HMO Complaints
Press Releases:
Cardiologists SUE Horizon for its Recoupment Efforts
MSNJ, the American College of Cardiologists (NJ), and several New Jersey cardiology practices filed suit against Horizon, alleging that Horizon is wrongfully attempting to recoup $15 million in fees from cardiologists. Horizon took the position that overpayments were due to a computer error and that it could recoup the overpayments, but agreed, in a court order, to refrain from certain recoupment efforts.
MSNJ has asserted in a legal brief that documents obtained during discovery indicate that Horizon willfully changed its characterization of the cardiologists’ role during cardiac catheterizations from surgery to the reading and interpretation of the catheterization data to decrease the reimbursement rate. Subsequently, Horizon asked the court to seal the brief, but the judge ruled against Horizon.
On March 15, 2005, Horizon asked the court to relieve it from its court-ordered agreement to discontinue certain recoupment efforts. MSNJ’s responsive legal brief asserts that Horizon’s action, claiming a computer error instead of acknowledging corporate decision-making, amounts to fraudulent behavior toward physicians and that it has misrepresented the facts to the court. In the interim, Horizon must continue to honor its agreement to refrain from recouping any monies it allegedly overpaid for cardiac catheterizations.
Recently, MSNJ moved to amend its complaint. Among other new allegations of wrong-doing, the complaint seeks class-action lawsuit status for New Jersey cardiologists.