Received this last week. Anyone wish to comment?
PRESS ADVISORY
For Immediate Release July 29, 2004
Livingston, New Jersey
On July 27, 2004, the Essex County (New Jersey) Superior Court
certified a major class action filed by Clifton pediatrician, John I.
Sutter, M.D., on behalf of over 40,000 physician providers in New
Jersey seeking tens of millions of dollars for improper claims
processing practices committed since 1996 by Horizon Blue Cross Blue
Shield of New Jersey ("Horizon"), the largest managed care organization
and HMO in the state.
In all, the Court certified three classes of physicians seeking redress
from several different claims processing abuses committed by Horizon.
The largest class numbers over 40,000 and seeks monetary damages for
Horizon's consistent failure to pay claims timely as well as the
insurer's failure to pay appropriate interest on late paid claims in
violation of the New Jersey prompt payment statutes (the "Prompt Pay
Claim Class"). In reaching its holding, the Court took note of the
"unrebutted" New Jersey Department of Banking and Insurance Market
Conduct Report which had examined Horizon's claims processing during
2000-2001 only and yet, observed the Court, found "fairly extensive
prompt pay violations" over that time period.
The Court also certified a class of almost 2,000 pediatricians damaged
by Horizon's intentional computerized alteration and manipulation of
bills submitted by the class which was done to pay less to these
doctors and significantly increase the "bottom line" of Horizon (the
"Contract Claim Class").
Finally, the Court certified a class of approximately 3,000 physicians
who have been damaged by the insurer's failure to pay the appropriate
compensation to those physicians who are entitled to monthly payments
based on the number of patients who have selected the physician as
their primary care provider (the "Capitation Claim Class").
The Court also held that the plaintiffs may apply for injunctive relief
on behalf of all physician specialties to prevent Horizon from
unlawfully processing claims in the future. The Court also left open
the opportunity for the plaintiffs to add additional lead class
representatives for other physician specialties (other than
pediatrics), as part of the Contract Claim Class, who have been
similarly affected by Horizon's improper automated claims processing,
thereby increasing the overall amount of monetary damages that can be
sought by the class.
According to lead plaintiffs' class counsel, Eric D. Katz, a partner
at the Livingston, New Jersey law firm of Nagel Rice & Mazie, "the
Court's ruling is very significant to the over 40,000 doctors in this
state that have been subjected to Horizon's claims processing abuses
for many years. Physicians in New Jersey have little choice but to
participate with Horizon in order to have access to its vast patient
base numbering over 3 million. Until now, however, these doctors have
had to helplessly take it on the chin from the insurer because they
have had no legitimate recourse to challenge the manner in which
Horizon does business. But all of that has changed now with this
ruling and we look forward to immediately adding additional physician
specialties as class representatives and moving this case along
swiftly to conclusion and obtaining the best possible relief for our
state's physicians."
In April 2002, Dr. Sutter filed his class action lawsuit against
Horizon. The suit was filed to address the ever-widening healthcare
crisis brought on by the continuing abusive practices of Horizon. The
healthcare providers seek damages against the HMO for its repeated
improper claims processing practices designed to delay and reduce
reimbursement to the healthcare providers for the medical services they
provide. Dr. Sutter alleges that the significant claims processing
abuses by Horizon continue on a daily basis and have jeopardized the
ability of New Jersey healthcare providers to offer quality medical
care to the people of the State of New Jersey. The costs associated
with the delivery of such care are substantial and include payment of
overhead and salaries for nurses and para-medical professionals and
payment for the purchase of supplies, equipment and medicines. These
costs can only be met if Horizon makes prompt and appropriate payment
of claims to the healthcare providers.
For further information and for interviews, please contact lead
plaintiffs' class counsel: Eric D. Katz, Esq., Nagel Rice & Mazie, 301
South Livingston Avenue, Suite 201, Livingston, New Jersey 07039, Tel.
No. 973-535-3100 x122; Fax No. 973-535-3373, and e-mail
.
--
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