Business

Pennsylvania Blues plan ordered to back off from clawbacks

A mediator ruled that efforts to recoup overpayments made more than 18 months earlier violated the plan's class-action settlement.

By Emily Berry — Posted Sept. 11, 2009

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Some Pennsylvania physicians faced with clawbacks from Independence Blue Cross will get a break following a mediator's ruling that some of the plan's collection efforts violated a 2007 class-action lawsuit settlement.

A mediator ruled Aug. 13 that the Philadelphia-based plan could not collect for overpayments made more than 18 months earlier because doing so would violate a class-action settlement over payment issues between physicians and the BlueCross BlueShield Assn., reached in 2007 and finalized in June this year.

Independence Blue Cross spokeswoman Karen Burnham said the company does not comment on matters under litigation.

Independence earlier this year sent letters to physicians at 1,483 practices notifying them that the plan intended to collect overpayments made for surgical services, some of which were in excess of $100,000, said Dennis Olmstead, chief economist and vice president for practice economics and payer relations for the Pennsylvania Medical Society.

Physicians in some cases disputed the accuracy of the overpayment claim. At a minimum, the medical society believed that collections for payments made prior to October 2007 would violate the class-action settlement, he said.

After trying unsuccessfully to work with the plan directly, the group filed a compliance dispute, Olmstead said. Dispute facilitatory Deborah Winegard was out of the country and could not be reached at this story's deadline.

The dispute eventually went to mediation with attorney Martin Quinn, Olmstead said.

The week after a hearing over the dispute, Quinn ruled that collecting for any payments made prior to October 2007 would indeed violate the terms of the settlement.

Olmstead said some details of the deal remain unclear, including how the plan will repay physicians who already succumbed to Independence's collection demands, and when the plan will send out new notices for remaining overpayment claims.

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn