|
Yellow Pages
|
|
Yellow Pages
|
|
Written by TAC Staff: Yellow Pages
|
|
Tuesday, 23 August 2011 23:23 |
|
TRENTON, N.J., Jun 23, 2011 (GlobeNewswire via COMTEX) -- In a decision filed on June 20, 2011, the Honorable Judge Joel A. Pisano of the District of New Jersey sustained the claims brought by a group of individual healthcare providers and state chiropractic associations against Aetna, Inc. and various of its subsidiaries under the Employee Retirement Income Security Act of 1974 ("ERISA"). In the action, the plaintiffs allege that Aetna improperly recouped monies from providers that had previously been paid on behalf of its members, based on retroactive determinations that the services at issue were not covered under the members' health care plans. Frequently, Aetna determined after-the-fact that the services were excluded from coverage because they were "experimental and investigational" and therefore demanded that the providers return the funds. If the providers did not agree, Aetna placed them into pre-payment review, which in reality meant that Aetna simply withheld payment as a means to punish the provider and save money through undisclosed denials. The entire process, as alleged in the complaint, was in violation of ERISA because Aetna made its retroactive adverse benefit determinations that served as the basis of its repayment demands without providing a "full and fair" review of its decision, as required under the law.
"This decision is very important," says D. Brian Hufford of Pomerantz Haudek Grossman & Gross LLP ("Pomerantz"), "as now we will be able to proceed to full-scale discovery where we anticipate finding substantial evidence supporting our claims that ERISA has, indeed, been violated as a result of Aetna's widespread actions." The case parallels a similar action brought by Pomerantz which is proceeding against a number of Blue Cross Blue Shield licensees in the Northern District of Illinois before the Honorable Matthew E. Kennelly, as well as a recently filed action against United Healthcare in the District of New Jersey before the Honorable Faith Hochberg, both of which allege violations of ERISA for improper repayment demands and recoupments of prior benefit payments.
In addition to the ERISA claims, Judge Pisano also upheld the standing of the association plaintiffs to pursue claims for injunctive relief on behalf of their members, including the Association of New Jersey Chiropractors, the New York Chiropractors Council, the Illinois Chiropractic Society and the International Chiropractors Association.
In addition to the ERISA claims, the plaintiffs also asserted violations of the Racketeer Influenced and Corrupt Organizations Act ("RICO"), which were dismissed. The court further dismissed one individual plaintiff, finding that he had released his claims by entering into an individual settlement prior to the filing of the class action, while granting a motion to compel arbitration against two other plaintiffs, who had arbitration clauses in their in-network provider agreements with Aetna, leaving six remaining individual plaintiffs. According to Robert J. Axelrod of Pomerantz, "while we continue to believe that RICO was violated, ERISA is the heart of our case, and we are very pleased with the result."
Counsel for plaintiffs are continuing to investigate these claims, and other related claims that may be added to the litigation. If you have any questions, please contact D. Brian Hufford, Esq. of Pomerantz Haudek Grossman & Gross LLP, by phone (212-661-1100) or email (
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
), or Vincent N. Buttaci, Esq., of Buttaci & Leardi, LLC, by phone (609-919-6312) or email.
SOURCE: Pomerantz Haudek Grossman & Gross LLP
|
|
|
Yellow Pages
|
|
Written by TAC Staff: Yellow Pages
|
|
Tuesday, 23 August 2011 23:19 |
|
MILWAUKEE, WI – Five Wisconsin women are suing their insurance companies for what they claim is an illegal collection of co-payments for chiropractic care.Hansen Riederer Dickinson Cruger LLC says patients' class-action lawsuit was filed on behalf of state chiropractic patients of five major health insurers. According to the complaint, the health insurance providers are violating state law by requiring chiropractic patients to pay a co-payment for each visit. Cynthia Larson, one of the plaintiffs, says, “How is it insurance if I have to pay for 100% of my treatment, whether I go once or 50 times? I am actually worse off submitting my chiropractic charges to my insurer than if I paid out-of-pocket because not only do I pay the entire cost through the co-payments but then the insurance company limits the number of times I can receive treatment from my chiropractor.” Larson, along with Kimberly Dehaan, Jeannette Borden, Rebecca Bavinck, and Amy Cloute, filed suit in federal court in the Western District of Wisconsin on Friday, alleging that their insurance companies used co-payments to shift all or nearly all of the cost of chiropractic care to them. They contend that Wisconsin law prohibits these co-payments. Russ Leonard, director of the Wisconsin Chiropractic Association, says “This is a huge step towards ending the systematic and destructive discrimination against Wisconsin chiropractic patients who paid for and have a legal right to an alternative to drugs or surgery.”
Source: WEAU News
|
|
Yellow Pages
|
|
Written by TAC Staff
|
|
Monday, 25 April 2011 21:24 |
|
COLUMBUS, OH--(Marketwire - 03/18/11) - On March 16, 2011, Ohio State Chiropractic Association (OSCA) announced that it was sponsoring the second PPACA Claims Regulations Claims Specialist training in an effort to meet a July 01, 2011 deadline for full enforcement of the Federal Health Reform Law, Patient Protection and Affordability Care Act (PPACA). PPACA is the new Federal Patient's Bill of Right, for almost all non-Medicare and non-Medicaid health claims and OSCA believes that it is critically important for health care providers as well as their patients to understand what is involved in this important new legislation. Earlier this year, on Jan. 24, 2011, OSCA and Dr. Judson G. Sprandel, II, D.C., past president of OSCA, filed a class action lawsuit against UnitedHealth group for the alleged violation of the Employee Retirement Income Security Act of 1974 ("ERISA"), arising from its post-payment audit and  recoupment practices. The OSCA's Board of Directors unanimously (19 - 0) voted to file this suit in early January. That decision was driven from a commit to protect the rights of its members and the insured they treat through use of ERISA, the federal statute governing most private employer benefit plans. On Feb. 8, 2011, the Congress of Chiropractic State Associations ("COCSA") announced that it had voted to join OSCA in pursuing the ERISA Class Action on behalf of providers nationwide. COCSA represents chiropractic member associations in in all 50 states. The American Medical Association described the pending class action in its member publication on March 4, 2011, stating that "the lawsuits could have implications for physicians who are the target of the same kind of collections, even though the plaintiffs are chiropractors." Through the ERISA class action against United and the PPACA Claims Appeal Compliance training OSCA is leading the nation in advocating for appropriate patient care and against abusive insurance practice.
The Second OSCA PPACA / ERISA Claims Specialists training will be held on April 28, 2011 in Columbus, OH for its PPACA / ERISA Committee Members. Once the eight module trainings are completed the OSCA will begin training all members and providers in the State. OSCA finished its first session in PPACA / ERISA training on March 3, 2011.
The OSCA's ERISA class action was originally filed on Jan. 24, 2011, in the United States District Court, District of New Jersey, Case 2:11-cv-00425-FSH-PS, by Pomerantz Haudek Grossman & Gross LLP. Pomerantz seeks to represent a nationwide class of all health care providers who have been subjected to improper 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 ERISA.
PPACA claims regulations will govern all claims processing, reimbursement, denials and appeals for almost all healthcare claims outside Medicare and Medicaid, the most significant reimbursement law changes in 45 years since Medicare was created. The PPACA claims regulations became effective on 09/23/2010 with a deadline on July 01, 2011 as full enforcement grace period.
On July 23, 2010 the United States Department of Labor released a bulletin entitled: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act; Interim Final Rule. You will find a copy of this bulletin here
These interim final regulations are effective on September 21, 2010.
Information regarding the OSCA and membership benefits can be accessed at http://www.oscachiro.org
Pass on the information to inform other D.C.’s about events that are really happening to chiropractors.
For further information, fax 1-305-716-9212. Write us at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
or #CO138, 8619 NW 68th St., Miami, FL 33166.
|
|
|
Yellow Pages
|
|
Written by TAC Staff
|
|
Monday, 25 April 2011 21:20 |
|
PHOENIX, AZ: Two Chiropractors and a patient, backed by the Arizona Chiropractic Society (ACS), filed a lawsuit on the 14th against the Arizona Department of Insurance (ADOI) alleging failure to enforce the chiropractic insurance equality law, ARS 20-461(A)17 and ARS 20-461(B). This law requires insurers to give patients the option to use their health insurance to see either an MD, DO or DC for neck and back problems and pay the same copays and deductibles with the same overall limitations on treatment. Currently, copays, deductibles and other limitations for chiropractic care discriminate severely against chiropractic care with financial barriers so huge that insurers, led by Blue Cross Blue Shield of Arizona, basically force patients to choose MDs or DOs for back and neck pain. ADOI, despite hundreds of consumer complaints, has refused to enforce this law which only they have the legal authority to enforce. Therefore, this legal action asks the courts to order ADOI to properly enforce the law. To read the official filed and stamped lawsuit documents go the Arizona Chiropractic Society’s website, www.azchiropractors.org.
Source: Arizona Chiropractic Society
Pass on the information to inform other D.C.’s about events that are really happening to chiropractors.
For further information, fax 1-305-716-9212. Write us at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
or #CO138, 8619 NW 68th St., Miami, FL 33166.
|
|
Yellow Pages
|
|
Written by TAC Staff
|
|
Tuesday, 12 April 2011 11:41 |
|
Chiropractor Attacked for Advertising Claims
Associated with DRX-9000 in California
CALIFORNIA: A Danville chiropractor has been pushing a device via his website to thousands of chiropractors with false claims that it's approved by the FDA and endorsed by NASA, the Alameda County District Attorney's office said in a news release.
Dr. Benjamin Altadonna made or caused to be made a traction device which he "sold or leased for between $90,000 and $115,000," according to the complaint. He advertised the device with deceptive claims as the "DRX9000 New Cash Patient Marketing System" or the "DRX9000 Spinal Decompression Lead Generation and Conversion Marketing System," the State said.
"Many different counties joined in on the lawsuit and decided to file it [in Alameda County," said D.A. Teresa Drenick. Contra Costa, Marin, Monterey, Napa, Orange, Santa Clara, Santa Cruz, Shasta, Solano, and Sonoma counties are all part of the civil complaint.
In 2006, the D.A. said, Altadonna made claims that "the DRX was a patented device having FDA approval or that it was used in a valid scientific study that demonstrated an 86 percent success rate in treating medical conditions like spinal herniation… that the DRX was affiliated with, endorsed or approved by NASA." The state of Oregon also fined Altadonna for similar things in 2007, the D.A. said, noting Altadonna does business as Doctor's Wealth Creators and other names.
According to Altadonna, he entered into a stipulated agreement with Oregon's attorney general in 2007, requiring the chiropractor to change his marketing practices and provide "reliable scientific evidence such as tests, analysis, research, studies…based on the expertise of professionals in the relevant area" to back up his claims, which Altadonna neglected to do.
Altadonna, under the umbrella Altadonna Communications Inc. (ACI) paid civil restitution as part of the agreement.
But, according to the Alameda County D.A., Altadonna is again using pseudonyms to sell and disseminate "thousands of marketing plans to thousands of licensed health care professionals inside and outside the State of California."
After meeting with the Monterey County D.A. in 2006, Altadonna began transferring assets to co-defendants Altadonna Living Trust and Diablo Park LLC, the state said.
California is seeking an injunction and penalties for false advertising, unfair competition, fraudulent transfer of assets and violations of the Business and Professions Code.
While the next court date and judge have not been assigned, Scott Patton, one of the prosecuting D.A.s, says there is no chance that Altadonna will go to jail.
"Since this is a civil complaint...the court will usually order injunctive terms and (Altadonna) will have to conduct business a certain way and may have to pay restitution if there are injured parties."
Danville Express
Probation for Chiropractor in Insurance Fraud
PENNSYLVANIA: A Bucks County chiropractor who participated in a scheme to bilk Independence Blue Cross of almost $2 million was sentenced recently to three years' probation and ordered to perform 450 hours of community service.
U.S. District Judge Gene E.K. Pratter gave Dr. Raymond W. Brozek, 57, of Telford, a big break after Assistant U.S. Attorney Anita Eve filed a motion for leniency based on "substantial" assistance from Brozek that led to charges against others.
Two other defendants in the case—Michael Karp and Mark Levin—were sentenced to prison terms of six months and a year and a day, respectively, in September and November.
Brozek, who is no longer practicing and likely faces suspension of his license, is working as a chauffeur. He admitted lately that he had made a "terrible, terrible mistake."
Authorities said Levin, 65, and Karp, 39, who is Levin's son-in-law, owned Hatfield Athletic Club and Rehab One, a chiropractic office at the club.
The men hired Brozek to work there from 2004 to 2006. Levin demanded that Hatfield workers be seen by Brozek as often as possible so he could bill IBC, prosecutors said.
Prosecutors said Brozek followed his superiors' directions and caused fraudulent bills to be submitted for treatments either he didn't perform or that weren't medically necessary.
Authorities said Brozek also prepared bogus bills that were used to submit claims to IBC that represented services provided to Hatfield workers, who were encouraged and forced to sign Rehab One's patient log regardless of whether they were treated.
At the direction of Karp and Levin, Brozek created office notes and other documents that included fictitious procedure codes and false depictions of symptoms and clinical findings, which were used to prepare bills submitted to IBC.
Authorities said the defendants submitted almost $2 billion worth of medical bills to IBC, resulting in payments from IBC of $399,882.
The three defendants must make a combined restitution of $399,822 to IBC.
Philadelphia Daily News
|
|
|
|
|
|
|
Page 11 of 21 |
|
|
|
