COCSA sues UnitedHealth Group, OptumHealth

May 9, 2011 — On April 22, 2011, the Congress of Chiropractic State Associations (“COCSA”), as a Named Class Plaintiff, joined by other providers, national and state associations, including OSCA & ACA, filed its first amended ERISA Class Action Complaint. The action was filed against UnitedHealth Group and its subsidiaries, including OptumHealth, for alleged ERISA violations in its abusive overpayment recoupment, pre-service and concurrent claim denials.

On Feb. 8, 2011, the Board of the Congress of Chiropractic State Associations (“COCSA”) voted to join the Ohio State chiropractic Association’s (OSCA) original class-action filed on January 24, 2011. COCSA welcomes the American Chiropractic Association’s (ACA) leadership in joining OSCA and COCSA in this class action, also as a named class plaintiff, with special vision on the OptumHealth Claims in this First Amended Complaint. This action was also joined by additional plaintiffs, including other chiropractic providers, The Missouri State Chiropractic Association (MSCA), a DME provider and an ambulatory surgical center (ASC) facility.

The first amended class complaint (Premier Health Center, P.C. et al v. UnitedHealth Group et al, Case 2:11-cv-00425-FSH -PS Doc. #15), filed on 04/22/11 in U.S. District Court of New Jersey, expands the original lawsuit, filed on Jan. 24, 2011.  The Complaint added additional class plaintiffs, additional defendants and additional complaints, to include DME and ambulatory surgical center plaintiffs, defendant OptumHealth, and alleged pre-service & concurrent claim denial ERISA violations.

The original action was previously filed on Jan. 24, 2011 by Pomerantz Haudek Grossman & Gross LLP, one of the nation’s preeminent class action law firms and a leader in combating the abuses of the health insurance industry, on behalf of a group of chiropractors, and the Ohio State Chiropractic Association (OSCA). Pomerantz seeks to represent a nationwide class of all health care providers.  These providers have been subjected to improper pre-service and concurrent claim denials, and overpayment 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 the Employee Retirement Income Security Act of 1974 (“ERISA”), the Federal law governing private employee benefit plans.

UnitedHealth Group, which acquired the health insurance business of Health Net of the Northeast in December 2009, is the nation’s largest private health plan by revenue. The action alleges that the post-payment audit and review process as applied by the Defendants violates ERISA.  The repayment demands are actually retroactive adverse benefit determinations that particular services are not covered under the terms of the United and Health Net health care plans, but do not allow for proper appeals or other protections otherwise available under ERISA for both self-funded and fully insured health care plans offered through private employers. Furthermore, Plaintiffs also allege that United and OptumHealth failed to comply with ERISA regulations in denying pre-service and concurrent care claims from chiropractic providers.

“ERISA establishes the procedures that insurance companies must follow when making benefit determinations – whether prior to payment or retroactively,” says Plaintiffs’ counsel, D. Brian Hufford of Pomerantz. “The Defendants here, as is true for many insurance companies, are violating their ERISA obligations in order to recover funds that simply do not belong to them.”

Plaintiffs’ Co-Counsel, Vincent Buttaci of Buttaci & Leardi, LLC, states that “providers are placed in an untenable position as a result of false fraud allegations made against them in an effort to coerce and intimidate, and through our lawsuit they are now fighting back.”

By far, chiropractic plaintiffs have led all other healthcare providers in seeking judicial guidance and legal victories against abusive overpayment recoupment crisis faced by all healthcare providers. The class plaintiffs, COCSA, ACA, OSCA, and MSCA, as well as other Durable Medical Equipment (DME) and ambulatory surgical center (ASC) providers, demonstrated their leadership by joining OSCA in this historic landmark class-action for all providers and specialties, by asserting their rights, through representational standing, to obtain appropriate equitable relief to address the abuses at issue on behalf of their Association or Industry members in all 50 states. This ERISA class action will benefit not only chiropractic providers but also all of the doctors and hospitals in U.S.A.

On March 4, 2011, AMA reported the importance of OSCA’s initial ERISA class actions for all physicians, stating: “This lawsuit could have implications for physicians who are the target of the same kind of collections, even though the plaintiffs are chiropractors.” (http://www.ama-assn.org/amednews/2011/02/28/bise0304.htm)

“Although COCSA didn’t lead to initiate these initial victories, COCSA is certainly taking the lead to finish our fight for justice and equality in the healthcare market, in advocating for appropriate chiropractic care for all of our patients. While we salute our colleagues whose legal wisdom guided our profession to this great start, COCSA has positioned itself with other national (ACA) and state associations (OSCA & MSCA) for our profession to ensure our victories from start to finish. Our COCSA decision to sue the defendants as a Named Class Plaintiff is the proof for this timely leadership,” said Dr. Kate C Rufolo, DC, President of COCSA.

“ERISA is the federal law that protects patients and providers from improper denials and delays. When any payer or health plan refused or failed completely to comply with federal law ERISA, a class-action lawsuit is most appropriate solution economically and legally for our profession, other doctors and hospitals,” said Dr. John LaMonica, DC, COCSA Officer, whose New York Chiropractic Council was the plaintiff for the class action against 23 BCBS entities, and also a key driver for today’s COCSA decision.

The Congress of Chiropractic State Associations, COCSA, was formed in the late 1960’s and is a not-for-profit organization consisting of state chiropractic associations in all 50 states. The mission of the Congress is to provide an open, nonpartisan forum for the promotion and advancement of the chiropractic profession through service to member state associations. COCSA will lead the profession in compliance with new healthcare reform law, PPACA and existing federal law, ERISA, for proper reimbursement.

Any questions on this press release, call COCSA at 316-613-3386, or visit COCSA at http://cocsa.org/.

Source: COCSA, www.cocsa.org