Legal Issues

August 25, 2010

Profile: New MAC Attorneys Michael J. Hodge & Richard A. Gaffin

Michael J. Hodge

Michael J. Hodge has an extensive background in governmental, labor and commercial litigation with lengthy trial experience in state and federal courts and before the Michigan Insurance Bureau and other state administrative tribunals. He also handles election law matters and serves as a commercial litigation mediator.

Mike is a Principal Attorney with Miller, Canfield, Paddock & Stone.

 

Richard A. Gaffin

Richard A. Gaffin specializes in intellectual property litigation and counseling involving patents, trademarks and copyrights, business tort litigation, product warranty litigation, and civil litigation.  In addition to being admitted to practice before the United States Patent and Trademark Office, he has tried patent infringement cases to juries, arbitrated overseas, successfully argued appeals in courts throughout the United States, and was part of the Miller Canfield team involved in representing utilities in disputes with the designers and builders of nuclear power plants in Texas and Washington. Those lawsuits lasted for years and involved damage claims in the billions. 

“I pride myself on helping clients achieve their business goals in an effective and cost-efficient manner.”
- Richard A. Gaffin

February 3, 2010

MAC Lawsuit Against Blue Cross in Discovery Phase

By: Dr. Don Reno, MAC President

For many years, Blue Cross Blue Shield of Michigan (BCBSM) has engaged in conduct that has been
discriminatory toward doctors of chiropractic and the patients who would seek our care.

Following years of attempted negotiations and the pursuit of required administrative remedies, our Board of Directors directed our Legal Affairs Committee and our attorney to file an all-encompassing “class action” complaint (lawsuit) to address BCBSM’s:

1) Unlawful policies and procedures as they relate to chiropractic
2) Prior and continued breaches of the provider and PPO contracts
3) Breach of contract as it relates to the 1999 settlement agreement
4) Improper interpretation of the scope of chiropractic
5) Non-payment of chiropractic services for which reimbursement should be allowed
6) Improper limitations on certain chiropractic services which are currently covered
7) Damages to each member of the “class of similarly-situated chiropractic physicians in Michigan.

The MAC cannot – and will not – tolerate discriminatory policies or activities from ANY insurance company. We believe that Michigan law is on our side and that we will prevail against these discriminatory Blue Cross activities.

Stay tuned to the MAC Action Report and Journal for more information on this important lawsuit as it develops.
 

February 2, 2010

MAC Lawsuit Against Blue Care Network in Discovery Phase

For many years, Blue Care Network (BCN) has engaged in conduct that we believe has been highly discriminatory toward doctors of chiropractic and their patients. Under Michigan law, BCN is not allowed to treat one class of providers, say DOs or MDs, differently than DCs. Furthermore, they are obligated to pay for all procedures allowed under a provider’s license at a rate equal to what they pay other provider classes. In our opinion, BCN routinely neglects to observe these anti-discrimination provisions. 

Our attorney has filed a complaint (lawsuit) to address Blue Care Network’s history of discrimination against chiropractors. The complaint address the following issues:

·            Limited access to chiropractic care by subscribers. BCN accomplishes this by various means, primarily by:

o     Limiting the network to a very few DCs.

o     Requiring that patients seeking chiropractic care have a primary care physician (PCP) referral. This tactic is very effective in limiting care by doctors of chiropractic by effectively placing chiropractic care “under prescription” of a medical physician.

o     No other provider—even specialists—are under PCP prescription, except chiropractors.

·            Payment for services that are allowed by our current scope of practice in Michigan.

·            Fair reimbursement for chiropractic services.

After exhausting all efforts to resolve these issues in the administrative arena, as required by Michigan law, we are left with this action as our only option to compel BCN to treat chiropractors and their patients in a lawful and fair manner.

It is the position of the MAC that these actions violate the Michigan Insurance Code. In addition to violating the Michigan Insurance Code, we believe that BCN, through these policies and practices, has also breached its contracts with chiropractors in its network. To maximize the complaint’s effectiveness, we have identified a MAC member doctor who has agreed to join the lawsuit. 

We are asking the court to enter a judgment declaring that through their discriminatory policies and practices, BCN has breached its contracts with chiropractic physicians. We are asking that damages be awarded.

Look for regular updates on this and other critical legal actions in future editions of the Journal and in our weekly emails.