Offsetting of Current Benefits Stopped

One of the nation’s largest health plan administrators starting taking current monies earmarked for payment to a medical provider and grabbed it for itself, alleging overpayment on unrelated past claims. This tactic of offsetting, which is occurring nationally with many health insurers, is actually an unlawful practice. The medical provider hired Quadrino Law Group for help.

Richard Quadrino is dedicated to enforcing ERISA and its federal health claims regulation and fighting offsetting in various ways. In this case, the client decided that quick and firm action was needed to make a statement that the law would be enforced and that the provider should assert it legal leverage, under ERISA.

Not only was the offsetting unlawful, but the alleged debt itself — the amount that the insurer wanted to “take back” — was not legally valid, as is the case in most circumstances in which Quadrino Law Group represents medical providers. So a lawsuit was drafted and filed, seeking a legal declaration from a federal court that no money was owed back to the health plan and that the tactic of offsetting needed to be declared illegal and stopped.

Within 24 hours, a conference call took place between counsel for the insurance company and Mr. Quadrino, resulting in an immediate stoppage of the offsetting. This result allowed the medical provider to maintain leverage and cash flow while the dispute was determined, on the medical provider’s agenda, using ERISA, and in court with the medical provider as the Plaintiff, pressing claims that the health plan was acting illegally.

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