Class Accuses Blue Cross of ExtortionPublished: 2009-10-02 01:31:46Author: BRIDGET FREELAND | Courthouse News Service | September 16, 2009CHICAGO (CN) - Three state chiropractic associations say Blue Cross
Blue Shield is trying "to extort millions of dollars" from
chiropractors, unfairly demanding that they return money paid on
claims, after "retrospective" determinations that the doctors did not
provide "covered services." The class action RICO complaint claims Blue
Cross unjustly accused chiropractors of fraud, demanded repayment of
benefits, and illegally withholds payments for new, unrelated claims,
in a "nationwide scheme ... to extort".
In the 155-page federal
complaint, the Pennsylvania Chiropractic Association, New York
Chiropractic Council and the Association of New Jersey Chiropractors,
14 chiropractors and one occupational therapist, claim that Blue Cross
Blue Shield and 22 of its nationwide "entities" subjected them to
unfair "post-payment audits and improper recoupment."
They say
that Blue Cross ignored their demands for explanations how to appeal,
in violation of the Employee Retirement Income Security Act. And it
claims Blue Cross denied them plan materials and descriptions upon
which the new assessments are made, and has wrongfully taken benefit
payments due on new claims.
The chiropractors also say that
when an employer is a plan sponsor in a self-funded plan, Blue Cross
unlawfully leads the employer to believe that claims have been paid to
the provider, though Blue Cross actually holds onto the money to cover
the alleged debt.
Dr. Gregory Kuhlman, a chiropractor in
Crystal Lake, Ill., says that after eight years providing services for
Blue Cross, he received 100 "vague" letters stating that he had been
overpaid and demanding immediate repayment. Kuhlman said Blue Cross
ignored his efforts to obtain adequate information to appeal the
decision. He says Blue Cross then withheld thousands of dollars in
benefit payments on new claims, without any further explanation or
justification.
A Rhode Island chiropractor claims that the day after
he criticized Blue Cross in the media, the company filed a frivolous
lawsuit against him, demanding $400,000 for "defamation ... as part of
its scheme to intimidate and extort improper payments, and to
discourage other providers from challenging defendants' practices."
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