On April 22, 2011, more healthcare providers, durable medical equipment (DME), ambulatory surgical center (ASC), national and state chiropractic associations, joined and expanded the ERISA class-action against UnitedHealthcare, originally filed on January 24, 2011 by a group of chiropractors, for alleged ERISA violations in its overpayment recoupment and pre-service claim denials in connection with managed care network practice by OptumHealth, a subsidiary of UnitedHealthcare. ERISAclaim.com offers free webinars to examine this ERISA class-action’s impact on healthcare industry.
The first amended class complaint (Premier Health Center, P.C. et al v. UnitedHealth Group et al, Case 2:11-cv-00425-FSH -PS Doc. #15), filed on 04/22/11 in U.S. District Court of New Jersey, expands the original lawsuit, filed on Jan. 24, 2011, with additional class plaintiffs, additional defendant and additional complaints, to include DME and ambulatory surgical center plaintiffs, defendant OptumHealth, and alleged pre-service & concurrent claim denial ERISA violations. All named class plaintiffs are asserting their rights, through representational standing, to obtain appropriate equitable relief to address the abuses at issue on behalf of their Associations or Industry members in all 50 states.
The original action was previously filed on Jan. 24, 2011 by Pomerantz Haudek Grossman & Gross LLP, one of the nation’s preeminent class action law firms and a leader in combating the abuses of the health insurance industry, on behalf of a group of chiropractors, and the Ohio State Chiropractic Association (OSCA). Pomerantz seeks to represent a nationwide class of all health care providers who have been subjected to alleged overpayment 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 the Employee Retirement Income Security Act of 1974 (“ERISA”), the Federal law governing private employee benefit plans.
“Health-care overpayment recoupment market is estimated to be over hundreds of billions of dollars. With little or no judicial guidance, most health plan’s relentless and abusive recoupment practices are mixed with genuine but little fraud investigation and mostly retroactive adverse benefits determination (overpayment demand) under ERISA, This UHC ERISA class-action, along with other overpayment ERISA class actions, will become a historical and unique part of U.S. healthcare history,” said Dr. Jin Zhou, President of ERISAclaim.com, a National Expert on ERISA and PPACA Appeals and Compliance.
According to the Court papers filed on April 22, 2011, in United States District Court, District Of New Jersey, Case 2:11-cv-00425-FSH -PS:
The plaintiffs are: PREMIER HEALTH CENTER, P.C., JUDSON G. SPRANDEL, II, D.C., BRIAN S. HICKS, D.C., TRI3 ENTERPRISES, LLC, BEVERLY HILLS SURGICAL CENTER, JEREMY RODGERS, D.C., and AMY O’DONNELL, D.C., on their own behalf and on behalf of all others similarly situated, and CONGRESS OF CHIROPRACTIC STATE ASSOCIATIONS, the AMERICAN CHIROPRACTIC ASSOCIATION, the OHIO STATE CHIROPRACTIC ASSOCIATION and THE MISSOURI STATE CHIROPRACTIC ASSOCIATION, in a representational capacity on behalf of their members.
The defendants are: UNITEDHEALTH GROUP, UNITEDHEALTHCARE SERVICES, INC., OPTUMHEALTH, INC., HEALTH NET OF THE NORTHEAST, INC., and HEALTH NET OF NEW YORK, INC..
The plaintiffs alleged complete violation of ERISA claim regulation by UnitedHealthcare, especially with ERISA requirements for compliant EOB practice, right to appeal and a full and fair review for all overpayment recoupment demand as an ERISA adverse benefits determination, overpayment withholding/offsetting as an ERISA adverse benefit determination, and pre-service claim and concurrent service claim denials.
Among other things, the Plaintiffs demand judgment in their favor against Defendants to find that United have breached the terms of the plan provisions and have violated federal law ERISA, to stop United from engaging any non-ERISA compliant overpayment recoupment demand and offsetting from any future payments, and to stop OptumHealth from denying pre-service claims and concurrent service claims without compliance with ERISA claim regulation and the plan provisions.
A copy of the initial Class Action Complaint is available at www.erisaclaim.com/UHC_Complaint.pdf
A copy of the First Amended Complaint is available at www.erisaclaim.com/UHC_Complaint2.pdf
This ERISA class action will have profound impact on not only DME providers, ambulatory surgical centers, chiropractic providers but also all of the doctors and hospitals in U.S.A, predicted Dr. Zhou.
On March 4, 2011, AMA reported the importance of this UHC ERISA class action for all physicians, stating: “This lawsuit could have implications for physicians who are the target of the same kind of collections, even though the plaintiffs are chiropractors.” (www.ama-assn.org/amednews/2011/02/28/bise0304.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.
ERISA claim.com offers complete spectrum of overpayment appeal and prevention services, including educational, consulting, litigation support services for overpayment demand, overpayment withholding/offsetting, PPO auditing, SIU investigation, ERISA & PPACA Claim Specialist Certification training.
For more information on overpayment appeal and other services: www.erisaclaim.com/products.htm
For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237