Hijacked Funds of $2.1 Million Released And Paid to Medical Provider
Some health plan payors (claims administrators / health insurers) use the tactic of withholding all payments to a medical provider “pending investigation”. This is an obviously unlawful practice because it violates the federal claims procedures that govern claims under all commercial health plans (whether self- insured or insured) and government employer sponsored plans.
Many of the claims activities and tactics used by these payors can be shown to be unlawful using both ERISA principles and the governing federal claims regulations. So when we were hired by a medical provider who had $2.1 million hijacked by a payor / claims administrator, we wrote to them demanding the release of the funds and placing them on notice of the applicability of ERISA.
Without the need for the filing of a lawsuit, the claims administrator knew how we would legally press the issue, based upon its correspondence with us and other related litigation. Therefore, the administrator promptly released the funds after receiving our correspondence.