Associate Alison Andersen Comments on ERISA Violation by Major Health Care Insurer
Arent Fox Complex Litigation associate Alison Lima Andersen spoke with Medical Practice Compliance after physicians won a big victory in their fight against private payers’ demands to return overpayments and unilateral offsets of the funds from a physician’s subsequent claims.
The publication reported that, “an Illinois federal court ruled in March in a class action lawsuit brought by the Pennsylvania Chiropractic Association (PCA) that Blue Cross Blue Shield Association and its affiliates violated the Employee Retirement Income Security Act (ERISA) when it recouped an alleged overpayment from an in-network provider without informing the provider why and how to appeal. The judge found that the payers’ actions ‘come nowhere near substantial compliance with ERISA’s notice and appeal requirements.’”
Ms. Andersen noted that while Blue Cross had established its own procedures for recovering overpayments, it did not provide those required by ERISA, which is common among payers. She also pointed out that while physicians may not ultimately be able to keep overpaid funds, the ruling gives them the opportunity to defend themselves and show that payments were made correctly.