Is this company trying to extort money from doctors?

Here is a story  from American Medical News about a company that is sending out letters requesting repayment for “overpaid” claims, many of them several years old:

When Snellville, Ga., internist Joel Fine, MD, read a note from a company called Health Research Insights, he thought it sounded a little bit like a chain letter — vaguely threatening, insistent on a quick response, with few details.

The letter, addressed “Dear Health Care Professional,” accused Dr. Fine of upcoding four claims for treating Georgia-Pacific employees. The earliest dated back to February 2005. “Of course, I was offended,” Dr. Fine said.

HRI’s letter offered him two choices: pay $347 to “immediately settle this issue” or send complete records proving he did not incorrectly bill for the visits in question. The letter warned that if Dr. Fine did not pay HRI or contact them with records to prove his innocence, his case could be turned over to federal authorities.

Since late last year, thousands of doctors in Georgia and Tennessee have received letters from HRI similar to Dr. Fine’s. The Indiana State Medical Assn. says it has received a warning from HRI that it will start collection efforts in that state.

Like health plans, HRI identifies physicians it believes are above the norm in the number of high-level codes they submit and targets them for recoupments. Unlike health plans, however, HRI does not analyze individual medical records along with the claims.

It uses, by the company’s own description, an algorithm to determine the amount of upcoding and overpayment — then demands that the physicians produce the medical records and other paperwork to fight the claim.

HRI’s chief executive officer, Theodore Perry, PhD, wouldn’t talk to American Medical News. But the company’s Web page describes its business as authorized under ERISA.

Health care attorneys and experts in ERISA law said doctors who receive the type of letter Dr. Fine received from HRI should think twice before just sending a check.

“The reality is you don’t even have to talk with these people,” said Michael F. Schaff, an attorney who specializes in health care and contracting with the firm Wilentz, Goldman & Spitzer in Woodbridge, N.J.

“Until they show they have some type of authority, they’re bluffing,” he said. “This comes out of the blue saying, ‘You owe us X amount of dollars.’ To me, that’s extortion.”

Both Blue Cross Blue Shield of Tennessee and Blue Cross Blue Shield of Georgia have sent out letters denying any complicity with HRI’s attempts at getting money from physicians.  So who and what are Health Research Insights, Inc.?  According to their website, Theodore L. Perry, Ph.D., Johnny E. Gore, M.D., and Charles L. Polatsek, M.B.A. are the company’s “founding partners.”  According to this website, they are also the entire company.  The HRI website lists the following address and phone number:

Health Research Insights, Inc.
P.O. Box 682467
Franklin, TN, 37068-2467
Recovery 615-916-4480

The MANTA website has other contact information:

Health Research Insights, Inc
381 Riverside Dr, Ste 300
Franklin, TN 37064-8934
Contact Phone: 615-224-0240

This website has yet another address and a fax number:

Health Research Insights, Inc.
1120 Holiday CT, Ste 4
Franklin, TN 37067-1302
Phone 615-224-0240
Fax 615-224-0241

The fax number given to Dr. Fine in the letter he received from HRI was 615-263-0196.

The Tennessee Medical Association (link requires TMA member log in) warns: “The TMA Legal Department says letters from Health Research Insights (HRI) demanding overpayment recoupment may not be based on prior review of clinical records.”


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