The Congress of Chiropractic State Associations (COCSA) board has voted to join a national class-action suit filed in late January against UnitedHealth Group, the nation's largest health care insurer in terms of revenue.
A COCSA press release announcing the board's decision to join the class-action suit and in so doing, represent state chiropractic associations and their members in all 50 states, outlined the primary allegations against the insurer:
"The action alleges that the postpayment audit and review process as applied by the defendants violates ERISA in that its repayment demands are retroactive adverse benefit determinations that particular services are not covered under the terms of the United and Health Net health care plans, but without proper appeals or other protections otherwise available under ERISA for both self-funded and fully insured health care plans offered through private employers."
"In the complaint, the plaintiffs allege that, as a means to maximize their profits, United and Health Net [UnitedHealth acquired Health Net of the Northeast in December 2009, according to the release] used their postpayment audit and review process to make retroactive adverse benefit determinations whereby they demanded that providers repay funds they had previously received for providing services to United and Health Net subscribers. Moreover, defendants 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, a practice called 'offsetting.'"
Explained D. Brian Hufford of Pomerantz, co-counsel for the plaintiffs: "ERISA establishes the procedures that insurance companies must follow when making benefit determinations - whether prior to payment or retroactively. The Defendants here, as is true for many insurance companies, are violating their ERISA obligations in order to recover funds that simply do not belong to them."
Vincent Buttaci of Buttaci & Leardi, LLC, whose firm is also representing the plaintiffs in the suit, added: "Providers are placed in an untenable position as a result of false fraud allegations made against them in an effort to coerce and intimidate, and through our lawsuit they are now fighting back."
Review the entire text of the class-action suit against UnitedHealth at www.erisaclaim.com/UHC_Complaint.pdf.
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