The NY Chiropractic Council, PCA, and ANJC sue the Blue Cross Blue Shield Association

Sep 11 2009

The NY Chiropractic Council (the "Council") as well as the Pennsylvania Chiropractic Association ("PCA"), the Association of New Jersey Chiropractors ("ANJC"), fourteen individual chiropractors and one occupational therapist, located around the country, have sued as the class representatives of the putative class.

Pomerantz Haudek Grossman & Gross LLP and co-counsel Buttaci & Leardi, LLC, have filed a class action lawsuit against the Blue Cross Blue Shield Association ("BCBSA") and a number of state BCBS entities. The suit alleges that BCBSA and its entities violate the Employee Retirement Income Security Act of 1974 "ERISA". 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").

The PCA, the Council and the ANJC are participating in the action in an associational capacity on behalf of their members. Dr. John LaMonica, Insurance Chair of the Council, adds that "this action is an important step by the chiropractic profession to fight back against the egregious actions being taken by BCBS against our members." The Council and the ANJC had previously joined in a class action recently filed against Aetna, Inc. for similar post-payment audit practices.

In the complaint, plaintiffs allege that, as a means to maximize its profits, the BCBS Entities are using its 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. "In essence," says plaintiffs' counsel Dr. Brian Hufford of Pomerantz Haudek, "the BCBS Entities are alleging overpayments and then just taking the money from the providers, without valid due process protections. We believe this is a blatant violation of law."

Pomerantz Haudek, which has offices in New York, Chicago, Washington, D.C., Columbus, Ohio and the San Francisco Bay area, is acknowledged as one of the premier plaintiff class action firms.

Buttaci & Leardi, based in Princeton, New Jersey, has a dynamic national health care practice, representing licensed health care providers, group practices and other provider-related entities throughout the country. It has extensive experience representing providers in challenging post-payment audits, including those pursued by Aetna, and has obtained tremendous success on behalf of its clients.