Federal Court Ruled Against BCBS in Providers Counter-Lawsuit for ERISA Violations in its Recoupment Practice

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ERISAclaim.com Offers Webinars to Examine the Federal Court Ruling on Feb. 16, 2010 that Denied BCBSRI’s Motion to Dismiss Two Providers’ Counterclaim Against BCBSRI for ERISA Violation when BCBSRI Initially Sued Two Providers to Recoup the Alleged Overpayment

The court ruling on Feb. 16, 2011 will have profound impact on all other pending ERISA provider class actions.

On Feb. 16, 2011, the federal district court in Rhode Island denied plaintiff BCBSRI's motion to dismiss two providers’ counter-lawsuit “alleging that Plaintiff's conduct constitutes a violation of ERISA, 29 U.S.C. §§ 1132 and 1133,” after BCBSRI initially sued the two providers to recoup alleged overpayment. In its Motion, plaintiff BCBSR argued that “The Defendants have not alleged that they are plan participants, beneficiaries, fiduciaries, or that they have any other status that would grant them standing to sue under ERISA”, and BCBSRI requested “Honorable Court dismiss the Defendants’ counterclaims for failure to state a claim upon which relief can be granted.” This is the fourth time that federal court ruled against BCBSRI in this high profile overpayment litigation. The court ruling on Feb. 16, 2011 will have profound impact on all other pending ERISA provider class actions, and each provider’s ERISA rights to counter sue if the federal law ERISA is violated in any overpayment practice.

ERISAclaim.com provided the ERISA compliance assistance and support in the defendant providers’ ERISA administrative appeals and judicial litigation in this case, and now offers free Webinars to discuss the profound impact of the court ruling in the entire overpayment recoupment market, estimated in trillions of dollars, and how to comply with federal law ERISA when any alleged overpayment claims are in dispute.

"It is extremely important for the federal court to clarify whether a provider will have any federal ERISA rights or a health plan will have any ERISA duties and obligations in an overpayment dispute, and exactly what laws govern the skyrocketing overpayment recoupment crisis faced by all healthcare providers and hospitals. Today’s judicial guidance is critical and timely 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.

“With this ERISA standing to sue or counter sue, a provider will have at least 180 days to appeal any ERISA denials and overpayment demand, be entitled to have a copy of the plan Summary Plan Description (SPD) and all relevant claims and review documents, and right to a full and fair review by plan fiduciary under federal law, ERISA,” added Dr. Zhou.

On July 17, 2009, Blue Cross Blue Shield of Rhode Island commenced an overpayment lawsuit against two healthcare providers in the Superior Court of State of Rhode Island. "Blue Cross alleges that Defendants purposely miscoded services which resulted in Blue Cross paying them over $412,952.93 for services that were not covered by "the applicable BCBSRI subscriber contracts.” “Blue Cross stated its conclusion that the miscoding was an "intentional misrepresentation” and demanded repayment of $412,952.93”. BCBSRI, among other things, also alleged: “Count I alleges that Defendants breached their Provider Agreements, by submitting claims for unauthorized services, and, in the case of Defendant Korsen, by terminating the Provider Agreement without proper notice to Blue Cross. Count II is for fraud based on false and fraudulent claims submitted by Defendants for compensation.” “Defendants removed the case to this Court arguing that Blue Cross' state law claims for breach of contract and fraud (Counts I and II) are completely preempted by the Employee Retirement Income Security Act ("ERISA").” The court case info: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND v. JAY S. KORSEN and IAN D. BARLOW, Case#: 1:09-cv-00317-L-LDA, UNITED STATES DISTRICT COURT FOR THE DISTRICT OF RHODE ISLAND

On October 27, 2010, a Federal district court ruled against BCBS of Rhode Island, finding that ERISA “completely preempts,” supersedes and limits BCBSRI overpayment recoupment practices. On Nov. 04, 2010 a Preliminary Injunction against BCBSRI was issued by the court to force it to halt its ongoing recoupment of new benefit payments. On Jan. 19, 2011, the court reaffirmed this decision, in denying BCBSRI’s motion to reconsider its earlier ruling on federal subject matter jurisdiction and denying its parallel motion to certify the Court’s interlocutory order for immediate appeal to the First Circuit. The court case info: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND v. JAY S. KORSEN and IAN D. BARLOW, Case#: 1:09-cv-00317-L-LDA, UNITED STATES DISTRICT COURT FOR THE DISTRICT OF RHODE ISLAND

For a complete copy of the court’s order denied BCBSRI motion to dismiss providers’ counterclaims: http://www.erisaclaim.com/BCBSRI_Denied4.pdf

For a complete copy of the court’s order denied BCBSRI motion for reconsideration: http://www.erisaclaim.com/BCBSRI_Denied.pdf

For a complete copy of the court preliminary injunction: http://www.erisaclaim.com/BCBSRI_Injunction.pdf

For a complete copy of the court BCBSRI decision: http://www.erisaclaim.com/BCBSRI_V_Korsen.pdf

For registration and scheduling info of the free webinar: http://www.erisaclaim.com/Free_ERISA_Webnars.htm

For more information on how to become an ERISA-PPACA & ERISA Claims Specialist under new and existing federal appeals regulations: http://www.erisaclaim.com/certification.htm

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.

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