ERISA Court Rules against BCBS Overpayment Practice with a Permanent Injunction - ERISAclaim.com Demystifies

On March 28, 2014, a federal ERISA court ruled against BCBS overpayment practice with a permanent injunction, in a provider class-action, as “IBC's practices come nowhere near substantial compliance with ERISA”. ERISAclaim.com demystifies this final ending of the overpayment legal gray zone.

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This permanent injunction as the healthcare landmark decision will serve as a roadmap for all payers and providers in all similar overpayment disputes,” says Dr. Zhou.

Hanover Park, IL (PRWEB) April 01, 2014

On March 28, 2014, a federal ERISA court ruled against BCBS (Independence Blue Cross, IBC) overpayment practice with a permanent injunction, and ruled in favor of providers in an ERISA class-action. “The court concludes that IBC's practices come nowhere near substantial compliance with ERISA's notice and appeal requirement.” according to the court document.

ERISAclaim.com demystifies this final ending of the “legal gray zone” in the nationwide overpayment recoupment and offsetting practices by almost every insurance company and health plan, when most American workers and their families as well as their health care providers were left with no protections at all as afforded under federal law ERISA.

As the final legal chapter of this ERISA overpayment provider class-action prevailed for all working families and their health care providers, ERISAclaim.com announced new webinars and advanced ERISA claim specialist programs in order to:
(1) demystify the profound impact of this final court decision for the nation’s No. 1 health care claim denial - overpayment demand recoupment and offsetting,
(2) correctly appeal every wrongful overpayment demand and subsequent claims offsetting with valid ERISA assignment and the first ERISA permanent injunction, possibly without a need for another class-action,
(3) provide proper litigation support against all wrongful overpayment recoupment and offsetting, to seek for enforcement and compliance with ERISA & PPACA claim regulations.

ERISAclaim.com provided the plaintiff providers with ERISA appeal compliance 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: 1:09-cv-05619 Document #: 912 Filed: 03/28/14, in the United States District Court for the Northern District of Illinois Eastern Division

“The medical bills are the No. 1 cause for all personal bankruptcies in USA, the epidemic wrongful overpayment recoupment and offsetting may be the No. 1 cause of the skyrocketing medical bills. The court’s decision on Friday just gave back all working families the minimum security and protections afforded by federal law ERISA,” says Dr. Jin Zhou, a national expert in ERISA & PPACA compliance and appeals.

“Providers nationwide shall celebrate and cheer for their patients, as this might be the first time in US healthcare history when a federal ERISA court ordered for a permanent injunction against a violative insurance company or health plan,” observed by Dr. Zhou.

In a final finding of the facts and conclusion of the law in this provider ERISA class action, initially against more than 23 BCBS entities in 2009, “the Court finds in favor of PCA on its claims against IBC and concludes that PCA is entitled to an appropriate permanent injunction. Because the parties have not yet briefed the question of the precise contours the injunction should take, the Court orders further briefing in that regard … The court concludes that IBC's practices come nowhere near substantial compliance with ERISA's notice and appeal requirement.” according to the court documents.

In general, the court finds in favor of the plaintiff providers in each and every following legal position in part, according to the court documents:

A.    Whether PCA can sue under ERISA
1.    Defining "benefit" under ERISA
2.    PCA members' status as beneficiaries
    a.    Whether PCA's evidence constitutes plan documents
    b.    Whether direct payment from IBC makes PCA's members beneficiaries
c.    Whether plaintiffs' assignments from patients make PCA's members beneficiaries
B.    Adverse benefit determination
C.    Notice and appeal requirements under ERISA
D.    Permanent injunction

In particular, the court finds in favor of the plaintiff providers in the following key legal positions in part:

“Notice and appeal requirements under ERISA: For these reasons, this Court finds that the notice that IBC provides to PCA members from whom it is recouping payments does not substantially comply with ERISA.” according to the court documents.

“Permanent injunction: The evidence showed that it has been IBC's usual course of business to provide inadequate notice and appeal rights in connection with recoupments of payments from PCA's members. The injuries at issue are irreparable, and PCA's members lack an adequate remedy at law to redress them….Finally, requiring a plan administrator to afford notice and appeal rights that comply with ERISA serves the public interest in enforcing duly enacted national legislation whose purpose is to protect workers who are the direct beneficiaries of employer-provided health and welfare benefit plans.” according to the court documents.

“This permanent injunction as the healthcare landmark decision will serve as a roadmap for all payers and providers in all similar overpayment disputes,” says Dr. Zhou.

To find out more about ERISA & 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.


Contact

  • Jin Zhou
    ERISAclaim.com
    +1 630-808-7237
    Email

Attachments

PCA v BCBSA - IBC PCA v BCBSA - IBC

ERISA Permanent Injunction against BCBS - IBC