OSCA Leads the Nation With ERISA UHC Class Action and PPACA Compliance for Patient Protection



COLUMBUS, OH–(Marketwire – 03/18/11) – On March 16, 2011, Ohio State Chiropractic Association (OSCA) announced that it was sponsoring the second PPACA Claims Regulations Claims Specialist training in an effort to meet a July 01, 2011 deadline for full enforcement of the Federal Health Reform Law, Patient Protection and Affordability Care Act (PPACA). PPACA is the new Federal Patient’s Bill of Right, for almost all non-Medicare and non-Medicaid health claims and OSCA believes that it is critically important for health care providers as well as their patients to understand what is involved in this important new legislation. Earlier this year, on Jan. 24, 2011, OSCA and Dr. Judson G. Sprandel, II, D.C., past president of OSCA, filed a class action lawsuit against UnitedHealth group for the alleged violation of the Employee Retirement Income Security Act of 1974 (“ERISA”), arising from its post-payment audit and stethoscopeandflagrecoupment practices. The OSCA’s Board of Directors unanimously (19 – 0) voted to file this suit in early January. That decision was driven from a commit to protect the rights of its members and the insured they treat through use of ERISA, the federal statute governing most private employer benefit plans. On Feb. 8, 2011, the Congress of Chiropractic State Associations (“COCSA”) announced that it had voted to join OSCA in pursuing the ERISA Class Action on behalf of providers nationwide. COCSA represents chiropractic member associations in in all 50 states. The American Medical Association described the pending class action in its member publication on March 4, 2011, stating that “the lawsuits could have implications for physicians who are the target of the same kind of collections, even though the plaintiffs are chiropractors.” Through the ERISA class action against United and the PPACA Claims Appeal Compliance training OSCA is leading the nation in advocating for appropriate patient care and against abusive insurance practice.

The Second OSCA PPACA / ERISA Claims Specialists training will be held on April 28, 2011 in Columbus, OH for its PPACA / ERISA Committee Members. Once the eight module trainings are completed the OSCA will begin training all members and providers in the State. OSCA finished its first session in PPACA / ERISA training on March 3, 2011.

The OSCA’s ERISA class action was originally filed on Jan. 24, 2011, in the United States District Court, District of New Jersey, Case 2:11-cv-00425-FSH-PS, by Pomerantz Haudek Grossman & Gross LLP. Pomerantz seeks to represent a nationwide class of all health care providers who have been subjected to improper demands by UnitedHealth Group to repay previously paid health care benefits for services provided to UnitedHealth Group subscribers, only to have such funds forcibly recouped by the withholding of future payments from unrelated claims in alleged violation of ERISA.

PPACA claims regulations will govern all claims processing, reimbursement, denials and appeals for almost all healthcare claims outside Medicare and Medicaid, the most significant reimbursement law changes in 45 years since Medicare was created. The PPACA claims regulations became effective on 09/23/2010 with a deadline on July 01, 2011 as full enforcement grace period.

On July 23, 2010 the United States Department of Labor released a bulletin entitled: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act; Interim Final Rule. You will find a copy of this bulletin here

These interim final regulations are effective on September 21, 2010.

Information regarding the OSCA and membership benefits can be accessed at http://www.oscachiro.org


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For further information, fax 1-305-716-9212. Write us at [email protected] or #CO138, 8619 NW 68th St., Miami, FL 33166.

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