New Jersey plan wants repayment from cardiologists

The legal fight is over money Horizon Blue Cross Blue Shield says it paid in error to doctors. The medical society is demanding proof.

By Robert Kazel — Posted Feb. 21, 2005

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Horizon Blue Cross Blue Shield of New Jersey wants its money after all. Now.

Impatient over a conflict with about 600 cardiologists that landed in court last fall, the company has asked a judge to let it collect $16 million in alleged overpayments to the physicians despite the insurer's previous agreement not to resort to involuntary set-offs to recoup the money while the matter is being litigated.

On Feb. 1, the plan's attorneys asked a state judge to permit it to unilaterally take back the funds it says it's owed by the doctors -- in some practices, hundreds of thousands of dollars. The Medical Society of New Jersey, in conjunction with the New Jersey Chapter of the American College of Cardiologists, had filed suit against the Blues plan in November 2004, asking the court to block retrospective collection efforts by the plan and to compel the company to prove that the overpayments were real.

Horizon filed a countermotion arguing that not collecting the payments was a burden on the Blues plan, and that the cardiologists' lawsuit should be thrown out.

The state medical society will continue with its original suit, with a court date scheduled for Aug. 30.

Horizon says it overpaid cardiologists in 273 practices for cardiac catheterizations because of computer problems in 2003 and part of 2004. Horizon spokesman Tom Rubino said the company changed course on involuntary set-offs because it grew pessimistic that a settlement could be reached.

The medical society has filed requests with Horizon to get lists of fee schedules, lists of all errors made in claims processing, documentation of how the mistakes were made, and explanations of the plan's payment policies, said Steve Kern, attorney for the medical society. The information has not been received, he said.

A settlement arrangement proposed in January by the Blues plan, the details of which neither side would discuss, was rejected by the medical society. "Everyone thought it was most inadequate," Kern said.

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