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PRESS RELEASE
For Immediate Release January 7, 2008
Roseland, New Jersey
On January 7, 2008, Michael H. Kirsch, D.D.S. filed his second class action on behalf of thousands of New Jersey dental providers against Horizon Blue Cross Shield of New Jersey (“Horizon”) -- the largest managed care organization in the state -- seeking tens of millions of dollars in damages for Horizon’s improper claims processing tactics designed to underpay dentists for the critical services they render to their patients. The complaint was filed in Essex County Superior Court. In the lawsuit, Dr. Kirsch exposes several illegal claims processing practices used by Horizon over the last six years or longer, including the carrier’s deliberate failure to pay dentists in accordance with their fee schedules and the insurer’s intentional manipulation and alteration of dentists’ bills by employing nefarious tactics such as the “bundling” or combining of services in order to pay for only one service even when multiple services were required to treat the patient and/or the “downcoding” of services from the procedure that was actually rendered by the dentist to a procedure that were never provided.
In his first lawsuit filed against Horizon, Kirsch was appointed lead plaintiff in October 2005 in the 8,000 member certified class action lawsuit captioned Kirsch v. Horizon, Essex County, Docket Number L-4216-05 (“Kirsch v. Horizon I”). That case, also brought on behalf of New Jersey dentists, seeks tens of millions of dollars for Horizon’s blatant and continuing violations of New Jersey’s prompt payment laws, most notably the HINT Act, committed since 1999. The HINT Act requires Horizon to pay or deny claims pursuant to specific statutory timeframes and requirements, or waive the right to contest payment. Kirsch v. Horizon I is currently in discovery. Dr. Kirsch is also involved in class action litigation against one other major New Jersey dental carrier.
“Unfortunately, organized dentistry has failed to protect the individual dentist by allowing insurance companies to set arbitrary rules to reduce payments for patient care. While the costs of delivering dental care steadily rise, insurance companies continue to deny fair compensation for what we do. Those ‘participating providers’ willing to accept lesser fees for their services are then often faced with denials and reduced payments. Fighting the insurance company one claim at a time is an impossible task for dentists like me and our only option left is through our legal system.” said Dr. Kirsch.
Dr. Kirsch’s attorney, Eric D. Katz, agrees: “This second class action filed by Dr. Kirsch on behalf of New Jersey dental providers is not surprising as Horizon’s unequivocal mission statement is to unfairly treat providers in order to increase its own bottom line. Dr. Kirsch must be commended for stepping up to the plate on behalf of thousands of his professional colleagues over the last several years to battle these abuses that jeopardize access to quality dental care.”
Mr. Katz, a partner in the law firm of Mazie Slater Katz & Freeman, in Roseland, New Jersey, is also lead class counsel in Kirsch v. Horizon I and has been appointed lead class counsel in two other provider/managed care class actions. The first case, John Ivan Sutter, M.D. v. Horizon Blue Cross Blue Shield, brought on behalf of some 60,000 physicians, settled in February 2007 for more than $39 million dollars worth of claims processing business reforms instituted by Horizon. The other, John Ivan Sutter, M.D. v. Oxford Health Plans, is currently proceeding in discovery as a class arbitration -- one of the first of its kind in the country -- brought on behalf of 20,000 physicians against Oxford Health Plans.
For further information and for interviews, please contact: Eric D. Katz, Esq., Mazie Slater Katz & Freeman, 103 Eisenhower Parkway, Roseland, New Jersey, tel. no. 973-228-9898 and e-mail ekatz@mskf.net.
PRESS ADVISORY
For Immediate Release November 14, 2005
Roseland, New Jersey
On October 21, 2005, Judge Stephen J. Bernstein of the Superior Court of New Jersey, Essex County, certified a major class action filed by Caldwell Oral and Maxillofacial Surgeon, Michael H. Kirsch, D.D.S, on behalf of several thousands of New Jersey dental providers seeking tens of millions of dollars from Horizon Blue Cross Blue Shield of New Jersey (“Horizon”), the largest managed care organization in the state, for its continuing improper and untimely claims processing practices in violation of New Jersey’s prompt payment laws, most notably the HINT Act, since 1999.
The certified class consists of all participating and non-participating dental providers and dental provider groups, regardless of specialty, who provided services to Horizon insureds and subscribers under any of Horizon’s dental and medical plans. Dr. Kirsch filed this class action to address the ever-widening healthcare crisis brought on by the continuing abusive claims processing practices of Horizon that have repeatedly violated the HINT Act since its enactment in 1999.
Pursuant to the HINT Act, Horizon must process claims and advise providers of its payment decisions within certain statutory timeframes, or it waives the right to contest payment for these claims. In addition, Horizon must pay statutory interest on claims that it pays outside of the statutory timeframes. The damages sought by the class will include not only statutory interest on late paid claims, but also payments for the countless claims which can no longer be contested by Horizon as a matter of law.
“Horizon’s failure to pay claims timely in accordance with the New Jersey prompt payment laws jeopardizes the ability of New Jersey dental providers to offer quality dental care to the people of the State of New Jersey. The costs associated with the delivery of such care are substantial and include payment of overhead and salaries as well as payment for the purchase of supplies and equipment. These costs can only be met when Horizon makes prompt and appropriate payment of claims to the dental providers,” noted lead class counsel, Eric D. Katz, a partner in the law firm of Nagel Rice & Mazie in Roseland, New Jersey.
"My costs for providing quality patient care have skyrocketed in the last several years. This is primarily due to salaries and benefits for additional staff required just to follow-up on unpaid and unanswered claims. By uniting New Jersey dentists together in this Class Action suit we can raise public awareness of the insurance companies' delays and frustrating tactics, and change the way these managed care organizations abuse the very doctors who are treating their subscribers," says lead plaintiff, Dr. Michael H. Kirsch.
This is the third significant provider class action certified against a managed care organization in New Jersey since 2004 to address improper claims processing. In July 2004, a 65,000-physician class was certified against Horizon asserting substantially similar claims as those asserted here by Dr. Kirsch. That case is scheduled to proceed to trial in March 2006. In January 2005, a 15,000-physician class was certified against Oxford Health Plans in arbitration, one of the first managed care class arbitrations in the country. The arbitration is currently in discovery. Mr. Katz is lead class counsel in those cases as well.
For further information and for interviews, please contact lead class counsel:
Eric D. Katz, Esq., Mazie Slater Katz & Freeman, 103 Eisenhower Parkway, Roseland, New Jersey, tel. no. 973-228-9898 and e-mail ekatz@mskf.net.
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