WOOD COURT ISSUES $276,000 AWARD AGAINST CLAY COUNTY PHYSICIAN

(01/13/2009)

More than $276,000 related to over payments made to a Clay County physician have been awarded to Mountain State Blue Cross Blue Shield by a Wood County Circuit Court. Blue Cross Blue Shield was awarded $182,047.86 in compensatory damages and $94,060.07 in prejudgment interest for a total of $276,107.93. The court decided Dr. Jamie submitted multiple medical claims to BC/BS without performing the services. BC/BS identified a problem with claims for blood test panels submitted by the Clay physician in August 2003. Although Dr. Jamie became a network provider in 1991, practiced in a rural area with a stable population, the number of blood test panels he claimed to be performing exceeded by hundreds the number performed by his peer providers, according to the court order. The report indicates multiple blood test panels were being billed by Dr. Jamie for the same patients on the same days, in addition to claims being submitted for unperformed blood draws and allergy injections. Mountain State BC/BS says they provided Dr. Jamie several opportunities to repay the overpayment's. He refused, canceling his participation in the Mountain State provider network. "With regard to the incorrect, inaccurate and wrongful billing practices alleged by (Mountain State Blue Cross Blue Shield), Dr. Jamie does not, and cannot, dispute that he over-billed the plaintiff by submitting claims for services and procedures he did not perform," Judge Beane wrote.

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