Fraud Investigation Halted and Withheld Monies Paid to Provider
A provider was under a fraud investigation by a major health insurer and all checks it received from the insurer were bouncing at the bank when deposited by the provider. Within weeks, hundreds of thousands of dollars in checks were bounced, and the insurer was threatening to pursue a large refund from the provider of over $1 million.
Mr. Quadrino was hired to review the matter and see if it could be resolved without a lawsuit. After his review and his own investigation, Mr. Quadrino drafted lengthy communications to the insurer, describing the applicable law regarding ERISA, audits, fiduciary duties, the illegality of issuing checks and bouncing them, and the legal inability of the insurer to recoup funds.
The insurer hired outside counsel, previously known to the Quadrino Law Group from prior dealings in other matters, and discussions and negotiations occurred regarding the various issues involved.
Mr. Quadrino was able to persuade the health insurance company, without filing a lawsuit, that it should give up its claim for over $1 million from the provider and actually render payment to the provider on the claims for which the checks were bounced. The resolution was highly favorable to the provider, demonstrating, yet again, the leverage that Quadrino Law Group can assert using its many years of ERISA and insurance industry experience and contacts.