Free Webinars: Court Watch - UnitedHealthcare Provider ERISA Class Action Counterclaims Over Its Overpayment Recoupment Practice
Free Webinars On United Healthcare Proivers ERISA Class Action Counterclaims On July 21, 2010 In United States District Court, Southern District Of New York, For The Alleged ERISA Violations In Its Overpayment Practice By Patients And Providers. It Is Very Important For All Providers To Closely Watch These Cases And Court Rulings, As Overpayment Recoupment Practice As A Form Of Retrospective Adverse Benefit Determination And National Healthcare Anti-Fraud Campaign Are Intertwined And Enforced With Multi-Billion Dollar Stakes.
Hanover Park, IL (PRWEB) August 9, 2010
ERISAclaim. com's Free Webinars was timely announced for the latest UNITED HEALTHCARE provider ERISA class action counterclaims on July 21, 2010 in United States District Court, Southern District of New York, for the alleged ERISA violations in its overpayment practice by patients and providers, when the healthcare providers are faced with increasing overpayment recoupment demands by payers on daily basis.
This is the third provider ERISA class action lawsuit against Insurers since Aetna was sued in last July (Case #: 3:09-cv-03761-JAP-TJB, UNITED STATES DISTRICT COURT DISTRICT OF NEW JERSEY, Filed: 07/29/2009) and 21 BCBS Entities in last Sept (CASE #: 1:09-cv-05619, UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION, Filed: 09/10/2009) in federal courts over payer's overpayment recoupment practice, after a federal court ruled in Chicago on BCBS case allowing provider's ERISA class action claim to proceed, said Dr. Jin Zhou, President of ERISAclaim. com.
(For a copy of the court order on BCBS case: http://www. erisaclaim. com/BCBS_Overpayment_%20Class_Action_Opinion. pdf (http://www. erisaclaim. com/BCBS_Overpayment_%20Class_Action_Opinion. pdf))
This is a seemingly very common but surprisingly twisted case in today's healthcare market, according to Dr. Jin Zhou. When United Healthcare denied a surgical claim, a patient sued the United Healthcare in a small claim court in New York. United healthcare quickly moved the case to the federal district court, asserting ERISA pre-emption. Instead of simply defending the cases, the United filed an overpayment claim for the already paid money against the patient's providers as well. The saga starts to unfold from here. The patient and providers filed a class action counterclaim under ERISA on behalf of all similarly situated against the United, among other claims, alleging ERISA violations and seeking for injunctive and declaratory relief.
This overpayment lawsuit and counter-lawsuits case is titled:
Gwendolyn Cunningham v. United Healthcare Insurance Company of New York;
United Healthcare Insurance Company Of New York v. Dr. Darrick Antell And Lenox Hill Ambulatory Surgery, P. C. F/K/A 850 Park Surgical;
Dr. Darrick Antell and Lenox Hill Ambulatory Surgery, P. C. F/K/A 850 Park Surgical, On Behalf Of Themselves And Others Similarly Situated v. Unitedhealth Group, Inc.; United Healthcare Services, Inc.; United Healthcare Insurance Company; and United Healthcare Insurance Company Of New York;
Case No. 10-CV-3194 (RJS) & Case No. 10-CV-3195 (RJS), Filed 07/21/10, in United States District Court, Southern District of New York.
For a copy of the case complaint:
Http://www. erisaclaim. com/UHC_Overpayment_ERISA_Class_Action. pdf (http://www. erisaclaim. com/UHC_Overpayment_ERISA_Class_Action. pdf)
The Counterclaim Plaintiffs alleged:
Count I: Claim For Benefits Under Group Plans Governed By ERISA;
Count II: Equitable Relief;
Count III: Claim For OBS Facility Fee Benefits Under Group Plans Governed By ERISA;
Count IV: Failure To Provide Full & Fair Review As Required By ERISA
The Counterclaim Plaintiffs demand judgment in their favor against United Healthcare as follows:
A. Certifying the Classes and appointing Dr. Antell and/or the Antell OBS Facility Class representative for each Class.
B. Declaring that United Healthcare breached the terms of its Health Plans by its Denial of Benefits and its recoupment efforts and awarding injunctive and declaratory relief to prevent United Healthcare's continuing actions detailed herein that are unauthorized under its Health Plans;
C. Declaring that United Healthcare failed to provide a full and fair review to the Counterclaim Plaintiffs and the other members of the Classes under 29 U. S.C. § 1133, and awarding injunctive, declaratory and other equitable relief to Counterclaim Plaintiffs and the other member of the Classes to ensure compliance with ERISA and its regulations;
D. Declaring that United Healthcare violated its disclosure and related obligations under ERISA and federal common law, including under 29 U. S.C. § 1022, for which Counterclaim Plaintiffs and the other members of the Classes are entitled to injunctive, declaratory and other equitable relief;
E. Enjoining United Healthcare from continuing to pursue its recoupment efforts as detailed herein, and ordering it to pay restitution in the form of a return of any sums previously paid by providers in response to such efforts;;
F. Declaring that United Healthcare breached the terms of its Health Plans by its denial of benefits for OBS Facility fees and ordering its payment of benefits for such fees;
G. Awarding Counterclaim Plaintiffs disbursements and expenses of this action, including reasonable attorneys' fees, in amounts to be determined by the Court and other appropriate relief;
H. Awarding interest from the date of benefit denials for the Counterclaim Plaintiffs and the other members of the Classes for all unpaid OBS Facility Fees and from the date of recoupment for all previously paid benefits that had been returned to United Healthcare due to its improper repayment demands; and
I. Granting such other and further relief as is just and proper.
In light of new federal appeals regulations going to effect on Sept. 23, 2010 for all new group health plans and existing employer sponsored health plans governed by ERISA for 35 years, it is very important for all providers to closely watch these cases and court rulings, as overpayment recoupment practice as a form of retrospective adverse benefit determination and national healthcare anti-fraud campaign are intertwined and enforced with multi-billion dollar stakes, as observed by Dr. Zhou, who advocated for ERISA administrative appeals and judicial reviews for all denied claims, in compliance with federal appeals regulations and state external review laws, as many of Dr. Jin Zhou and ERISAclaiom. com's clients, who had appealed overpayment denials under ERISA, have served as class Rep. in Aetna and BCBS cases, and the United case is almost identical to Aetna and BCBS cases in provider's ERISA claims.
Free Webinar Registration: http://www. erisaclaim. com/Free_ERISA_Webnars. htm (http://www. erisaclaim. com/Free_ERISA_Webnars. htm)
For more information on how to appeal overpayment denials under new federal appeals regulations: http://erisaclaim. com/overpayment_refund. htm (http://erisaclaim. com/overpayment_refund. htm), please contact Dr. Jin Zhou of www. ERISAclaim. com at 630-808-7237.
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