Court Rules against BCBS in Century Provider Overpayment ERISA Class Action: BCBS Violates ERISA - ERISAclaim.com Demystifies

On November 7, 2013, Federal Court rules in Summary Judgment against BCBS in an overpayment ERISA class action for certain providers: 1) providers are entitled to sue under ERISA; 2) certain BCBS entities completely violated ERISA; 3) providers are not liable to BCBS overpayment claims.

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Every healthcare provider in USA must understand and sleep on today’s federal court Summary Judgment decision in favoring plaintiff providers for all key legal points

Hanover Park, IL (PRWEB) November 08, 2013

On November 7, 2013, a Federal Court in northern district of Illinois rules in Summary Judgment against BCBS in an overpayment ERISA class action for certain plaintiff providers: 1) providers are entitled to sue under ERISA; 2) certain BCBS entities completely violated ERISA; 3) these providers are not liable to BCBS overpayment claims. The federal court summary judgment decisions were made in the wake of the court’s prior decision on May 22, 2012, denying BCBS motion to dismiss and in favoring of the provider ERISA arguments.

In compliance with this landmark court decision, ERISAclaim.com announced new webinars and advanced ERISA claim specialist programs to demystify this federal court century decision on the nation’s No. 1 health care claim denial: overpayment demand recoupment and offsetting; and how to correctly appeal every overpayment demand with valid ERISA assignment, and in complete compliance with ERISA & PPACA claim regulations.

ERISAclaim.com provided ERISA appeal compliance to the plaintiff providers and ERISA litigation support in this provider ERISA class action.

Case Info: Pennsylvania Chiropractic Association, et al. vs Blue Cross Blue Shield Association, et al., Case No.: 1:09-cv-05619, Document #: 846, Filed: 11/07/13, in the United States District Court for the Northern District of Illinois Eastern Division

“Every healthcare provider in USA must understand and not sleep on today’s federal court Summary Judgment decision in favoring plaintiff providers for all key legal points as the final words on whether BCBS or any payer may recoup or offset any money from providers without compliance with ERISA, as the overpayment recoupment demand or offset has been the No. 1 claim denial or offset in USA, which can make or break every healthcare provider or hospital,” says Dr. Jin Zhou, a national expert in ERISA & PPACA compliance and appeals.

“This federal court decision doesn’t mean that no insurance company can ask any providers for any money back as overpayment, it simply means that no insurance company can do so without compliance with ERISA, as federal law ERISA governs and regulates claim dispute for all private healthcare plans,” cautions by Dr. Zhou.

In denying motion for summary judgment for BCBS entities and granting motion for summary judgment for certain plaintiff providers, among other things, the federal court makes the following conclusion:

“Conclusion:    For the foregoing reasons, the Court grants plaintiff Reno's motion for summary judgment [docket no. 793] on the question of liability as to defendant Anthem Health Plans of Virginia, Inc. but denies the motion with regard to defendant WellPoint, Inc. The Court grants plaintiffs Barnard & Wahner's motion for summary judgment [docket no. 795] as to liability on their claim against defendant Independence Blue Cross for improper denial of benefits but denies in part plaintiffs' motion on their claim that Independence denied them the appropriate notice and appeal rights, while making findings in plaintiffs' favor on certain points pursuant to Rule 56(g). At tomorrow's status hearing, counsel should be prepared to discuss what further proceedings are required on the claims of these plaintiffs.” according to court records

In particular, the court makes the following legal reasoning and discussion in part:

Reno's summary judgment motion against Anthem and WellPoint:

“1. Standing: ……The Court concludes that Reno is a beneficiary for purposes of ERISA and thus has standing, conferred on him by section 1132, to bring his claims.” according to the court records.
“2. Denial of notice and appeal rights: ……The Court therefore concludes that Reno is entitled to summary judgment as to liability on his claim that Anthem denied him the notice and appeal rights to which he was entitled under ERISA. The only matter that remains for determination on that claim is the appropriate relief.” according to the court records.
“3. Denial of benefits: …… The Court therefore grants summary judgment to Reno against Anthem as to liability on this claim as well.” according to the court records.

Dr. Zhou further advocates for ERISA compliance by every healthcare provider to appeal every overpayment denial or offset, regardless whether a plan or provider may be right or wrong on its overpayment determination, as specifically advised by DOL, federal agency in charge of ERISA interpretation and enforcement.

DOL Tri3 Enterprises Amicus Brief, supporting plaintiff-appellant, No. 12-2308, File on 11/30/2012, In the United States Court of Appeals for the Third Circuit

“The crux of the question at issue here is not whether the plaintiff or the defendant is correct in their views of the plan terms, but whether Aetna must comply with the procedures mandated by ERISA section 503 and its accompanying regulations in rendering a determination based on a plan interpretation that is adverse to the plan participants and beneficiaries. Under the statute and regulations, the beneficiary or participant is entitled to a claims procedure that "afford[s] a reasonable opportunity . . . for a full and fair review by the appropriate named fiduciary of [a] decision denying [a] claim," ...... In either event, Tri3 is entitled to insist upon its assigned right to challenge the allegedly wrongful decision to deny benefits through a process that complies with the claims regulation.” http://www.dol.gov/sol/media/briefs/tri3-enterprises(A)-11-30-2012.htm#.UMfi5z9MHFo

To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/products.htm

Located in a Chicago suburb in Illinois, for over 14 years, 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 numerous pending national ERISA class action 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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Attachments

PCA v BCBSA  -  Summary Judgement PCA v BCBSA - ERISA Overpayment Class Action

Overpayment Landmark Decision