info@avym.com
- Home
- About
- Resources
- Recovery Tools
- Challenge medical necessity denials
- Contest policy exclusion denials
- Create strategic policies and guidelines
- Out of network providers and facilities
- Overturn pre-authorization and pre-certification denials
- Overturn UCR and low-pay denials
- Recover written-off receivables
- Self-Insured Plan Tools
- Stop unauthorized overpayment refunds/recoupments
- Turnkey systems for billing companies
- FAQ
- Contact
Search Results for "overpayment"
In Landmark Class Action Case, a Federal Judge would shut down United HealthCare’s “cross-plan offsetting” practice as a “troubling use of plan assets”, ruling the industry standard practice of “Cross‐plan offsetting creates a substantial and ongoing conflict of interest” for all claims administrators who “simultaneously administer both self‐insured and fully insured plans.” The court also more »
Read The Rest →
On May 10, 2016, in the southern district of Texas Federal Court, United HealthCare administered self-insured ERISA plan, GAP Inc. and its Plan Administrators, Cynthia Radovich and Lesley Dale, were sued for alleged ERISA plan assets “self-dealing and embezzlement”, deceptively concealed through an “illegitimate recoupment scheme that financially rewards United for wrongfully recouping valid benefits”. more »
Read The Rest →
On January 20, 2016, Supreme Court ruled that an ERISA plan cannot sue to recover medical expenses paid on the participant’s behalf after the settlement funds have dissipated. This high court decision also protects hospitals from all health plan’s overpayment recoupment. On January 20, 2016, Supreme Court ruled that an ERISA plan cannot sue to more »
Read The Rest →
On October 24, 2014, Aetna was slapped with a new provider class-action lawsuit alleging ERISA violations and fraud for its overpayment recoupment and offset practice. The suit also alleges Aetna engaged in withholding or offsetting new payments from providers as part of an “enterprise level” scheme of “illegally” withholding payments for covered services. Case Info: more »
Read The Rest →
On September 3, 2014, a California federal judge ruled in favor of a Los Angeles surgical center by dismissing with prejudice, Cigna’s overpayment lawsuit against La Peer Surgery Center after Cigna administered self-insured plans were counter-sued by the surgical center. The dismissal came in spite of the fact Cigna prevailed over the provider’s motion to more »
Read The Rest →
On June 23, 2014, UnitedHealthcare was sued in a new provider class-action for its overpayment recoupment and offset practice, alleging ERISA violations and fraud. The new suit also alleges UHC engaged in withholding or offsetting new payments from providers while misinforming patients. Overpayment offset and recoupments are Healthcare provider’s No. 1 denial; correspondingly, for self-insured more »
Read The Rest →
Overpayment offset and recoupments are Healthcare provider’s No. 1 denial; correspondingly, for self-insured health plans, the No. 1 hidden cost is overpayment recoupment and possible plan assets embezzlement. On May 14, 2014, a federal appeals court upheld a district court’s $6.1 million award for a self-insured ERISA plan against Blue Cross and Blue Shield of more »
Read The Rest →
BCBS IBC Ordered To Permanently Reform Its Overpayment Policies In Provider Class Action In what is being seen as provider’s class action victory in the insurer-provider overpayment battle, an Illinois federal judge finalized a permanent injunction requiring BCBS Independence Blue Cross (IBC) to permanently reform its overpayment policies. BCBS IBC is permanently restrained and enjoined more »
Read The Rest →
On March 28, 2014, a federal ERISA court ruled against BCBS (Independence Blue Cross, IBC) overpayment practice by granting a permanent injunction and ruling in favor of providers in an ERISA overpayment class-action. According to the court’s opinion, the insurer’s “practices come nowhere near substantial compliance with ERISA’s notice and appeal requirement.” This might be more »
Read The Rest →
On November 7, 2013, the United States District Court for the Northern District of Illinois granted in Summary Judgment against BCBS in an overpayment ERISA class action for certain plaintiff providers. The court clarified among other issues that: Providers are entitled to sue under ERISA; Certain BCBS entities completely violated ERISA; These providers are not more »
Read The Rest →
