organizations Act (RICO).
The PCA, the Council and the ANJC are participating in the action in an
associational capacity on behalf of their members. Dr. John LaMonica,
Insurance Chair of the Council adds that this action is an important step by
the chiropractic profession to fight back against the egregious actions being
taken by BCBS against our members. The Council and the ANJC had previously
joined in a class action recently filed against Aetna, Inc. for similar
post-payment audit practices. Dr. Glenn Scarpelli, Council President notes,
that solidarity in cause and purpose will ultimately lead us forward, we felt
that as an organization representing doctors in New YorkState with a common
vision to serve that this action as well as our recent action against Aetna
had to occur for a better future.
In the complaint, plaintiffs allege that, as a means to maximize its profits,
the BCBS Entities are using its post-payment audit and review process to make
retroactive adverse benefit determinations whereby they demand that providers
repay funds they had previously received for providing services to BCBS
subscribers. In essence, says plaintiffs counsel Dr. Brian Hufford of
Pomerantz Haudek, the BCBS Entities are alleging overpayments and then just
taking the money from the providers, without valid due process protections. We
believe this is a blatant violation of law.
Pomerantz Haudek, which has offices in New York, Chicago, Washington, D.C.,
Columbus, Ohio and the San FranciscoBay area, is acknowledged as one of the
premier plaintiff class action firms misconduct.
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