BCBSNC Files Lawsuit Against Lumberton Doctor

CHAPEL HILL, N.C. – Blue Cross and Blue Shield of North Carolina (BCBSNC) is seeking to recover millions of dollars in overpayments made to a Lumberton Ear Nose and Throat (ENT) specialist and two medical practices in Robeson County. In a motion filed today in Superior Court in Orange County, the insurer asks to amend an earlier complaint against Anita L. Jackson, M.D. to allege false and excessive billing by the doctor.
 
BCBSNC identified evidence of significant overcharging for certain services through medical claims submitted by Jackson. The doctor refused requests by BCBSNC to audit needed medical and billing records. As a result, the insurer filed a lawsuit - BCBSNC v. Anita L. Jackson, MD, Greater Carolina Ear, Nose & Throat, P.A. and Carolina Family and Urgent Care, Inc. - on March 18 asking the court to direct Jackson to cooperate with its request to audit records.
 
Jackson’s attorney responded to BCBSNC by filing a countersuit alleging that the insurer has withheld payments for medical claims submitted by Jackson - including the same claims for which BCBSNC is seeking records. Following Jackson’s countersuit, BCBSNC is seeking to amend its lawsuit, to allege claims for breach of contract, false and excessive billing, fraudulent misrepresentation and concealment, negligent misrepresentation, civil conspiracy, unfair and deceptive trade practices and state and federal Racketeer Influenced and Corrupt Organization Acts (RICO). The lawsuit seeks to recover compensatory and punitive damages.
 
"We have tried for months to work with Dr. Jackson and her attorney to give her an opportunity to back up these medical claims," said Maureen O’Connor, BCBSNC senior vice president and general counsel. "Her refusal to reasonably cooperate with us and her decision to withhold the requested billing information left us with no choice but to file this action."
 
In her contract with BCBSNC, Jackson agreed - as do all doctors in the insurer’s network - to cooperate with audits of medical and administrative records. "We have an obligation to our customers to ensure that doctors in our network bill fairly and accurately," said O’Connor. "That’s a responsibility we take very seriously."
 
 
About Blue Cross and Blue Shield of North Carolina:
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.1 million members, including approximately 549,000 served on behalf of other Blue Plans. The company offers its members the Blue ExtrasSM value–added programs, which provide discounts and information on a wide variety of health–related services at no additional cost. BCBSNC also offers life, dental, long–term care and disability insurance products. For 71 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health.
 
BCBSNC’s HMO product has earned Excellent Accreditation from the National Committee for Quality Assurance (NCQA), an independent, not–for–profit organization dedicated to improving the quality of health care. BCBSNC also has North Carolina’s first and only NCQA accredited PPO plan – Blue OptionsSM. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at bcbsnc.com.
 
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