Order Regarding Audit Investigations

 

 

 

Order Regarding Audit Investigations

On July 13, 2018, the Special Masters, pursuant to the authority granted them by the Court (Document 9913), entered an Order related to the Claims Administrator’s Audit investigations (click here to read it).  In the Order, the Special Masters explain that:

  1. Retired NFL Football Players whose claims are in Audit may at any time be examined by a Qualified BAP Provider (if eligible for the BAP) or a Qualified MAF Physician and if found to have a Qualifying Diagnosis, withdraw the audited claims and substitute new Diagnosing Physician Certification Forms for review by the Claims Administrator.
  2. The Claims Administrator is required to investigate all facts that bear upon the integrity and reliability of the materials and assertions submitted in a Monetary Award Claim Package but need not find a deliberate intent to deceive; instead, the Claims Administrator must determine whether there is a reasonable basis to conclude that there has been any misrepresentations, omissions or concealments of material fact relating to a claim.
  3. All processing of a claim is suspended while that claim is the subject of an Audit investigation.
  4. Rule 10 in the Rules Governing the Audit of Claims authorizes the Claims Administrator to require the production of information and documents from persons and entities involved in an Audit investigation and gives the Claims Administrator’s requests the force and effect of a subpoena.
  5. The Claims Administrator’s authority to seek information and documents extends to Retired NFL Football Players, their families and representatives, health care providers, lawyers, claims service providers and any other persons and entities it deems necessary to assess the legitimacy and integrity of asserted diagnoses.
  6. If anyone refuses to provide information requested in an Audit investigation, the Claims Administrator will maintain a hold on the claim and not process it further until the information and/or documents are provided, unless the Claims Administrator later determines the requested information is no longer necessary to the investigation.
  7. Section 10.3(b)(ii) of the Settlement Agreement and Rule 11 in the Rules Governing the Audit of Claims allow the Claims Administrator to deny any claim where a person unreasonably fails or refuses to cooperate with an Audit investigation, with no right of appeal from that denial.