A New Jersey medical society and several Garden State cardiology groups on Monday filed a civil lawsuit against that state's Blues plan, which in October demanded payment within six weeks of $15 million in alleged overpayments it made to cardiologists dating back to January 1999.
Newark, N.J.-based Horizon Blue Cross and Blue Shield of New Jersey sent letters to more than 100 cardiologists claiming that an audit uncovered overpayments for certain coded cardiac catheterization claims and that Horizon would seek to recover those claims by Nov. 30 (recently amended to Dec. 10). Horizon told the cardiologists that the overpayments resulted from a computer error.
Horizon demanded payment or threatened to impose a "self help remedy" that would automatically adjust future claims and deduct the alleged overpayments over time.
In their complaint, the Medical Society of New Jersey, Morristown (N.J.) Cardiology Associates and Diagnostic and Clinical Cardiology of West Orange, N.J., request a judicial order to halt the self help remedy and prove Horizon's entitlement to any alleged overpayments. The doctors contend that under contractual arrangements, they have up to 90 days to repay overpayments and should have the right to inspect the documentation for money they allegedly owe.
To date, the insurer has not proven that they made overpayments, the medical society said in a news release. "If Horizon prevails in recouping this $15 million from cardiologists this time, nothing would stop them or any insurer from going after other specialties next," said society President S. Manzoor Abidi, M.D. "Our obligation is to confront and stop this abuse of physicians and the healthcare system."
The Morristown practice alone would owe $400,000, the medical society said. Horizon alleged no fraud.
In a news release, Horizon spokesman Thomas Rubino said the insurer is disappointed the Medical Society of New Jersey decided to "engage in costly litigation." Rubino said the doctors' allegations "are without merit" and that the health plan would defend itself in court.