Balance Billing Take 5, Horizon Blue Cross NJ Suing Non-Pars for Failure to Balance Bill
In response to last week's emails about balance billing, one of the listserv participants has forwarded to my attention a letter from Horizon Blue Cross Blue Shield of New Jersey, dated August 2009, that addresses the routine waiver of applicable co-payments by non-participating providers. The letter details that in response to this activity, Horizon is suing "various" nonparticipating providers, explaining that:
"By waiving member deductibles, copayments and coinsurance amounts, nonparticipating providers are overstating and misrepresenting the actual charges for the services they provided. In the context of Medicare and Medicaid fee-for-service, the Office of Inspector General has already identified the waiver of copayments and deductibles as a potential violation of the Medicare and Medicaid Anti-Kickback Law."
Action taken by Horizon NJ against providers is a prime example of how practices may be targeted for failing to balance bill. It is important that you make every good faith effort to balance bill.
