Navigation Links
Fox Insurance Company Awarded $3.3 Million in Arbitration Against Former Pharmacy Benefit Manager
Date:12/12/2011

NEW YORK, Dec. 12, 2011 /PRNewswire/ -- Fox Insurance Company, a Medicare Part D provider, with offices in New York, NY, announces a judgment in the arbitration between the company and ProCare, its former pharmacy benefit manager, in excess of $3.3 million, following a suit against ProCare based on Fox's allegations of negligence and breach of contract. 

Nathan M. Barotz, chairman of Fox Insurance Company commented: "Fox Insurance is gratified for the judgment in arbitration, as it clearly supports Fox's ongoing assertion that it was ProCare's failure to carry out its duties under its contract with Fox, and not any failure of Fox Insurance Company, that resulted in the improper denial of claims."

The November 22, 2011 arbitration award includes a finding that ProCare breached the Client Services Agreement (CSA) between the companies. ProCare was cited as failing to have software to carry out Fox's instructions (as well as Centers for Medicare & Medicaid Services (CMS) requirements) regarding prior authorization and high cost edits, and incorrectly informing Fox that it had fixed the problems with its software.

Fox had presented evidence that ProCare's claims processing system returned thousands of drug claims to pharmacies with the message that prior authorization was required, when no such requirement was in place – including on certain "protected class" medications that would never have such a designation.  This caused the rejection of thousands of claims. 

Fox also demonstrated that it had repeatedly asked ProCare to upgrade its software in order to satisfy CMS requirements and instructions regarding prior authorization and protected class drugs.  While ProCare had informed Fox that these upgrades had occurred, they had, in fact, not, which may have threatened Fox's standing with CMS. 

These claim denials drove CMS to take action against Fox in 2010, which resulted in the termination of its contract as a Medicare Part D provider.  Fox maintained that these denied claims, which were the impetus behind CMS's actions, were caused by ProCare's negligence and not any direct actions by Fox itself.  This assertion was the focal point of the arbitration between Fox and ProCare, with the award resulting in findings that ProCare breached the CSA, improperly withheld rebates owed to Fox, and must collect and turn over to Fox sums identified in a Fraud, Waste and Abuse (FWA) audit of the pharmacies in ProCare's pharmacy network.

Contact:
Jules Abraham
JQA Partners, LLC
917-885-7378
jabraham@jqapartners.com


'/>"/>
SOURCE Fox Insurance Company
Copyright©2010 PR Newswire.
All rights reserved

Related biology technology :

1. USDA Approves Syngenta and John Deere for Broadened Biotechnology Endorsement for Corn Crop Insurance
2. In the Midst of International Economic Crisis, VidaCura Offers a Helping Hand to Those Without Insurance
3. Biotech Endorsement Insurance Discount Expanded to Nebraska, Kansas Growers Planting Corn with HERCULEX XTRA Traits
4. AMERIGROUP Praises Expansion of State Childrens Health Insurance Program (SCHIP)
5. Value-Based Insurance Design: Helping Employers Improve the Value of Health Care
6. American Oriental Bioengineering Announces the Inclusion of 158 Drugs in Chinas National Insurance Catalog
7. China Sky Medical, Inc. Has 30 Medicines that will Be Included in Chinas National Insurance Directory
8. Commercial Insurance Buyers Benefit From Ample Capacity
9. Cord Blood America Says Outreach Program to OB/GYN Nurses, Insurance Case Workers, Paying Significant Dividends
10. Medical Malpractice Insurance Company- Healthcare Providers Insurance Exchange (HPIX) has Expanded its Presence in New Jersey, Opens New Office
11. New ACO Reinsurance Program Launched by Star Line Group, U.S. Advisors and Ascendent Care
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/23/2017)... and NEW YORK ... HIMSS, Lumeon , a leading digital health ... Telehealth), a provider of telemedicine and remote patient ... pathways for telemedicine reimbursements.  DN ... their patients, in real-time, extending consultations beyond a ...
(Date:2/23/2017)... ... February 23, 2017 , ... ... portfolio to include an array of biochemical analyses critical for Lead Discovery. ... drive their hit-to-lead and SAR programs, including inhibitor potency and selectivity, mechanism of ...
(Date:2/23/2017)... Feb. 23, 2017  MIODx announced today that ... key immunotherapy technologies from the University of California, ... method to monitor a patient for response to ... CTLA-4.  The second license extends the technology with ... likely to have an immune-related adverse event (IRAE) ...
(Date:2/23/2017)... 23, 2017  Seattle,s upscale Capitol Hill neighborhood, with its swanky ... for a head lice treatment salon to set up shop. ... restaurant and a French bistro on E Madison Ave, and ... just any old lice clinic, we pride ourselves on being ... release some of the stigma associated with lice. Everyone can ...
Breaking Biology Technology:
(Date:2/8/2017)... 2017 Report Highlights The global ... $8.3 billion in 2016 at a compound annual growth ... Report Includes - An overview of the global market ... data from 2015 and 2016, and projections of compound ... the market on the basis of product type, source, ...
(Date:2/6/2017)... Feb. 6, 2017 According to Acuity ... driving border authorities to continue to embrace biometric ... are 2143 Automated Border Control (ABC) eGates and ... at more than 163 ports of entry across ... 2016 achieving a combined CAGR of 37%. APC ...
(Date:2/2/2017)...  EyeLock LLC, a market leader of iris-based identity ... What You Should Know About Biometrics in the Cloud ... is a growing concern. In traditional schemes, cryptography is ... authentication schemes such as username/password suffer from inherent weaknesses. ... an elegant solution to the problem of high-security user ...
Breaking Biology News(10 mins):