Health plans face suits challenging collection of "overpayments"

Litigation against UnitedHealth Group, Aetna and 23 Blues plans could affect physicians who are subject to the same kind of recoupments.

By — Posted March 4, 2011

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Three class-action lawsuits fighting health plans' efforts to collect so-called overpayments on behalf of self-insured companies are pending in federal court, including one against UnitedHealth Group.

The lawsuits could have implications for physicians who are the target of the same kind of collections, even though the plaintiffs are chiropractors.

The most recent suit was filed Jan. 24 in U.S. District Court in New Jersey on behalf of two Ohio chiropractic clinics and the Ohio State Chiropractic Assn. The Council of State Chiropractic Assns. joined the lawsuit against UnitedHealth as plaintiffs Feb. 8.

The lawsuit against UnitedHealth also names Health Net of the Northeast, which UnitedHealth acquired in December 2009, as a defendant.

UnitedHealth has not filed a response to the lawsuit, but company spokeswoman Cheryl Randolph said in a statement, "We believe this claim is without merit and intend to defend ourselves vigorously."

The plaintiffs' law firm, New York City-based Pomerantz, Haudek Grossman & Gross, filed similar lawsuits against 23 Blues plans and Aetna on behalf of chiropractors in 2009. Both of those cases are pending in federal court. The plaintiffs are seeking class-action status in all three cases.

Aetna said at the time the lawsuit was filed against it that the company "takes seriously our obligations to our employer customers and members to identify health care fraud and seek payment from those who abuse the health care payment system."

At issue in all three lawsuits is whether insurers can collect alleged overpayments on behalf of self-insured employers and, if they do, whether they may lump similar claims together or give a chiropractor or physician a chance to appeal each instance.

In general, when a company covers the cost of employees' medical bills rather than paying a premium to a health plan and having it pay the bills, the federal Employee Retirement Income Security Act governs that benefit plan, preempting most state regulations.

The plaintiffs in these cases argue that where ERISA applies, administrators can't dock unrelated claims in a process called "offsetting" and must give the chiropractor or practitioner an opportunity to appeal each alleged overpayment.

D. Brian Hufford, an attorney with Pomerantz, Haudek Grossman & Gross representing the chiropractor plaintiffs, said insurers have been subjecting physicians to the same overpayment recoupments.

"We think this action will benefit all health care providers," he said.

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