State medical societies strategize against collector

Legal action is one option against Health Research Insights.

By Emily Berry — Posted May 18, 2009

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Medical societies in several states are talking about how to fight back against a Tennessee-based firm hired by self-insured companies to collect perceived overpayments to physicians.

Doctors in Georgia were the first to be contacted by Health Research Insights, and the Medical Assn. of Georgia is "exploring all legal remedies," said Donald Palmisano Jr., MAG general counsel.

The Tennessee Medical Assn. said HRI has contacted its state's physicians on behalf of Averitt Express, a trucking company. Averitt didn't return phone calls seeking comment.

Georgia-Pacific, which had hired HRI, has asked the firm to stop its work while the Atlanta-based manufacturer examines legal issues.

Representatives from medical groups in multiple states have spoken with their counterparts in Georgia and Tennessee to discuss HRI.

"It's fair to say we have a lot of questions and concerns about whether [HRI's] practices are going to be legal," said Julie Reed, general counsel for the Indiana State Medical Assn. HRI also has caught the attention of state medical societies in Texas, Massachusetts and New Jersey, where HRI either has been working on behalf of a company or is believed to be planning to do so.

HRI's chief executive officer, Theodore Perry, PhD, declined to comment. But HRI's Web site cites the Employee Retirement Income Security Act as the basis for its authority to claim overpayments on behalf of self-insured groups. In most but not all cases, self-insured health plans are governed by ERISA and not by state insurance laws.

On its Web site, HRI says it runs an algorithm that identifies where upcoding is likely to have occurred, and then assigns a dollar amount it believes physicians should repay. It does not examine individual claims.

State laws that regulate insured employee benefit plans often do limit how far back a payer can seek a "clawback" payment -- in Georgia, it's only one year -- but ERISA has no such statute of limitations.

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