Company stops tapping physicians for "overpayments"

Doctors protested self-insured Georgia-Pacific's attempt to collect refunds of suspected claims upcoding.

By — Posted May 11, 2009

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Following an outcry from physicians and discussions with the Medical Assn. of Georgia, one of Atlanta's largest employers has temporarily halted work by a company it hired to seek supposed overpayments from doctors.

Earlier this year, Georgia-Pacific authorized Franklin, Tenn.-based Health Research Insights to send 1,100 letters to doctors in Atlanta, Savannah, Ga., and Brunswick, Ga., on what it called a "pilot basis" to solicit repayment for medical claims the company believes were overpaid.

Georgia-Pacific, a self-insured company, had been considering expanding the effort across all of its employee locations. But in late April, it pulled back.

"We instructed HRI to temporarily halt the pilot project while we gather data, review HRI's processes and practices, and review concerns raised by MAG," Georgia-Pacific spokeswoman Sheila Weidman said.

Donald Palmisano Jr., general counsel for the Medical Assn. of Georgia, said the organization had been "in discussions with Georgia-Pacific." He added, "We appreciate that they have agreed to halt their collection efforts."

Doctors in Tennessee have also received letters from HRI, and Palmisano said "there's evidence HRI is working in other states."

The Indiana State Medical Assn. was notified earlier this year that HRI was planning to contact physicians there, but medical society spokeswoman Adele Lash said nothing had materialized.

According to its own description on its Web site, the company does not examine medical records in making the allegations, only claims data. HRI claims to run an algorithm that identifies aberrant coding where upcoding is likely to have occurred.

The letters sent doctors in Georgia demanded payment or medical records proving that coding was appropriate.

Health plans that accept risk on behalf of employers, collecting premiums and paying claims for employees' care, are regulated by state law. Many states, including Georgia, impose a statute of limitations on overpayment collections.

In contrast, self-insured plans like Georgia-Pacific's are generally governed by federal ERISA law. The Employee Retirement Income Security Act regulates both pensions and health plans, and does not explicitly limit overpayment collections, though it also does not explicitly allow ERISA plans an unlimited amount of time to go back and collect from doctors.

HRI Chief Executive Officer Theodore Perry, PhD, did not respond to phone messages seeking comment for this article.

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