SOURCE: Ohio State Chiropractic Association

Ohio State Chiropractic Association

April 26, 2011 11:03 ET

OSCA Sues UnitedHealth Group & OptumHealth in ERISA Class Action for Abusive Overpayment and Claims Practice

Ohio State Chiropractic Association (OSCA), Joined by Other Providers, Associations, DME Provider and Ambulatory Surgical Center (ASC), Filed Its First Amended ERISA Class Action Complaint Against UnitedHealth Group and OptumHealth, for ERISA Violations in Its Abusive Overpayment Recoupment, Pre-Service Plan and Concurrent Claim Denials

CLEVELAND, OH--(Marketwire - Apr 26, 2011) - On April 22, 2011, the Ohio State Chiropractic Association (OSCA), along with Dr. Judson Sprandel, II, D.C., past president of OSCA, as named class plaintiffs, joined by other providers, national and state associations, including COCSA & ACA, filed its first amended ERISA Class Action Complaint against UnitedHealth Group and its subsidiaries, including OptumHealth, for ERISA violations in its abusive overpayment recoupment, pre-service plan and concurrent claim denials. On Feb. 8, 2011, the Board of the Congress Of Chiropractic State Associations ("COCSA") voted to join OSCA's original class-action. OSCA shares American Chiropractic Association's (ACA) vision on the OptumHealth Claims in this First Amended Complaint. OSCA will hold conference calls and free webinars to discuss this historical landmark legal action and ERISA & PPACA compliant steps to be taken to appeal improper denials before the final court decision is available.

The first amended class complaint (Premier Health Center, P.C. et al v. Unitedhealth Group et al, Case 2:11-cv-00425-FSH -PS Doc. #15), filed on 04/22/11 in U.S. District Court of New Jersey, expands the original lawsuit, filed on Jan. 24, 2011, with additional class plaintiffs, additional defendant and additional complaints, to include DME and ambulatory surgical center plaintiffs, defendant OptumHealth, and pre-service & concurrent claim denial ERISA violations.

The original action was previously filed on Jan. 24, 2011 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 a group of chiropractors, and the Ohio State Chiropractic Association (OSCA). Pomerantz seeks to represent a nationwide class of all health care providers who have been subjected to improper pre-service and concurrent claim denials by OptumHealth, and overpayment 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 the Employee Retirement Income Security Act of 1974 ("ERISA"), the Federal law governing private employee benefit plans.

"OSCA filed this ERISA class action lawsuit because UHC/OptumHealth demanded refund and withhold payments for the alleged overpayment without any ERISA compliance, and also denied our members' pre-certification or concurrent claims claim without any ERISA compliance," said Dr. Otto J. Schmidt, DC, President of OSCA.

"OSCA is still investigating various complaints from OSCA member and nonmember providers, and will file more similar class actions against any other violators of federal law ERISA and PPACA," added Mr. Bharon Hoag, Executive Director of OSCA.

UnitedHealth Group, which acquired the health insurance business of Health Net of the Northeast in December 2009, is the nation's largest private health plan by revenue. The action alleges that the post-payment audit and review process as applied by the Defendants violates ERISA in that its repayment demands are retroactive adverse benefit determinations that particular services are not covered under the terms of the United and Health Net health care plans, but without proper appeals or other protections otherwise available under ERISA for both self-funded and fully insured health care plans offered through private employers. Furthermore, Plaintiffs also allege that United and OptumHealth failed to comply with ERISA regulations in denying pre-service and concurrent care claims from chiropractic providers.

"ERISA establishes the procedures that insurance companies must follow when making benefit determinations -- whether prior to payment or retroactively," says Plaintiffs' counsel, D. Brian Hufford of Pomerantz. "The Defendants here, as is true for many insurance companies, are violating their ERISA obligations in order to recover funds that simply do not belong to them."

A copy of the OSCA's initial Class Action Complaint is available at

A copy of the OSCA's First Amended Class Action Complaint is available at

By far, chiropractic plaintiffs have led all other healthcare providers in seeking judicial guidance and legal victories against abusive overpayment recoupment crisis faced by all healthcare providers. OSCA welcome COCSA, ACA and Missouri State Chiropractic Association (MSCA), as well as other Durable Medical Equipment (DME) and ambulatory surgical center (ASC) providers for their leadership by joining OSCA in this historic landmark class-action for all professions, by asserting their rights, through representational standing, to obtain appropriate equitable relief to address the abuses at issue on behalf of their Association or Industry members in all 50 states. OSCA is also delighted in overwhelming participating actions by other providers of other specialties, as OSCA's ERISA class action will benefit not only chiropractic providers but also all of the doctors and hospitals in U.S.A.

On March 4, 2011, AMA reported the importance of OSCA's initial ERISA class actions for all physicians, stating: "This lawsuit could have implications for physicians who are the target of the same kind of collections, even though the plaintiffs are chiropractors." (

Located in Columbus, OH, the Ohio State Chiropractic Association (OSCA) is the leading 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 or by contacting Executive Director, Bharon Hoag at (800) 837-6721 or (614) 229-5290.

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