Federal Court Ruled Against BCBS Overpayment Class-Action Counterclaims – PPO & Unjust Enrichment Claims Completely Preempted By ERISA

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ERISAclaim.com Webinars To Examine Federal Court Ruling Dismissing Regence BCBS Counterclaims Against Plaintiff Providers In The Largest Provider Overpayment ERISA Class Action Against 23 BCBS Entities.

"it is a trillion dollar market with little legal guidance,”

On Jan. 21, 2011, the federal northern district court of Illinois in Chicago dismissed the defendant Regence BCBS’s counterclaims for PPO contract breach and unjust enrichment on the ground of ERISA complete preemption, in the largest provider overpayment ERISA class action against 23 BCBS entities, after the federal court ruled on 05/17/2010 against BCBS’s motion to dismiss and permited providers’ ERISA class action to proceed while dismissed providers’ RICO claims. ERISAclaim.com provided the ERISA compliance assistance and support in the defendant providers’ ERISA administrative appeals and judicial litigation in this case, and is now offering free Webinars to discuss the profound impact of the court ruling in the entire overpayment recoupment market, estimated in trillions of dollars.

"After numerous recent federal court orders that federal law ERISA completely governs, preempts and limits overpayment recoveries by health plans, it is increasingly popular that health plans are asserting state law claims of healthcare fraud, unjust enrichment, or provider contract breach in recouping and withholding payments from healthcare providers. This court order is an extremely timely and important legal guidance for all parties," said Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and overpayment.

According to the court papers filed on Jan. 24, 2011, “the Court grants plaintiff Miggins and third party defendant Miggins & Miggins, Inc.'s motion to dismiss The Regence Group's counterclaim, docket no. 276. The Court also directs the Clerk to terminate the remaining motions to dismiss, all of which the Court believes it has previously ruled upon, docket nos. 259, 261 & 267 . The Regence Group is granted leave to file an amended complaint in conformity with this order on or before 2/11/11”.

The court document revealed providers’ ERISA preemption argument:

“Miggins argues that Regence’s claim is preempted by ERISA section 514(a), which provides that ERISA supersedes state laws that “relate to any employee benefit plan.” 29 U.S.C. § 1144(a). State law relates to a benefit plan if is has connection with or reference to such a plan. Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 47 (1987). This occurs in various ways, only one of which is relevant here: if the state law “provides an alternative enforcement mechanism to ERISA.” Trustees of the AFTRA Health Fund v. Biondi, 303 F.3d 765, 774 (7th Cir. 2002). That happens if the benefit plan’s existence is a critical element of a state law claim, such that the state law relies on a direct and unequivocal nexus with an ERISA plan. Id. at 778.”

The federal court's ERISA preemption legal reasoning:

“At least some parts of Regence’s claim are, in fact, preempted by ERISA. As indicated earlier, Regence relies in part on a contention that Miggins obtained payment on claims that were not covered under patient subscriber agreements. Regence does not disclose whether any of those agreements are ERISA benefit plans, but it is overwhelmingly likely that some or even most of them are. In addition, it is conceivable that other parts of Regence’s claim rely on the terms of one or more ERISA benefit plans.”

Court case info: Pa. Chiropractic Assn. vs. BCBS Assn., et al., CASE #: 1:09-cv-05619, United States District Court, Northern District of Illinois.

For a complete copy of the court order May 17, 2010:

For a complete copy of the court order Jan 21, 2011:

"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, it is a trillion dollar market with little legal guidance,” warned Dr. Zhou. “This is the largest class action seeking for judicial guidance, in addition to recent court rulings in Rhode Island federal district court.”

On Jan. 19, 2011, the federal district court in Rhode Island denied plaintiff BCBSRI's motion to reconsider its earlier ruling on federal subject matter jurisdiction and denies plaintiff's motion to certify the Court’s interlocutory order for immediate appeal to the First Circuit. On October 27, 2010 the Court ruled against BCBSRI over its recoupment practice for over $400,000 against two healthcare providers, finding that federal law ERISA pre-empts, supersedes and limits BCBSRI overpayment recoupment practice. A Preliminary Injunction Against Plaintiff BCBSRI Was Issued On 11/04/2010.

The court case info: BCBSRI v. Korsen et al, filed on 01/19/2011, 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 for reconsideration: http://www.erisaclaim.com/BCBSRI_Denied.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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