Hanover Park, IL (PRWEB) June 21, 2011

On June. 20, 2011, the federal District Court in New Jersey allowed a provider ERISA overpayment class action lawsuit against Aetna, Inc. to proceed under ERISA (ASSOCIATION OF NEW JERSEY CHIROPRACTORS et al v. AETNA, INC. Et al, Case 3:09-cv-03761-JAP-TJB, Document 90, Filed 06/20/11). The court dismissed provider’s RICO claims and granted Aetna’s motion to enforce a settlement agreement and release from one provider and motion to compel arbitration and to dismiss two provider’s claims. The federal court ERISA class-action ruling is timely significant for July 1, 2011, the official enforcement date for new federal health reform laws, health-care claims and appeals regulations. ERISAclaim.com provided the ERISA compliance assistance for many provider class representatives in this case, and it will provide free webinars to examine the legal and market impacts of the court ERISA ruling in connection with new PPACA & ERISA claim regulations.

“This court ruling underscores the importance of providers’ ERISA claims & appeals practice for both unpaid claims and the alleged overpayment refund disputes, especially before the July 1, 2011, the official enforcement date of PPACA claims regulations,” says Dr.  Jin Zhou , president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

According to the court paper, with respect to provider’s ERISA claims, the court states in part:

“The plaintiffs in this case are licensed medical providers or chiropractic professional associations. Defendant Aetna is an insurer that offers, underwrites and administers commercial health plans (“Plans”) through which healthcare expenses incurred by Plan participants for services covered by the Plans are reimbursed by Aetna pursuant to the terms of the Plan.”

“Overall, Plaintiffs are challenging Aetna’s practice of demanding the repayment of healthcare benefits that Aetna later determines had been improperly paid to the provider. Plaintiffs allege that Aetna is required to and failed to comply with certain procedural protections provided by ERISA in demanding such repayment from providers. For example, Plaintiffs assert that Aetna, prior to requesting repayment from a provider, must issue a revised Explanation of Benefits (“EOB”) to the insured. Plaintiffs also challenge Aetna’s “prepayment review” process as to the individual providers, under which Aetna reviews records before it pays a claim submitted by a provider from whom Aetna has requested repayment.”