After spending 20 hours a week for three years fighting an HMO's accusations of overbilling by more than $2 million, Glennon Paul, M.D., can now declare victory. But the central Illinois physician said the time he spent preparing for an arbitration joust with the HMO that made the accusation against him and two colleagues sapped precious time away from his life.

"I was so angry, I'll talk to God about this case," said the 62-year-old allergist and leader of the Central Illinois Allergy and Respiratory Service in Springfield. "I have 11 kids and I didn't see much of my family in the last three or four years. We see a lot of patients, and then I spent a lot of nights working on this."

A three-judge panel from the American Health Lawyers Association ruled Jan. 24, denying the claim of Health Alliance Medical Plans, which initiated the action in 2000 against the group as well as Paul and his practice partners, pulmonologists Pradeep Kulkarni, M.D., and Donald Gumprecht, M.D., as individuals.

The arbiters also ordered the Urbana-based HMO to pay the physicians' attorney fees, set by their counsel at $760,000. In addition, the physicians submitted a counter-claim that the payer had wrongfully retained $75,967 in "withhold" payments. The arbiters ordered the plan to pay them that amount as well.

Renee Besel, communications manager for Health Alliance Medical Plans, declined comment.

"According to our vice president of legal affairs, (Lori Cowdrey) it's not yet closed," Besel said.

The legal fees will be paid directly to the physicians, said their attorney, Jerry Clousson of Chicago, who said he did not take the case on contingency and has received ongoing payment since 2000.

"They've got a lot of guts," Clousson said. "I've been representing physicians since 1975, and these are as good and as tough a group of doctors as I've ever worked with. They felt they were right and they put their money where their mouth was. And as it turned out, they were right."

Paul said the HMO, after its initial calculations, claimed he and his colleagues overbilled the plan by as much as $2.1 million, but cut the amount to $1.3 million after a second claims audit was conducted before arbiters began hearing the matter early last year.

Paul said the allegations were based on extrapolations drawn from small samples of claims and compared with claims data from other practices that didn't have patients with the level of acuity his group typically sees.

"They went after us on E & M (evaluation and management) coding, saying there wasn't a bell-shaped curve when they compared us to general internists and general allergists. Then they figured out the costs of overcharges by us charging mostly (E & M) level threes and fours."

"We do a lot of critical-care medicine," Paul said. They accused us of fraud, of upcoding office visits and all sorts of inappropriate treatment. It was just horrible."

But the doctors dug in and, in the end, the plan simply didn't understand the physicians' practice.

Paul said there is a cautionary tale in his case for other physician practice leaders.

"You're dead if you don't have the good documentation and you don't do the work to defend yourself," he said. "It's scary."