SOURCE: Ohio State Chiropractic Association

Ohio State Chiropractic Association

March 18, 2011 11:07 ET

OSCA Leads the Nation With ERISA UHC Class Action and PPACA Compliance for Patient Protection

Ohio State Chiropractic Association (OSCA) Announces Continued PPACA Claims Regulation Training in an Effort to Meet the Deadline on July 01, 2011 for Full Enforcement of Federal Health Reform Law; This is Following the Filing of an ERISA Class Action Against UnitedHealth Group for ERISA Violation; OSCA Leads the Nation's Providers in Advocating Patient's Bill of Right for Healthcare Coverage

COLUMBUS, OH--(Marketwire - March 18, 2011) - On March 16, 2011, Ohio State Chiropractic Association (OSCA) announced that it was sponsoring the second PPACA Claims Regulations Claims Specialist training in an effort to meet a July 01, 2011 deadline for full enforcement of the Federal Health Reform Law, Patient Protection and Affordability Care Act (PPACA). PPACA is the new Federal Patient's Bill of Right, for almost all non-Medicare and non-Medicaid health claims and OSCA believes that it is critically important for health care providers as well as their patients to understand what is involved in this important new legislation. Earlier this year, on Jan. 24, 2011, OSCA and Dr. Judson G. Sprandel, II, D.C., past president of OSCA, filed a class action lawsuit against UnitedHealth group for the alleged violation of the Employee Retirement Income Security Act of 1974 ("ERISA"), arising from its post-payment audit and recoupment practices. The OSCA's Board of Directors unanimously (19 - 0) voted to file this suit in early January. That decision was driven from a commit to protect the rights of its members and the insured they treat through use of ERISA, the federal statute governing most private employer benefit plans. On Feb. 8, 2011, the Congress of Chiropractic State Associations ("COCSA") announced that it had voted to join OSCA in pursuing the ERISA Class Action on behalf of providers nationwide. COCSA represents chiropractic member associations in in all 50 states. The American Medical Association described the pending class action in its member publication on March 4, 2011, stating that "the lawsuits could have implications for physicians who are the target of the same kind of collections, even though the plaintiffs are chiropractors." Through the ERISA class action against United and the PPACA Claims Appeal Compliance training OSCA is leading the nation in advocating for appropriate patient care and against abusive insurance practice.

"We believe in full compliance with federal laws by education and the full enforcement of federal laws by litigation for any violators," said Mr. Bharon Hoag, Executive Director of the OSCA.

The Second OSCA PPACA / ERISA Claims Specialists training will be held on April 28, 2011 in Columbus, OH for its PPACA / ERISA Committee Members. Once the eight module trainings are completed the OSCA will begin training all members and providers in the State. OSCA finished its first session in PPACA / ERISA training on March 3, 2011.

"OSCA is investigating more complaints on non-compliant and abusive insurance and managed care practices from its member and non-member providers as well as chiropractic patients, and looking into possibly more ERISA or other class actions against any violators and abusers of federal and state laws," said Mr. Hoag, adding that "our members are counting on us to lead and fight for their patients."

Judson G. Sprandel, II, D.C., past President of OSCA, concurs, stating that "OSCA is leading the nation for all specialties of providers in PPACA compliance and ERISA enforcement on behalf of patients around the country, no matter the specialty affected."

The OSCA's ERISA class action was originally filed on Jan. 24, 2011, in the United States District Court, District of New Jersey, Case 2:11-cv-00425-FSH-PS, by Pomerantz Haudek Grossman & Gross LLP, one of the nation's preeminent class action law firms and a leader in combating the abuses of the health insurance industry on behalf of chiropractors. Pomerantz seeks to represent a nationwide class of all health care providers who have been subjected to improper demands by UnitedHealth Group to repay previously paid health care benefits for services provided to UnitedHealth Group subscribers, only to have such funds forcibly recouped by the withholding of future payments from unrelated claims in alleged violation of ERISA.

PPACA claims regulations will govern all claims processing, reimbursement, denials and appeals for almost all healthcare claims outside Medicare and Medicaid, the most significant reimbursement law changes in 45 years since Medicare was created. The PPACA claims regulations became effective on 09/23/2010 with a deadline on July 01, 2011 as full enforcement grace period.

On July 23, 2010 the United States Department of Labor released a bulletin entitled: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act; Interim Final Rule. You will find a copy of this bulletin here: http://webapps.dol.gov/FederalRegister/HtmlDisplay.aspx?DocId=24056&AgencyId=8&DocumentType=2 
These interim final regulations are effective on September 21, 2010.

A copy of the official Class Action Complaint against UnitedHealth Group can be found at http://www.erisaclaim.com/UHC_Complaint.pdf

On Feb. 8, 2011, COCSA has voted to join OSCA's ERISA class action, representing its members, State Chiropractic Associations in all 50 states, in combating alleged ERISA violations in overpayment recoupment abuses. A copy of this press release can be found here: http://www.chiroeco.com/news/chiropractic-news.php?id=10848

On March 4, 2011, American Medical News, published by AMA, reported OSCA's ERISA class action, stating: "This lawsuit could have implications for physicians who are the target of the same kind of collections, even though the plaintiffs are chiropractors." A copy of this publication can be found here: http://www.ama-assn.org/amednews/2011/02/28/bise0304.htm

Located in Columbus, OH, the Ohio State Chiropractic Association (OSCA) is the only Chiropractic State association with hundreds of Doctor Members statewide. OSCA represents its members through advocating and promoting chiropractic science and healthcare services, supporting and protecting its members through compliance assistance in claims educational guidance and appeals, and patient advocacy. OSCA provides accurate information and advice to the state legislators and prospective patients in the State of Ohio.

Information regarding the OSCA and membership benefits can be accessed at http://www.oscachiro.org.

Contact Information

  • Contact:
    Executive Director
    Bharon Hoag
    (800) 837-6721
    (614) 229-5290