ERISAclaim.com Press
Release
FOR
IMMEDIATE RELEASE:
New Free Webinars
Announced to Discuss the Latest Federal Court Overpayment Lawsuit
Ruling and New Obama Health Laws for the Skyrocketing $6 Trillion
Overpayment Recoupment Market
03-29-2010, Hanover Park, IL
New Free Webinars Announced From
ERISAclaim.com To Discuss The Latest And The First Federal Court
Ruling On March 18, 2010 That A PPO Participating Provider’s Lawsuit
Against Anthem BCBS, For The Alleged Wrongful Overpayment Recoupment
and Even Withholding From Different Patients, Is Completely Governed
By Federal Law, ERISA, Rather Than PPO Contracts And State Laws. The
Court Decision Was Mainly Relied Upon U.S. Supreme Court Rulings, the
Federal Court Ruling Is Timely Consistent With New Obama Health Reform
Laws That Mandate ERISA Appeals For All Group Health Plans And Health
Providers. The Federal Court Timely Ruling and New Health Reform Law
Mandates Are Vital and Crucial Guidance for a Potentially $6 Trillion
Overpayment Market for Every One In Healthcare Delivery System.
Hanover Park, IL (PRWEB) March 29, 2010 –
As an industry leader in compliance and reimbursement, ERISAclaim.com
announced the special free Webinars in the wake of the latest and
first federal court ruling on March 18, 2010 that that a PPO
participating provider’s lawsuit against Anthem BCBS, for the alleged
wrongful overpayment recoupment and even withholding from different
patients, is completely governed by federal law, ERISA, rather than
PPO contracts and state laws. The Court decision was mainly relied
upon the U.S. Supreme Court rulings. The healthcare overpayment
recoupment and withholding crisis, with or without fraud allegations,
has been the most expensive and detrimental financial crisis for most
healthcare providers, yet embraced by health plans and every managed
care entities, for a potential market as large as $6 trillion in
dispute, as many health plans or TPA’s are going back 5 – 6 years for
allegedly overpaid claims, especially from ERISA plans. The stake is
extremely high for every one. The industry has been in total chaos
without clear legal guidance to follow as the governing laws for this
$6 trillion market. At the same time, historical new Obama Health
Reform Laws now require all group health plan and health care
providers to comply with ERISA Appeals Regulations for all claims
disputes.
The new overpayment Webinars will discuss
in details the Federal Court ruling, and its profound impact to
providers and health plans as well as managed care entities,
especially the U.S. Supreme Court ruling upon which the court made its
final decision. The Webinar will also review the new Obama Healthcare
Reform Law mandates in claims appeals and reviews. The ERISAclaim.com
webinars are free to public, providers, health plans and TPA’s,
starting the first webinar on April 2, 2010, at 1:30 pm CST for 30
minutes each session. More dates, schedules and registration can be
found at
http://www.erisaclaim.com/Free_ERISA_Webnars.htm.
“It is extremely important for all health
plans, TPA’s, managed care operators and healthcare providers to
comply with governing federal laws in resolving and prevailing all
overpayment claims disputes and overpayment recoupment and
withholding,” said Dr. Jin Zhou, President of ERISAclaim.com, a
national ERISA expert, and reimbursement compliance consultant.
In the case of
Porter v. Anthem Health Plans Of Kentucky, Inc, a PPO
participating provider sued the Anthem BCBS for alleged wrongful
overpayment recoupment in the state court. "Defendant argues that this
case could have been brought under ERISA and is thus subject to
federal jurisdiction. The Court agrees." The Federal Court reasoned
that “Plaintiffs' claim sounds in ERISA. Absent ERISA, there would be
no obligation between the parties. Of note in this regard is United
States Supreme Court decision ....Aetna Health, Inc. v. Davilla, 542
U.S. 200 (2004). ….As in Davilla, that Porter and his practice have a
provider contract with Anthem does not, in and of itself, create an
independent legal duty for Anthem to make payments to Porter. What is
payable, and, more importantly, what is not is defined by the terms of
the benefit plans and, thus, governed by ERISA."
An official copy of
the Federal Court record with decision for Porter v. Anthem Health
Plans Of Kentucky, Inc is available at:
<http://www.erisaclaim.com/Porter%20_v_Anthem_BCBS_Court_Opinions.pdf>
Civil Action No.
10-8-HRW, March 18, 2010.
DWAIN P. PORTER,
D.C., and PORTER CHIROPRACTIC PLLC, Plaintiffs, v. ANTHEM HEALTH PLANS
OF KENTUCKY, INC. d/b/a/ANTHEM BLUE CROSS AND BLUE SHIELD, Defendant.
United States
District Court, E.D. Kentucky, Northern Division, Ashland.
On March 23, 2010, President Obama signed
into law the Senate Bill passed in the House of Representatives,
making this year-long debated healthcare legislation into the law of
land for more than 95% of Americans, with most significant overhaul to
U.S. healthcare delivery system and reimbursement laws.
According to Dr. Jin Zhou, contrary to
popular misinformation, the Obama health law, Patient Protection
and Affordable Care Act, has established significant consumer
protections and plan claim processing and appeal simplification to
reduce administrative costs and enhance provider reimbursement rights
and patient protections. New Obama health law incorporates or adopts
existing ERISA claim regulation in its entirety as internal ERISA
appeal mandates, and Uniform External Review Model Act promulgated by
the National Association of Insurance Commissioners as external ERISA
appeal mandates as final and binding authority to all parties, in
absence of judicial appeals.
“After the legislation becomes the law of
land for America health care, it is time for everyone who truly cares
about reimbursement and compliance to forget about yesterday's
legislation enthusiasm, set aside personal emotions and political
preferences, to get hands on today’s new reality, statutory and
regulatory compliance and reimbursement by learning and mastering new
rule of the game for health care reimbursement through compliance”,
said Dr. Jin Zhou.
In the past 10 years, ERISAclaim.com has
been the only ERISA Specialized Company offering the most practical
and comprehensive ERISA education, consulting and publishing services
for healthcare providers in administrative ERISA appeals for real
problem oriented denials under the most mysterious 35-year-old federal
law, ERISA. Dr. Jin Zhou, president ERISAclaim.com has been regarded
as the Godfather of ERISA claims for healthcare providers by some in
Professional billing and coding industry.
For more information or to arrange an
interview, please contact Dr. Jin Zhou, president of ERISAclaim.com at
630-808-723 and ERISAclaim@aol.com or visit: <http://www.erisaclaim.com/Free_ERISA_Webnars.htm>
###
Contract:
Jin Zhou,
President
ERISAclaim.com
Tel:
630-808-7237 (Mobile)
Tel:
630-736-2974 (Office)
Fax:
630-736-1439
E-mail:
ERISAclaim@aol.com
website:
http://www.ERISAclaim.com
Related Links:
ERISAclaim.com: 50% Savings - Healthcare Crisis
Turnaround for Employers, Insurers & TPA's
ERISAclaim.com - A $1.0 Trillion Nuclear Solution
to U.S. Health-care Crisis & $44 Trillion Budget Deficits
American Benefits Council:
News Room - Supreme Court Ruling on Health Care Claims Raises Important
Policy Issues: American Benefits Council. June 21, 2004
"Sadly
and predictably trial attorneys and their allies are already calling on
Congress to unravel today’s decision by the Supreme Court, but they should
first ask why the two physicians in these cases did not act swiftly to help
make sure their patients got the care they were seeking.
In neither
case did the patient or their physician seek a further review of the health
plan’s initial coverage decision, despite being specifically informed of
their right to such a review under federal law."
Klein said."
"These
review procedures are available under ERISA
to help patients get the care they deserve, quickly and without having to
resort to costly and lengthy legal procedures. Clearly, a speedy and factual
review aided by the expertise of the physicians
involved with
these two cases could have avoided the need for the courts to be involved at
all,"
Klein said."
# # #
The American Benefits Council is the national
trade association for companies concerned about federal legislation
and regulations affecting all aspects of the employee benefits system.
The Council's members
