This class action is an urgent class appeal seeking for judicial guidance for every stakeholder in a trillion dollar market with little legal guidance.
Hanover Park, IL (Vocus/PRWEB) February 02, 2011
On Jan. 24, 2011, two healthcare providers and one provider state Association filed an ERISA class-action lawsuit against UnitedHealth Group in New Jersey District Of Federal Court, alleging federal law ERISA violations in its overpayment recoupment practice and seeking, among other things, for benefits payment from recouped or withheld money and injunctive and declaratory relief for all similar situated providers and hospitals. This is the third national ERISA class-action lawsuit by healthcare providers in escalating overpayment recoupment dispute with large health insurers and plans, in addition to the similar recent lawsuits against Aetna (ANJC v. Aetna) and 23 BCBS Entities (PCA v. BCBSA et al), with initial favorable court rulings for providers. ERISAclaim.com provided the ERISA compliance assistance and support in the plaintiff providers’ ERISA administrative appeals and judicial litigation in these cases, and now offers free Webinars to discuss the profound impact in the entire overpayment recoupment market, estimated in trillions of dollars.
"With skyrocketing overpayment recoupment crisis faced by all healthcare providers and hospitals, this class action is an urgent class appeal seeking for judicial guidance for every stakeholder in a trillion dollar market with little legal guidance, when health-care overpayment recoupment market is estimated to be from billions to trillions of dollars, considering U.S. annual healthcare expenditure in about $2.6 trillion and denied healthcare claims as well as the number of 3 to 5 years subject to overpayment scrutiny,” said Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and overpayment.
"After numerous recent federal court orders, in BCBS overpayment class-action lawsuits, that federal law ERISA completely governs, preempts and limits state law overpayment recoveries by health plans, it is vital and prudent for all parties to act in accordance with judicial clarification and guidance," added Dr. Zhou.
According to the court papers filed on Jan. 24, 2011, in United States District Court, District Of New Jersey, Case 2:11-cv-00425-FSH –PS:
The plaintiffs are: PREMIER HEALTH CENTER, P.C., and JUDSON G. SPRANDEL, II, D.C., on their own behalf and on behalf of all others similarly situated, and the OHIO STATE CHIROPRACTIC ASSOCIATION, in a representational capacity on behalf of its members;
The defendants are: UNITEDHEALTH GROUP, UNITED HEALTHCARE SERVICES, INC., HEALTH NET OF THE NORTHEAST, INC., and HEALTH NET OF NEW YORK, INC.,
The allegations are:
COUNT I - CLAIM FOR BENEFITS UNDER GROUP PLANS GOVERNED BY ERISA (on behalf of Plaintiffs and the ERISA Class)
COUNT II - FAILURE TO PROVIDE FULL AND FAIR REVIEWAS REQUIRED BY ERISA (on behalf of Plaintiffs and the ERISA Class)
COUNT III - EQUITABLE RELIEF UNDER ERISA
The Plaintiffs demand judgment in their favor against Defendants as follows:
A. Certifying the Class, as set forth in this Complaint, and appointing the Individual Plaintiffs as Class representatives.
B. Declaring that United has breached the terms of its EOCs and SPDs and awarding unpaid benefits to the Individual Plaintiffs and the members of the Class, as well as awarding injunctive and declaratory relief to prevent United’s continuing actions detailed herein that are undisclosed and unauthorized by EOCs and SPDs;
C. Declaring that United failed to provide a “full and fair review” to the Individual Plaintiffs and ERISA Class members under 29 U.S.C. § 1133, and awarding injunctive, declaratory and other equitable relief to ensure compliance with ERISA and its regulations;
D. Declaring that United violated its disclosure and related obligations under ERISA and federal common law, for which all Plaintiffs and ERISA Class members are entitled to injunctive, declaratory and other equitable relief;
E. Declaring that United violated federal claims procedures, and awarding declaratory and injunctive relief to remedy such violations;
F. Ordering United to recalculate and issue unpaid benefits to Providers that were unpaid or underpaid as a result of United’s actions, as detailed herein, with interest;
G. Enjoining United from continuing to pursue their recoupment efforts as detailed herein, and ordering them to pay proper benefits in the form of a return of any sums previously paid by or withheld from the Individual Plaintiffs and other Class members in response to United’s recoupment efforts;
H. Awarding Plaintiffs disbursements and expenses of this action, including reasonable counsel fees, in amounts to be determined by the Court;
I. Awarding interest from the date of initial benefit reductions for the Individual Plaintiffs and members of the Class for all improperly billed amounts; and
J. Granting such other and further relief as is just and proper.
For a complete copy of the court document filed on Jan 24, 2011:
For news coverage on similar ERISA class actions against BCBS and Aetna:
Located in a Chicago suburb in Illinois, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers. For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.