Plaintiffs v Blue Cross Blue Shield Association (BCBS)
Pomerantz Files Class Action Against Blue Cross Blue Shield Association
Pomerantz Haudek Grossman & Gross LLP announced that it and co-counsel Buttaci & Leardi, LLC filed a class action lawsuit against the Blue Cross Blue Shield Association (BCBS) and 22 leading BCBS insurers across the country on behalf of a putative nationwide class of health care providers, as well as the Pennsylvania Chiropractic Association (PCA), the New York Chiropractic Council (the Council), and the Association of New Jersey Chiropractors (ANJC). The suit challenges the Defendants abusive practices in using post-payment audits and reviews, and improper repayment demands, to pressure providers to repay substantial sums that have previously properly been paid as health insurance benefits for services provided to BCBS subscribers.
The action alleges that the post-payment audit and review process as applied by the various named BCBS Entities violates the Employee Retirement Income Security Act of 1974 (ERISA), in that its repayment demands are retroactive determinations that particular services are not covered under the terms of the BCBS health care plans, but without proper appeal or other protections otherwise available under ERISA for both self-funded and fully insured health care plans offered through private employers. The complaint further alleges that the post-payment audit and review process, as well as the forced withholds of unrelated benefit payments to offset alleged prior overpayments, violate the Racketeer Influenced and Corrupt Organizations Act (RICO).
In the complaint, Plaintiffs allege that, as a means to maximize its profits, the BCBS Entities use their post-payment audit and review process to make retroactive adverse benefit determinations whereby they demand that providers repay funds they had previously received for providing services to BCBS subscribers. Moreover, the BCBS Entities frequently withhold new benefit payments for unrelated services to apply toward the alleged overpayments, even where there has been no valid appeal process or validation that any sums are in fact owed by the providers.
Plaintiffs seek to enjoin the BCBS Entities from continuing to engage in these practices and to compel them to return the funds they have improperly withheld.
Contacts:
Pomerantz Haudek Grossman & Gross LLP
Teresa L. Webb, 888-476-6529 / (888) 4.POMLAW
D. Brian Hufford, Esq. of Pomerantz Haudek Grossman & Gross LLP, by phone (614-410-6501) or email (dbhufford@pomlaw.com),
Vincent N. Buttaci, Esq., of Buttaci & Leardi, LLC, by phone (609-919-6312) or email (vnbuttaci@buttacilaw.com).
