Pennsylvania Chiropractic Association Wins Federal Injunction Against Independence Blue Cross
Written by Editor   
Friday, April 04, 2014 12:00 AM
The American Chiropractic Association (ACA) announced that on March 28, 2014, in the case of Pennsylvania Chiropractic Association, et al., v. Blue Cross Blue Shield Association, et al., Judge Matthew F. Kennelly, District Judge, for the United States District Court (Northern District of Illinois), granted the Pennsylvania Chiropractic Association's (PCA) request for a permanent injunction to address Independence Blue Cross' (IBC) inadequate notice and appeal procedures and practices regarding recoupment of paid benefits from doctors of chiropractic and other health care providers.
The PCA commenced the action in 2009, under the federal Employee Retirement Income Security Act (ERISA), and alleged that IBC violated, and continues to violate, notice and appeal requirements under ERISA in recouping payments from PCA members. Judge Kennelly determined that when IBC recoups payments from PCA members without adequate notice and appeal, IBC deprives them of monetary benefits along with information supporting the adverse claim determination and the right to an appropriate appeal.  Judge Kennelly held PCA is entitled to a permanent injunction to address IBC's ERISA violations. PCA will submit a proposed injunction by April 11, 2014. IBC will reply and Judge Kennelly will decide the injunction specifics.
Upon learning of the decision, ACA President Anthony Hamm, DC called the court's decision a "significant win for the profession and the patients we serve."  Hamm added, "I commend the PCA, its leadership and its members, for its continued persistence and tireless efforts in ensuring the profession is treated fairly and equitably."
One of the attorneys for PCA, Brian Hufford, also represents the ACA in a pending legal action seeking similar injunctive relief. Dr. Hamm noted that the decision is "extremely important and could have wide-ranging implications, including in the pending action we have brought on behalf of the ACA against United Healthcare challenging its post-payment audit and recoupment practices under ERISA."