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ERISAclaim.com Press
Release
FOR
IMMEDIATE RELEASE:
Court Watch:
UnitedHealthcare Sued In ERISA Class Action Over Its Overpayment
Recoupment Practice
© Jin Zhou, President, ERISAcalim.com
08/06/2010
Hanover Park, IL (ERISAclaim.com) August
06, 2010 - UNITED HEALTHCARE was sued
in 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.
This is the third provider ERISA class
action lawsuit against Insurers since
Aetna was sued
in last July and
21 BCBS Entities
in last Sept 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. Zhou.
This is a
seemingly very common but surprisingly twisted case in today’s
healthcare market, according to Dr. Jin Zhou, President of
ERISAclaim.com. 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
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.
For more information on how to
appeal overpayment denials under new federal appeals regulations,
please contact Dr. Jin Zhou at ERISAclaim.com: email:
ERISAclaim@aol.com;
phone: 630-808-7237.
###
Contract:
Jin Zhou,
President
ERISAclaim.com
Tel:
630-808-7237 (Mobile)
Tel:
630-736-2974 (Office)
Fax:
630-736-1439
E-mail:
ERISAclaim@aol.com
website:
http://www.ERISAclaim.com
Related Links:
ERISAclaim.com - Health Reform for
Out-Of-Network Providers: Receiving Insurance Checks Directly? – CD
Books & Seminars on Why
ERISAclaim.com: 50% Savings - Healthcare Crisis
Turnaround for Employers, Insurers & TPA's
ERISAclaim.com - A $1.0 Trillion Nuclear Solution
to U.S. Health-care Crisis & $44 Trillion Budget Deficits
American Benefits Council:
News Room - Supreme Court Ruling on Health Care Claims Raises Important
Policy Issues: American Benefits Council. June 21, 2004
"Sadly
and predictably trial attorneys and their allies are already calling on
Congress to unravel today’s decision by the Supreme Court, but they should
first ask why the two physicians in these cases did not act swiftly to help
make sure their patients got the care they were seeking.
In neither
case did the patient or their physician seek a further review of the health
plan’s initial coverage decision, despite being specifically informed of
their right to such a review under federal law."
Klein said."
"These
review procedures are available under ERISA
to help patients get the care they deserve, quickly and without having to
resort to costly and lengthy legal procedures. Clearly, a speedy and factual
review aided by the expertise of the physicians
involved with
these two cases could have avoided the need for the courts to be involved at
all,"
Klein said."
# # #
The American Benefits Council is the national
trade association for companies concerned about federal legislation
and regulations affecting all aspects of the employee benefits system.
The Council's members
represent the entire spectrum of the private employee benefits
community and either sponsor directly or administer retirement and
health plans covering more than 100 million Americans."
http://www.americanbenefitscouncil.org/issues/health/mischealth.htm
Lexology - Notes on the National Summit on Health Care Fraud
Reed Smith LLP,
Last
week, in my capacity as president of the
American Health
Lawyers Association, I attended the first
National Summit on
Health Care
Fraud,
a joint undertaking by the
U.S. Department of
Health and Human Services and the
U.S. Department of Justice. The conference brought together
private sector leaders, law enforcement personnel, and
health
care experts as part of the Obama Administration’s coordinated effort
to fight health
care fraud.
This was the first national gathering on
health
care fraud
between law enforcement and the private and public sectors."
STOP Medicare Fraud
- U.S. Department of Health & Human Services and U.S. Department of
Justice (http://www.stopmedicarefraud.gov)
"National
Summit on Health Care Fraud
U.S.
Department of Health and Human Services Secretary Kathleen Sebelius
and Attorney General Eric Holder convened a “National Summit on
Health Care Fraud” on Thursday January 28, to bring together leaders
from the public and private sectors to identify and discuss
innovative ways to eliminate fraud, waste and abuse in the U.S.
health care system. The National Summit is the latest initiative of
the Health Care Fraud Prevention & Enforcement Action Team (HEAT)."
Related Press Release links:
The New 2010 Obama
Healthcare Reimbursement Law Webinars Announced As ERISA Appeals
Procedures Now Mandatory for All Group Health Plans and Healthcare
Providers 01-04-2010, Hanover Park, IL
Free Overpayment Webinar Announced For
Self-insured Health Plans To Get Immediate Relief from New $1 Trillion
Overpayment Recoupment Embezzlement Market 11-23-2009,
Hanover Park, IL
New Healthcare
Overpayment Recoupment Embezzlement Recovery Service Announced In Wake
Of Launch of New Federal Task Force To Combat Healthcare Fraud Crisis 11-19-2009, Hanover Park, IL
The New Healthcare
Reform Bill Passed by The Congress Prompted The New Claim Specialist
Certification Class from ERISAclaim.com 11-9-2009, Hanover Park, IL
ERISAclaim.com
Announced The Nation's First Embezzlement Recovery Services for Large
ERISA Health Plans from the $6 Trillion Healthcare Denial Management
Market 10-23-2009, Hanover Park, IL
ERISAclaim.com Announced Free ERISA Webinar for Healthcare Overpayment
Dispute and Claim Denials in Response to Increasing High Demand from
the $6 Trillion Healthcare Denial Management Market
10-19-2009, Hanover Park, IL
ERISAclaim.com Announced the Expansion of Its ERISA Litigation Support
For the Healthcare Claims In Response to Increasing High Demand from
the $6 Trillion Healthcare Denial Management Market.
10-19-2009, Hanover Park, IL
ERISAclaim.com
Announced 2010 ERISA Seminars for Healthcare Overpayment and Claim
Denial Appeals for the $6 Trillion Healthcare Denial Management
Market.
10-14-2009, Hanover Park, IL
ERISAclaim.com
Announced the Nation's First Certification Program for the ERISA
Claim Appeal Specialist for Healthcare Providers and Managed-Care
Payers,
10-13-2009, Hanover Park, IL
Interactive Side-By-Side
Health Reform Comparison Tool of Major Proposals
(Kaiser Family Foundation)
Excerpt: "The Foundation has updated its health
reform resources to reflect provisions of the Affordable Health Care for
America Act (HR 3962) as passed on Saturday by the U.S. House of
Representatives."
Information updated 03/26/2010
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