Many health insurers who have conducted post-payment audits of medical providers and decided that money is due to repaid to the health insurer have unilaterally decided to stop all payments to the provider. This “hijacking” of current claims is nothing more than an effort to extort a repayment from the medical provider for alleged “overpayments”.
The hijacking causes even more legal problems for the health insurer. In the first instance, the post-payment audits in the commercial insurance arena are typically prohibited. Demands for repayment due to alleged “overpayments” are usually not authorized under ERISA governed health plans. Thus, the demands for repayment are unlawful. By stopping all claims payments after an audit, the health insurers are merely compounding their legal troubles and subjecting themselves to various remedies.
Medical providers who have the proper ERISA counsel can stop this unlawful activity by the health insurers. ERISA provides for an injunction to be issued by a federal judge to stop practices and acts that are unlawful under ERISA. A federal court can also direct that all unpaid claims be paid immediately.
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Schwartz, Conroy & Hack is the premier disability insurance law firm in the United States. To see how we can help you, contact us.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack