COCSA Joins National Erisa Class Action

On February 8, 2011, the Board of the Congress of Chiropractic State Associations (COCSA) voted on behalf of its State Association members to join the national Pomerantz ERISA class action against UnitedHealth Group to challenge overpayment recoupment abuses.

The action was originally filed on Jan. 24, 2011 by Pomerantz 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 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 the Employee Retirement Income Security Act of 1974 (“ERISA”), the Federal law governing private employee benefit plans.

"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."

The latest Class Action against UnitedHealth Group is the third national class action filed by Pomerantz, following similar litigations brought against Aetna and 23 Blue Cross Blue Shield entities filed within the last two years. Initial court rulings have been favorable to provider plaintiffs.

United's acquisition of Health Net of the Northeast's health insurance business closed in December 2009, adding to United's status as the nation's largest private health plan by revenue.

In the complaint, Plaintiffs allege that, as a means to maximize their profits, United and Health Net used their post-payment audit and review process to make retroactive adverse benefit determinations whereby they demand that providers repay funds they had previously received for providing services to United and Health Net subscribers. Moreover, Defendants frequently withhold new benefit payments for unrelated services to apply toward the alleged overpayments, even where there has been no valid appeal process or validation that any sums are in fact owed by the providers, a practice called "offsetting."