DOL Advises Court That Aetna Must Comply with ERISA for Overpayment Demands
On November 30, 2012 the Department of Labor (DOL), filed an amicus bBrief in the Court of Appeals for the Third Circuit in support of plaintiff providers in an overpayment ERISA class action. The DOL’s position on the pertinent issues includes:
- 1. Aetna must comply with federal law ERISA for all post-payment overpayment demands due to ERISA plan coverage dispute guidelines.
- 2. A healthcare provider with a valid assignment has federal rights to ERISA appeals and lawsuit in federal court.
- 3. Post-payment, retroactive, overpayment demand is an ERISA adverse benefit determination, triggering full and fair reviews guaranteed under ERISA.
- 4. Aetna’s hypothetical state law claims of fraud may not short circuit federal ERISA procedural protections for both in-network and out-of-network providers and patients.
Learn how AVYM can help you prevail over post-payment denials under ERISA here.
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