Pennsylvania Health Law Lawyer & Attorney : Fox Rothschild LLP : serving Philadelphia, Pittsburgh, Allentown, Erie, Upper Darby Twp

Think hanging on to insurance overpayments is no big deal?  Think again.  According to a press release by the U.S. Attorney for the Eastern District of Tennessee, one cardiology practice that neglected to refund overpayments to federal and private insurers and patients has learned a valuable ... and expensive lesson: if you have money you're not entitled to, give it back!  East Tennessee Heart Consultants has reportedly entered into a settlement with the US Attorney for $2.9 Million in connection with the alleged failure to refund overpayments.  For tips on investigating and refunding overpayments, click here.

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According to a December 22, 2006 press release by the Pennsylvania Orthopaedic Society, 25,000 Philadelphia area doctors, chiropractors, therapists and others who provide care for patients insured by Independence Blue Cross (IBC) were notified by e-mail that they will now be able to view IBC's fee schedule online.  Disclosure of its standard fee schedule is one of the terms IBC agreed to in settlement of a 2001 class action settlement. 

For many physicians and other providers in the Philadelphia region who are paid on the standard fee schedule, this information should serve as a useful tool to ensure that they are receiving full reimbursement.  However, although IBC is required to disclose its standard fee schedule, they are still free to negotiate special fee schedules on a case by case basis and they have no obligation to disclose these special arrangements.  Nevertheless, when it comes to third party payor arrangements, the more transparency  the better.

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