In the ongoing battle surrounding audits by health insurers of medical providers, health plans and health insurers are now employing the unlawful technique of offsetting. This involves the health insurer issuing EOBs that show that payments would be due — but no check is issued — because the insurer offsets the payments with debt it alleges to be due in connection with a past audit. These are prohibited and unlawful acts under the Employee Retirement Income Security Act (“ERISA”).
Health insurers are typically unaware that they are “claim fiduciaries” under ERISA. When they process and handle health insurance claims, they are dealing with ERISA governed benefits under employee benefit plans. Thus, ERISA is the governing law. Health insurers have been engaging in conduct that they either don’t know is unlawful or do not think that the medical providers will hire ERISA experts to discover their illegality.
We are pressing these issues throughout the United States, with great success, on behalf of medical providers facing audits and various associated aggressive and unlawful tactics by health plans (self-insured) and health insurers (insured plans).
Schwartz, Conroy & Hack is the premier disability insurance law firm in the United States. To see how we can help you, contact us.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schwartzlawpc.com