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ERISAclaim.com Press
Release
11-30-2011
FOR
IMMEDIATE RELEASE:
Court Ruled
Against CIGNA & UHC UCR Class Actions by Out-of-Network Providers On
Poor ERISA Assignment - 11-30-2011
ERISAclaim.com Offers Webinars To
Examine The New Federal Court Ruling On Sep. 23, 2011 That Dismissed
All Out-Of-Network Provider UCR Class Action Claims Against CIGNA And
UnitedHealthcare Solely Based On Poor ERISA Assignment.
Hanover Park, Illinois
(Vocus/PRWeb) November 30, 2011
Hanover Park, IL (Vocus/PRWeb)
November 30, 2011 – On Sep. 23, 2011, the federal District Court in
New Jersey dismissed all out-of-network provider plaintiffs UCR class
action claims against CIGNA and UnitedHealthcare solely based on the
poor and limited ERISA Assignment of Benefits. Franco v. Connecticut
General Life Ins. Co. (Case 2:07-cv-06039-SRC–PS) was filed in federal
court, District of New Jersey, as one of the largest UCR class actions
after the UnitedHealthcare UCR settlement, by several patients,
numerous out-of-network providers, several provider State Associations
and the American Medical Association (AMA), alleging violations of the
ERISA for wrongful UCR denials and reimbursement. ERISAclaim.com
offers new webinars to examine the profound impact of this federal
court ruling on ERISA requirements for Assignment of Benefits, and to
discuss on how to secure valid ERISA and PPACA Assignment of Benefits,
in order to prevail on all provider appeals and judicial reviews.
“This court ruling underscores the importance of the urgent providers’
compliance with ERISA and PPACA requirements of Assignments of
Benefits. Now the Court has found that all of provider’s traditional,
decade old Assignments of Benefits without ERISA compliance are
legally useless for reimbursement, appeals and lawsuits, we must
change now to comply with ERISA," says Dr. Jin Zhou, president of
ERISAclaim.com, a national expert on PPACA and ERISA appeals and
compliance.
Usual, Customary and Reasonable (UCR) denials are the most commonly
seen partial claim denials for all out-of-network providers and
hospitals in USA.
According to the court documents, the federal Court finds that all
provider plaintiffs have failed to provide the court with complete
ERISA Assignment of Benefits as a matter of law in provider plaintiff
complaints. All the providers, State Associations and AMA have
provided in court are only limited Assignment of Benefits. After
finding that there isn't any valid or complete ERISA Assignment of the
Benefits by all providers, the Court dismissed all UCR ERISA claims
asserted by all provider plaintiffs, State Associations and AMA.
In particular, among other things, the Court concluded the following:
“At best, the allegations provide only the most ambiguous and
conclusory information about what the purported assignments entail. At
worst for Provider Plaintiffs, they indicate that the assignments were
limited to a patient’s assigning his or her right to receive
reimbursement from CIGNA for the covered portion of the service bill,
which in no way can be construed as tantamount to assigning the right
enforce his or her rights under the plan. The Court cannot conclude,
based on the information supplied in the Complaints, that the
assignments encompass a CIGNA-insured’s claim to benefits, such that
any of the Provider Plaintiffs can legally be deemed a “participant or
beneficiary” of his or her patient’s ERISA health plan. Simply put,
Provider Plaintiffs have not met their burden of demonstrating that
they have derivative standing to sue under ERISA.
All ERISA claims asserted by Provider Plaintiffs in the CAC and North
Peninsula Complaint will accordingly be dismissed.” (Case
2:07-cv-06039-SRC -PS Document 638 Filed 09/23/11 Page 20 of 82 PageID:
25499)
A copy of complete court decision is available at:
http://ERISAclaim.com/Franco_v_CIGNA.pdf
The new ERISAclaim.com webinars will discuss in detail of this Court
order and explain why providers nationwide have failed in ERISA
compliance for valid Assignment of Benefits as the most important
first step in claim reimbursement and appeals, ultimately lawsuits in
federal court.
The webinar will cover the following topics:
-
The court factual
and legal analysis and conclusion of provider traditional, decade
old Assignment of Benefits, for the one of the largest
out-of-network provider UCR class action lawsuits against CIGNA and
UnitedHealthcare: the court decision from page 11 to page 20.
-
The court concluded
that the decade old, industry traditional provider assignment of
benefits are only limited assignment under ERISA and legally
useless, but a complete ERISA assignment of benefits is required for
all ERISA appeals and lawsuits by third-party providers.
-
What exactly does an
ERISA complete Assignment of Benefits mean?
-
How to secure a
valid and complete ERISA compliant Assignment of Benefits?
-
Why is ERISA
Assignment of Benefits Form required for both in and out of network
providers?
On March 23, 2010, President Obama signed into law the Health Reform
Bill, PPACA (Patient Protection and Affordable Care Act). PPACA claims
and appeals regulations went into effect on September 23, 2010. PPACA
adopts ERISA claim regulation in its entirety, for group health plans
and health insurance coverage in the group and individual markets, for
almost all non-Medicare and/or non-Medicaid claims.
http://webapps.dol.gov/FederalRegister/PdfDisplay.aspx?DocId=24056
Complete PPACA Regulations and Guidance can be found on DOL website:
http://www.dol.gov/ebsa/healthreform/
To find out more about the Total PPACA Claims and Appeals Compliance
Services from ERISAclaim.com:
http://www.erisaclaim.com/Press_Releases.htm
Located in a Chicago suburb in Illinois, ERISAclaim.com is the only
ERISA & PPACA consulting, publishing and website resource for
healthcare providers in the country. ERISAclaim.com offers free
webinars, basic and advanced educational seminars and on-site claims
specialist certification programs for doctors, hospitals and
commercial companies, as well as litigation support. Dr. Jin Zhou is
regarded as the industry “Godfather of ERISA claims” for healthcare
providers.
For any questions, please contact Dr. Jin Zhou, president of
ERISAclaim.com, at 630-808-7237.
###
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:
Supreme Court &
PPACA Provide New Protections for Hospitals, Doctors and Patients –
Free Webinars From ERISAclaim.com -
08-12-2011
U.S. Supreme Court ended a 36 year
managed care injustice under ERISA due to an error in law by
clarifying that ERISA provides compensatory make-whole remedies for
fiduciary breaches. DOL Recently Filed An ERISA Amicus Brief For
Patients And Hospitals. PPACA Adopts ERISA For All Doctors and
Hospitals. Free Webinars From ERISAclaim.com to Evaluate New
Healthcare Legal Landscape
New Federal PPACA
Laws for Direct Claims Payment to Out-of-Network Doctors & Hospitals –
PPACA Claims Specialists Readying for Full Enforcement of PPACA -
07-21-2011
On July 14-15, 2011, YF Corp Completed
More PPACA Claims Specialist Certification Training, Readying For The
Full Official Enforcement Of PPACA Claims Regulation After July 1,
2011, Focused On New Federal Mandate For Direct Claims Payment To
Out-Of-Network Providers.
Federal Court
Permits Aetna ERISA Class Action to Proceed in Providers’ Overpayment
Disputes -
06-21-2011
ERISAclaim.com Offers Webinars to
Examine the New Federal Court Ruling on June 20, 2011 to Permit Aetna
ERISA Class Action to Proceed in Providers’ Overpayment Disputes under
ERISA, and Its Impact in Connection with Official Enforcement Date of
PPACA & ERISA Claim Regulations on July 1, 2011.
July 1, 2011 - U.S.
Hospitals' PPACA Readiness for New Federal Claims & Appeals Laws -
06-04-2011
ERISAclaim.com Announced Its
Preliminary Internet Research Results On The U.S. Hospitals' PPACA
Readiness By July 1, 2011, For The Official Enforcement On Health
Reform PPACA Claims & Appeals Regulations, In A Follow-Up With A
Congressional GAO PPACA Report Published On March 16, 2011.
Health Reform Law
for Claims & Appeals: July 1, 2011 - PPACA Enforcement Date For
Provider’s Bill Of Rights -
06-01-2011
ERISAclaim.com Announced The Total
PPACA Claims & Appeals Compliance Services For Doctors And Hospitals,
To Be Compliant By July 1, 2011, PPACA Enforcement Date, Including
Education For PPACA Claims Specialists And PPACA Appeals Department,
Claims Recovery, And Litigation Support.
PPACA Webinars for
Hospital CFOs: Most Sweeping Health Reform Revenue Laws &
"Overpayment" Crisis -
04-26-2011
ERISAclaim.com Announced PPACA Webinar
For Hospital CFOs: “PPACA - The Most Sweeping Health Reform Revenue
Laws & Overpayment Recoupment Crisis”, To Assist Hospitals In
Compliance With PPACA, Federal Claims & Appeals Regulations, With
Certified PPACA Claim Specialists & PPACA Appeals Department.
UnitedHealthcare
Overpayment ERISA Class Action Expanded with DME and ASC Providers for
Additional Complaints -
04-25-2011
More Healthcare Providers, Durable
Medical Equipment (DME), Ambulatory Surgical Center (ASC) And National
Chiropractic Associations, Joined and Expanded ERISA Class-Action
against UnitedHealthcare for Alleged ERISA Violations in Its
Overpayment Recoupment and Pre-service Claim Denials. ERISAclaim.com
Offers Free Webinars to Examine This Class-Action's Impact in
Healthcare Industry.
Federal PPACA
Claim Laws for Out-of-Network Doctors & Hospitals – Same Rights as
In-Network Providers -
04-18-2011
ERISAclaim.com Announced 2001 New
Health Reform Law, PPACA, Webinars & Seminars For All Out-Of-Network
Doctors & Hospitals: Same Rights For Receiving Reimbursement Checks,
EOB's, Plan Documents, Verifying Coverage, Appeals, Emergency Service
Coverage And More, As In-Network Providers.
Feds: No Delays For
99% PPACA Claims & Appeals Laws Except For 3 Minor Standards
ERISAclaim.com Adds New Webinars For
The PPACA Enforcement Guidance On 03/18/2011 By DOL, HHS & IRS: No
Grace period or Extension For The 99% PPACA Claims Laws, Effective On
Sept. 23, 2010, Except For 3 Minor New Standards (<1% of PPACA) with
Extension on 01/01/2012.
Overpayment Fraud Or
SIU / TPA Fraud? – Health Plans Countdown On PPACA Health Reform Laws
ERISAclaim.com Announced 2011 PPACA
Health Plan Compliance Programs – Fraud & Abuse Prevention, And Plan
Assets Audit And Recovery, To Assist Health Plans In PPACA Compliance
In The Practice Of Overpayment Recovery, To Review Recent Federal
Court Class-Action Rulings And To Recover Plan Assets From TPA’s In
The $225 Billion Overpayment Recovery Market.
“Overpayment”: Fraud
Or Retroactive Denials? - Doctors & Hospitals Countdown V On PPACA
Health Reform Laws
ERISAclaim.com Announced 2011 PPACA
Corp. Compliance – Fraud & Abuse Prevention And Appeal Programs To
Assist Doctors & Hospitals In Fighting Against Increasing Improper
Overpayment Recoupment & Fraud Allegations In True Retroactive
Benefits Denials, And Advocating PPACA Compliance For Fraud And Abuse
Prevention To Avoid True Fraud Prosecution.
Doctors & Hospitals
Countdown IV On PPACA Health Reform Laws – 51% of Doctors Going Broke
(TX) & PPACA 911 CPR
On 03-23-2011, PPACA 1st Birthday,
ERISAclaim.Com Announced A PPACA 911 CPR Program, For 51% Of Doctors
Going Broke In TX And USA: A 10-Day Self Resuscitation Program, To
Read Entire 10 Pages Of Complete PPACA Claims Regulations, And To File
Just One (1) PPACA Appeal, As PPACA Appeal Laws Govern All
Non-Medicare/Medicaid Claims Denials.
Doctors &
Hospitals Countdown III On PPACA Health Reform Laws – Court & Feds: No
Delays For PPACA Health Claims Litigation & Enforcement
On 03-23-2011, PPACA 1st Birthday,
ERISAclaim.com Will Offer A Free Webinar To Examine New Feds PPACA
Claims Enforcement Guidance On March 18, 2011, Clarifying For The
Effective Date, Extension Date and No Delays for Private PPACA Health
Claims Litigation, And PPACA Awareness & Usage By Doctors and
Hospitals Since Sep. 23, 2010.
Doctors & Hospitals
Countdown II On PPACA Health Reform Laws Deadline On July 01, 2011 -
With 0.5% Of Claim Denials Appealed Reported By Congress
- 03-20-2011
ERISAclaim.com Announced Its Initial
Survey results of less than 0.001% PPACA Appeals Law Education by
Provider Associations To Ensure Millions Of Doctors And About 5,815
Hospitals In Compliance with New Federal Appeals Laws By July 01, 2011
Deadline As PPACA Full Enforcement. This Finding Is Much Less Than
0.5% of Claim Denials Appealed (OH) Reported by Congress.
In BCBS
Overpayment ERISA Class Action, Provider Plaintiffs Seek For Class
Certification and Remedies -
03-18-2011
ERISAclaim.com Offers Webinars To
Examine Provider Plaintiffs’ Motion, Filed On March 17, 2011, In PCA
v. BCBSA Et Al Class Action Lawsuit, To Certify Class, Seeking For
Remedies In Injunctive Relief, Asking Court To Find That 23 BCBS
Entities Violated Federal Law ERISA And BCBS Must Return Wrongfully
Recouped Money.
Doctors & Hospitals
Countdown On PPACA Health Reform Laws Deadline on July 01, 2011 - With
39% To 59% Winning Appeals Report From Congress
ERISAclaim.com Announced New Slate Of
Services To Ensure Millions Of Doctors And About 5,815 Hospitals In
Compliance with New Federal Claims and Appeals Laws By July 01, 2011
Deadline As PPACA Full Enforcement. On March 16, 2011, Congress
Reported That 39% To 59% Appeals Reversed Health Insurance Denials
While Only A Small Portion Of Denials Are Challenged.
Feds 2011 Report:
39% to 59% Appeals Reversed Health Insurance Denials, And New PPACA
Claims Regulations Enforcement Deadline Countdown
ERISAclaim.com Announced New Webinars
To Examine The 2011 Feds Report – U.S. GAO: Private Health Insurance:
Data On Application And Coverage Denials Published On 03-16-2011,
Indicated That 39% To 59% Of Appeals Reversed Original Coverage
Denials, And To Prepare The Nation For New Federal Claims Regulations
For Full Enforcement Deadline On July 01, 2011
Court Affirmed ERISA
Embezzlement Convictions – Healthcare Overpayment Recovery Impact &
Compliance For Self-Insured Plans
ERISAclaim.com Announced 2011 Free
Webinars To Examine A Recent 9th Cir. Court Decision, USA v. Eriksen,
Affirming ERISA Embezzlement Convictions, And Its Impact In Healthcare
Overpayment Recoupment Market, As A Part Of The New ERISA Plan Assets
Recovery Programs To Assist Self-Insured Health Plans In Compliance
And Overpayment Recovery Audits.
Free Webinars On
2011 New Federal Health Claims Denials & Appeals Laws – Reimbursement
Mandates Under PPACA
ERISAclaim.com Announced New Webinar
Schedules For 2011 New Federal Health Claims Denials & Appeals Laws,
New PPACA Mandates All Group Health Plan & Individual Market Claims,
Effective On 09/23/2010 With A Deadline On July 01, 2011 As Full
Enforcement Grace Period. Any Failure To Comply With PPACA By Health
Providers Will Result In More Denials And Loss Of Rights To Appeal
Self-Insured Health
Plans Should Have Recovered Millions Of Dollars From Billions Of
Dollars In TPA’s Overpayment Recoupment Practice
ERISAclaim.com Announced 2011 Free
Webinars And Plan Assets Recovery Programs To Assist Self-Insured
Health Plans To Recover Hundreds Of Millions Of Dollars In Plan Assets
From Successful TPA’s Overpayment Recovery In Billions Of Dollars, As
More Than 60% Of TPA Recovered Money Originated From Self-Insured
Plans And Should Be Returned To Self-Insured Health Plans Under New
DOL Contributory Plans Criminal Project.
HFMA NCA Webinar
Held On Health Reform Law 2011 Mandates for Claims Reimbursement &
Appeals
On Feb. 22, 2011, HFMA Northern
California Chapter Held Its First 2011 Webinar On Health Reform Law
2011 Mandates For Claims Reimbursement & Appeals, Taught By
ERISAclaim.Com. New Federal Claims Regulations Have Been Effective
Since 09/23/2010, With An Enforcement Grace Period Until July 1, 2011
For Strict And Full Enforcement, For All Group Health Plans,
Individual Policies And Healthcare Providers.
Federal Court
Ruled Against BCBS in Providers Counter-Lawsuit for ERISA Violations
in its Recoupment Practice
ERISAclaim.com Offers Webinars to
Examine the Federal Court Ruling on Feb. 16, 2010 that Denied BCBSRI’s
Motion to Dismiss Two Providers’ Counterclaim Against BCBSRI for ERISA
Violation when BCBSRI Initially Sued Two Providers to Recoup the
Alleged Overpayment
COCSA Joins ERISA
Class Action Against UnitedHealth Group For Improper Recoupment Abuses
The Congress Of Chiropractic State
Associations, COCSA, Has Voted To Join A National ERISA Class Action
Filed By Pomerantz, One Of The Nation’s Preeminent Class Action Firms,
Against UnitedHealth Group. In The Action, COCSA Will Be Representing
Its Members, State Chiropractic Associations In All 50 States, In
Combatting Alleged ERISA Violations In Overpayment Recoupment Abuses.
UnitedHealth Group Sued by Pomerantz for
Improper Recoupment Practices
GlobeNewsWire (press
release) - Feb 2, 2011
"NEW YORK, Feb. 2,
2011 (GLOBE NEWSWIRE) -- Pomerantz Haudek Grossman & Gross LLP, one
of the country's preeminent class action firms and a leader in
combating the abuses of the health insurance industry, filed a class
action lawsuit against UnitedHealth Group and Health Net of the
Northeast, Inc. on behalf of a putative nationwide class of health
care providers, as well as the Ohio State Chiropractic Association.
United's acquisition of Health Net of the Northeast's health
insurance business closed in December 2009, adding to United's
status as the nation's largest private health plan by revenue. The
suit challenges the Defendants' abusive practices in using
post-payment audits and reviews, and improper repayment demands, to
pressure providers to repay substantial sums that had previously
been paid as health insurance benefits."
UnitedHealth Sued in
Providers' ERISA Class-Action in Overpayment Recoupment Dispute for
ERISA Violations -
02-02-2011
ERISAclaim.com Webinars to Examine the
Providers' ERISA Class Action against UnitedHealth, the Nation’s
Largest Health Insurer, In Overpayment Recoupment Dispute and the
Potential Economic and Legal Impact on All Healthcare Providers and
Hospitals As Well As Health Plans.
Federal Court
Ruled against BCBS Overpayment Class-Action Counterclaims – PPO &
Unjust Enrichment Claims Completely Preempted by ERISA
-01-25-2011
ERISAclaim.com Webinars To Examine
Federal Court Ruling Dismissing Regence BCBS Counterclaims Against
Plaintiff Providers In The Largest Provider Overpayment ERISA Class
Action Against 23 BCBS Entities.
Federal Court
Reaffirmed Its Ruling Against BCBS In A $400,000 Overpayment Lawsuit -
Free Webinars On Its Impact For Entire Healthcare Industry
On 01/19/2011, Federal Court Reaffirmed
Its Earlier Ruling Against BCBSRI On 10/27/2010 In An Overpayment
Lawsuit Against Two Providers. “The Court Has Not Changed Its Mind”
That Federal Law ERISA Supersedes And Limits BCBSRI Overpayment
Recoupment Practice. A Preliminary Injunction Against Plaintiff BCBSRI
Was Issued On 11/04/2010.
Healthcare Reform
Law PPACA Claim Specialists: New Legal Assignment of Benefits Required
Under New Federal Provider’s Bill of Rights -01-17-2011
ERISAclaim.com Officially Released
2011 Updated Legal Assignment Of Benefits Forms And Notices To Comply
With Newly Effective Federal Health Reform Law, New Provider’s Bill Of
Rights Provisions Of New PPACA’s Patients Bill Of Rights, For All
Healthcare Providers, To All Health Plans And Individual Insurance
Policies.
Healthcare Reform
Law PPACA Claim Specialists: YF Corp. Leading the Nation in Advocating
Patient's Bill Of Rights & Provider’s Bill of Rights
- 01-14-2011
Yolanda Flores (YF) Corp. and
ERISAclaim.com Start Nation's First PPACA & ERISA Claims Specialist
Certification Program Under New Health Reform Law Last Year, This
Month YF Corp. Renews Its Official PPACA Mission Statement And
Planning For PPACA Certification Training Throughout 2011.
2011: Healthcare
Reimbursement under New Health Reform Laws - With Criminal, Prompt Pay
Enforcement, And More PPACA & ERISA Claims Specialists
- 01-03-2011
Beginning on Jan 01, 2011, New Federal
Claims Regulations Under Health Reform Laws, PPACA, And New Criminal &
Prompt Pay Enforcement On 36 Year Old Federal ERISA Claims Regulations
Are Effective For All Health Plans And Individual Policies. PPACA &
ERISA Claims Specialists Will Lead Changes In 45 Year Healthcare
Reimbursement History.
Are You Ready For
2011 New Federal Prompt Pay Laws Under Health Reform PPACA? – For
PPACA & ERISA Claim Specialists
On Jan 01, 2011, New Federal Internal
And External Prompt Pay Laws Under Health Reform Laws, PPACA, Will Be
Effective For All Non-Grandfathered Health Plans And Individual
Policies. ERISAclaim.com Announced New Federal Prompt Pay Law
Trainings For PPACA & ERISA Claim Specialist And Free Webinars For
2011
Health Reform Law
Pays For More Certified PPACA & ERISA Claim Specialists - More
Healthcare Experts Ready To Cash In On New Patient’s Bill of Rights
- 12-17-2010
On Dec 15, 2010, ERISAclaim.com and
Yolanda Flores Corporation Entered an Agreement for PPACA & ERISA
Claims Specialist Certification Training Under New Federal Health
Reform Laws, Federal Claims & Appeals Regulations, Effective Sep. 23,
210, To Benefit from New Patient’s Bill of Rights & Reimbursement
Protections
BCBS Overpayment
Class Action Defendants Sought Testimony From The National Expert On
Healthcare ERISA Appeal Compliance With ERISAclaim.com
- 12-06-2010
On Dec. 6, 2010, Dr. Jin Zhou of
ERISAclaim.com Received a Subpoena from 23 Blue Cross Blue Shield
Entities to Testify in a Class-Action Lawsuit against Blue Cross Blue
Shield over the ERISA Appeals And Overpayment Recoupment Lawsuit, As
Many Plaintiffs Were Taught on ERISA Appeal Compliance from
ERISAclaim.com.
12/3/2010:
Group Health
Plans: Are You Ready for Healthcare Reform? (PDF)
(Morgan, Lewis & Bockius LLP) (Counsel for BCBS Defendants) [Page 4 of
7]
" Internal Claims and Appeals:
Currently, health plans must
substantially comply with the
existing
ERISA claims and appeals regulations. Under HCR,
nongrandfathered plans
must strictly adhere to the existing regulations
as well as to a number of new requirements. An
enforcement grace period will apply until July 2, 2011 with respect to
certain of the new requirements— including the review of urgent care
claims within 24 hours, new content for notices of adverse benefit
determination, and the strict adherence standard—to give plans time to
make necessary procedural and systems changes. Model claim denial
notices have been issued by the Department of Labor (DOL); the agency
is expected to issue model claims and appeals language soon.
External Review: Insured plans that are subject to a state
external review process that meets the HCR requirements must comply
with that process. Other plans
must comply with a federal external review process. An interim
enforcement safe harbor has been established for nongrandfathered
self-insured plans subject to the federal external review process. If
such a plan either complies with the safe harbor procedures outlined
in DOL Technical Release 2010-01, or voluntarily complies with an
available state external review process, enforcement action will not
be taken against the plan during the interim enforcement period."
Federal Court
Stopped BCBS Overpayment Withholding Claim Practice - Free Webinars On
Its Impact For Entire Healthcare Industry
- 11-15-2010
On 11-04-2010, Federal Court Granted,
Without Objection From BCBSRI, A Preliminary Injunction Against
Plaintiff Blue Cross & Blue Shield Of Rhode Island Preventing It From
Withholding Any Further Payments Due To The Defendant Provider To
Satisfy An Alleged Debt Of Overpayment, One Week After Court Ruled, On
10-27-2010, That Federal Law ERISA Supersedes And Limits BCBSRI
Overpayment Recoupment Practice.
Federal Court Ruled Against Blue Cross Blue Shield Overpayment Recoupment Practice: “Court's ruling limits Blue Cross' potential
recovery” - FREE WEBINARS
ON ITS IMPACT FOR ENTIRE HEALTHCARE INDUSTRY 11-01-2010
Federal Court Ruled Against BCBSRI's
Overpayment Recoupment Practice On October 27, 2010. Relied Upon
Recent U.S. Supreme Court Rulings, The Court Ruled That Federal Law
ERISA Limits Blue Cross 'Potential Recovery, And BCBSRI's State Law
Breach Of PPO Contract Claim And Fraud Claim Are Completely Preempted
By ERISA. BCBSRI’s Post-Payment Audit Is A Fiduciary Conduct Governed
By Federal Law ERISA Instead Of Provider PPO Contract.
Insurance News - Pomerantz Haudek Grossman & Gross LLP
Announces That Court Permits Provider ERISA Class Action to
Proceed Against Blue Cross Blue Shield Companies for Improper
Overpayment Demands and Forced Recoupment
"This
is a landmark decision, with widespread implications for the
health care industry," says Jin Zhou, D.C. "Providers finally have
a means to fight back against insurance companies for making
invalid overpayment demands." Dr. Zhou is a national ERISA
consultant who, through his website, www.ERISAclaim.com, and
consulting services he offers to providers and plan sponsors, has
long advocated the use of ERISA to combat improper post-payment
audit activities.
"
For a Copy
of the Court Ruling
PCA et al v. BCBSA et al
May 17, 2010
Today, Sep. 23,
2010, Date of Birth For New Obama Patient’s Bill Of Reimbursement
Rights: Claims & Appeals Laws Going Into Effect
09/23/2010 Hanover Park, IL
Free Webinar: New
Federal Laws For Overpayment Dispute Going Into Effect On Sep. 23,
2010 With External Appeals and Possible $100/Day/Patient Penalties
09/16/2010 Hanover Park, IL
On 36th Birthday of
ERISA, Historical Obama-Appeal Seminar Announced for Sep. 23, 2010 -
New Federal Appeals Laws Effective Date
09/02/2010 Hanover Park, IL
Webinars On New
Federal Penalties In $100 / Day / Patient On Insurers, HMO’s, TPA’s &
IRO’s Under External Review Laws, Effective Sept. 23, 2010 Per IRS,
DOL & HHS
08/30/2010 Hanover Park, IL
Webinars for New
Federal Appeals Laws on New EOB’s For Claims Denials, Internal And
External Appeals Released On August 24, 2010 from IRS, DOL and HHS
08/26/2010 Hanover Park, IL
New Protections for
Out-of-Network Providers Under New Federal Health Laws and Regulations
– Free Webinars Announced from ERISAclaim.com
08/17/2010 Hanover Park, IL
New Webinars,
Seminars & Certification Classes Announced for New Federal Health
Claim Appeals Regulations on July 22, 2010 from HHS, DOL & Treasury
08/05/2010, Hanover Park, IL
New Health Reform
Law Claim Denial Appeal Book Announced for Healthcare Providers to
Comply with New PPACA Deadline – 09/23/2010 06/28/2010, Hanover Park,
IL
New Health Reform
Law Appeal Certification Class Announced for Hospitals to Comply with
New PPACA Deadline – 09/23/2010
06/24/2010, Hanover Park, IL
ERISAclaim.com
Webinars On Healthcare Revenue Cycle Crisis Turnaround: Pre-Payment
Review Delays and Denials – Deemed Denial ERISA Appeals
04/19/2010, Hanover Park, IL
Health Reform for
Out-Of-Network Providers: Receiving Insurance Checks Directly? –
Free Webinars on Why and How
04/05/2010, Hanover Park, IL
Health Reform For
Doctors And Hospitals: Obama Made An Offer We Can’t Refuse!
-
ERISAclaim.com Celebrates its Successful
Webinars on New Healthcare Reimbursement Laws 04/05/2010,
Hanover Park, IL
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 Obama Health Law Webinars Announced For
Healthcare Providers and Health Plans on New Reimbursement Laws for
Claims Processing and Appeals
03-23-2010, Hanover Park, IL
The New TPA ERISA
Appeals Department Training Program Announced for Self-Insured Health
Plan’s Denial and Appeal Management To Compliantly Contain
Administrative Costs 02-11-2010, Hanover Park, IL
The New ERISA
Overpayment Appeals And Anti-Fraud Services Announced For Healthcare
Providers Through ERISA Appeals And Anti-Fraud Compliance 02-08-2010, Hanover Park, IL
The New Hospital
ERISA Appeals Department Program Announced for Hospital In-House
Denial Management and Financial Crisis Turnaround
02-08-2010, Hanover Park, IL
The New 2010 Obama
Healthcare Reimbursement Law Webinars Announced As ERISA Appeals
Procedures Now Mandatory for All Group Health Plans and Healthcare
Providers 01-04-2010, Hanover Park, IL
Free Overpayment Webinar Announced For
Self-insured Health Plans To Get Immediate Relief from New $1 Trillion
Overpayment Recoupment Embezzlement Market 11-23-2009,
Hanover Park, IL
New Healthcare
Overpayment Recoupment Embezzlement Recovery Service Announced In Wake
Of Launch of New Federal Task Force To Combat Healthcare Fraud Crisis 11-19-2009, Hanover Park, IL
The New Healthcare
Reform Bill Passed by The Congress Prompted The New Claim Specialist
Certification Class from ERISAclaim.com 11-9-2009, Hanover Park, IL
ERISAclaim.com
Announced The Nation's First Embezzlement Recovery Services for Large
ERISA Health Plans from the $6 Trillion Healthcare Denial Management
Market 10-23-2009, Hanover Park, IL
ERISAclaim.com Announced Free ERISA Webinar for Healthcare Overpayment
Dispute and Claim Denials in Response to Increasing High Demand from
the $6 Trillion Healthcare Denial Management Market
10-19-2009, Hanover Park, IL
ERISAclaim.com Announced the Expansion of Its ERISA Litigation Support
For the Healthcare Claims In Response to Increasing High Demand from
the $6 Trillion Healthcare Denial Management Market.
10-19-2009, Hanover Park, IL
ERISAclaim.com
Announced 2010 ERISA Seminars for Healthcare Overpayment and Claim
Denial Appeals for the $6 Trillion Healthcare Denial Management
Market.
10-14-2009, Hanover Park, IL
ERISAclaim.com
Announced the Nation's First Certification Program for the ERISA
Claim Appeal Specialist for Healthcare Providers and Managed-Care
Payers,
10-13-2009, Hanover Park, IL
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
represent the entire spectrum of the private employee benefits
community and either sponsor directly or administer retirement and
health plans covering more than 100 million Americans."
http://www.americanbenefitscouncil.org/issues/health/mischealth.htm
Lexology - Notes on the National Summit on Health Care Fraud
Reed Smith LLP,
Last
week, in my capacity as president of the
American Health
Lawyers Association, I attended the first
National Summit on
Health Care
Fraud,
a joint undertaking by the
U.S. Department of
Health and Human Services and the
U.S. Department of Justice. The conference brought together
private sector leaders, law enforcement personnel, and
health
care experts as part of the Obama Administration’s coordinated effort
to fight health
care fraud.
This was the first national gathering on
health
care fraud
between law enforcement and the private and public sectors."
STOP Medicare Fraud
- U.S. Department of Health & Human Services and U.S. Department of
Justice (http://www.stopmedicarefraud.gov)
"National
Summit on Health Care Fraud
U.S.
Department of Health and Human Services Secretary Kathleen Sebelius
and Attorney General Eric Holder convened a “National Summit on
Health Care Fraud” on Thursday January 28, to bring together leaders
from the public and private sectors to identify and discuss
innovative ways to eliminate fraud, waste and abuse in the U.S.
health care system. The National Summit is the latest initiative of
the Health Care Fraud Prevention & Enforcement Action Team (HEAT)."
Related Press Release links:
The New 2010 Obama
Healthcare Reimbursement Law Webinars Announced As ERISA Appeals
Procedures Now Mandatory for All Group Health Plans and Healthcare
Providers 01-04-2010, Hanover Park, IL
Free Overpayment Webinar Announced For
Self-insured Health Plans To Get Immediate Relief from New $1 Trillion
Overpayment Recoupment Embezzlement Market 11-23-2009,
Hanover Park, IL
New Healthcare
Overpayment Recoupment Embezzlement Recovery Service Announced In Wake
Of Launch of New Federal Task Force To Combat Healthcare Fraud Crisis 11-19-2009, Hanover Park, IL
The New Healthcare
Reform Bill Passed by The Congress Prompted The New Claim Specialist
Certification Class from ERISAclaim.com 11-9-2009, Hanover Park, IL
ERISAclaim.com
Announced The Nation's First Embezzlement Recovery Services for Large
ERISA Health Plans from the $6 Trillion Healthcare Denial Management
Market 10-23-2009, Hanover Park, IL
ERISAclaim.com Announced Free ERISA Webinar for Healthcare Overpayment
Dispute and Claim Denials in Response to Increasing High Demand from
the $6 Trillion Healthcare Denial Management Market
10-19-2009, Hanover Park, IL
ERISAclaim.com Announced the Expansion of Its ERISA Litigation Support
For the Healthcare Claims In Response to Increasing High Demand from
the $6 Trillion Healthcare Denial Management Market.
10-19-2009, Hanover Park, IL
ERISAclaim.com
Announced 2010 ERISA Seminars for Healthcare Overpayment and Claim
Denial Appeals for the $6 Trillion Healthcare Denial Management
Market.
10-14-2009, Hanover Park, IL
ERISAclaim.com
Announced the Nation's First Certification Program for the ERISA
Claim Appeal Specialist for Healthcare Providers and Managed-Care
Payers,
10-13-2009, Hanover Park, IL
Interactive Side-By-Side
Health Reform Comparison Tool of Major Proposals
(Kaiser Family Foundation)
Excerpt: "The Foundation has updated its health
reform resources to reflect provisions of the Affordable Health Care for
America Act (HR 3962) as passed on Saturday by the U.S. House of
Representatives."
Information updated 03/26/2010
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