One topic of concern to the chiropractic community, and all medical providers, is the use of audits or retrospective reviews by health insurers as a means of pursuing refunds from medical providers. Mr. Quadrino addressed the legal obstacles faced by insurers who cannot establish fraud in the billing and claims process. He also discussed the role of ERISA, the federal law governing group employee benefits, which can be employed to shield certain lawsuits by health insurers.
A second topic of the seminar focused upon the many advantages that medical providers have in pursuing collection of denied claims from health insurers. ERISA can also play a major role here, shaping the rights of the patients and their doctors and potentially the outcome of litigation.
Mr. Quadrino also reviewed the class actions currently pending against the health insurance industry and their potential impact upon the rights of medical providers.