His original lawsuit was filed in 2003, alleging that the company, acting as a Medicare contractor, engaged in fraud, gross negligence and criminal acts that forced him to close his practice.
In 1997, Dr. Edwards said, the company placed him on a 100 percent prepayment review and denied 96 percent of his Medicare claims for three consecutive years.
Dr. Edwards said the denials, usually citing non-covered services and lack of medically necessity, were mostly overturned on appeal through Medicare’s administrative process and were paid.
Read the release from Dr. Edwards on his Blue Cross Blue Shield of Texas lawsuit.
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