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District Court Holds ERISA Plans Can't Recoup Overpayments from Healthcare Providers without Following Procedural Steps
Arent Fox 
Apr. 13, 2014
"[A] federal district court in Illinois recently held that health plans may not simply unilaterally recover overpaid funds from health care providers, but rather must provide the appeal and other procedural protections required under the [ERISA] ... While it has long been the rule that ERISA's appeal and other procedural rights must be allowed when ERISA plans issue 'adverse benefit determinations' on claims submitted for reimbursement, it has not always been clear that these same procedures are required with respect to recoupment decisions." [Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, No. 09 C 5619 (N.D. Ill. Mar. 28, 2014)]
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