|
|
|
|
New Federal Health Claims & Appeals Laws
&
Regulations
for 193 Million Americans
Effective 09-23-2010
©2010, Jin
Zhou, ERISAclaim.com |
|
 |
 |
|
President
Obama Signing Health Bill on
03/23/2010
|
President
Gerald R. Ford Signing ERISA on 09/02/1974 |
|
New Webinars,
Seminars & Certification Classes Announced for New Federal Health
Claim Appeals Regulations on July 22, 2010 from HHS, DOL & IRS,
Effective On Sept. 23, 2010 for 193 Million Americans |
|
 |
 |
UNITED STATES
DEPARTMENT OF LABOR
(Links to DOL)
©2010, Jin Zhou, ERISAclaim.com |
|
Statutory Laws [PDF]
[PDF]
|
|
Employee Retirement Income Security Act — ERISA |
|
|
|
Webinars,
Seminars & Certification Classes for New Federal Health Claim Appeals
Regulations
ERISAclaim.com
- Free Webinars - New Federal Claims & Appeals Regulations, Effective
Sept. 23, 2010, for 193 Million Americans
ERISAclaim.com: Seminars - 2010 Two-day
Basic ERISA Appeal Seminars - Denials and Overpayment Appeals
ERISAclaim.com - 2010
PPACA & ERISA Claim
Specialist Certification Programs in Chicago, Illinois
ERISAclaim.com: Create An Appeal
Department for Your Hospital or Practice
(In-house, onsite ERISA Claim Specialist Certification Programs)
|
|
"Failure of Imagination" Again?
THE 9/11 COMMISSION REPORT (pdf)
Congress Finds No Simple
Solutions to Current Pension Problems (The Washington
Post; one-time registration required)
NASA identifies foam flaw that killed astronauts (Reuters)
Jin Zhou Identifies "ERISA Failure" That Killed
U.S. Healthcare
|
Health-Care 9/11 Report of 2005
Health-care WMD
by Jin Zhou,
02/05/2005
© 2005,
Jin Zhou,
ERISAclaim.com |
|
Unanimous US Supreme Court: |
Employer-Sponsored Health-Care Is
Completely Governed by ERISA laws and rules;
Aetna Health Inc. v. Davila, 06/21/04 |
|
Congressional Leaders: |
One
Administration = One Voice = ERISA Self Enforcement only, or
No Enforcement? |
|
Health-care Terrorists? |
"ERISA Advantage"
bogus
plans,
"unlimited and frequent premium increases, and the potential for
rampant fraud with little, if any, regulatory recourse" in 30
years of ERISA self enforcement. |
|
Health-care WMD (Weapons of Mass Destruction) |
"Medical
Inflation, WMD" for
"ERISA Advantage" from
ERISA Failure -
"Failure of Imagination" Again
for US Healthcare:
USA:
$1.9 Trillion, 15.7% of GDP
GM:
$5.6 Billion, $1,500 Per Car
Economists: Federal deficit a bigger risk than terrorism (USA
Today) "The survey, taken
between Feb. 28 and March 8, found U.S. businesses had three nearly
equal concerns about longer-term risks: health care, the aging
population and the federal deficit." |
| USA
2005: |
-
Personal Bankruptcy
-
GM Chapter 11,
-
National healthcare expenditure $$1,9 trillion
-
One nation under debt
-
GAO Report: Tax
Expenditures Represent a Substantial Federal Commitment and Need to
Be Reexamined (PDF) (U.S. Government Accountability Office)
Abstract Highlights-PDF PDF
|
| White
House Rx: |
$1,000
HSA personal responsibility + AHP with
More "ERISA advantage" for "widespread
plan insolvencies and fraud"
and "A
Prescription For Disaster". |
| 2005 for
Michael Moore? |
"John Q. ERISA
Enforcement"??? |
|
Congressional conclusion 2008:
|
"Failure of Imagination" Again,
with No One's Responsibility and Accountability. |
|
Unanimous US Supreme Court Ruling
In US Health Care Crisis
by Jin Zhou,
02/11/2005
© 2005,
Jin Zhou,
ERISAclaim.com
Managed-Care Nightmares?
Health-Care Crisis without True Solutions?
What Does
an Unanimous US
Supreme Court Say?
On June 21, 2004, an unanimous US Supreme
Court ruled that claim processing and denials of benefits under the
employer-sponsored health plans,
ERISA-regulated benefit
plans,
for
both self-insured and
fully-insured (through purchase of insurance) health plans,
are completely governed by federal law ERISA, that supersedes and
invalidates state laws.
How
Can Anyone in USA, from Congress to General Motor to the White House,
from Industry Experts to Patient Advocates, Solve US Health Care Crisis
without Even Thinking of ERISA?
"Failure of Imagination" As a
Nation Is the Real Tragedy
ERISAclaim.com - Supreme Court
Managed Care ERISA Watch
Unanimous US Supreme Court Ruling In US Health Care Crisis
Aetna Health Inc. v. Davila
06/21/04
Opinion of the
Court
"Held:
Respondents’ state causes of action fall
within ERISA§502(a)(1)(B), and are therefore completely
pre-empted by ERISA §502 and removable to federal court.
Pp. 4–20."
"We hold that
respondents’ causes of action, brought to
remedy only the denial of benefits under
ERISA-regulated benefit
plans, fall within the scope of, and are completely pre-empted
by, ERISA §502(a)(1)(B), and thus removable to federal
district court. The judgment of the Court of Appeals is
reversed, and the cases are remanded for further proceedings
consistent with this opinion.7
It is so ordered."
|
|
"Failure of Imagination" Again?
(Copyright © 2004
by
Jin Zhou,
ERISAclaim.com)
08/20/2004
"Failure of Imagination" Again
Led to
U.S. Health-Care
Disaster,
"Labor Market
Impotence",
"Pension Anemia/Failure",
New Economy Recession
&
"John Q. ERISA
Enforcement"
in 2006 for
"Failure of Imagination" As a
Result of Political Viagra
|
|
"ERISA
FAILUR" = "FOAM FLAW"
"ERISAflation":
The combination of ERISA preemption, medical inflation, tax
incentive protection and cost shifting to preserve inflated
health-care coverage and to stabilize short-term premiums, and to
ignore long-term health-care, labor market, pension and social
security disasters. -- Jin Zhou, 10/11/2004.
Kydland and
Prescott win Nobel economics prize ((Reuters)
(Mon 11 October,
2004)
"Their 1977 article on the "time consistency problem" showed
that policy makers tend to abandon longer-term
aims to milk shorter-term benefits -- for example, setting out to
keep prices stable, but then fomenting inflation to reduce debt."
|
|
U.S. HMO 9/11
"John Q. ERISA
Enforcement"
in 2006 for
(Copyright © 2004
by
Jin Zhou,
ERISAclaim.com)
10/08/2004
|
John Q.:
My son is dying, no one seemed to care.
HMO Hospital: We are
sorry,
your insurance won't cover the care, it was
determined not necessary, besides,
the
heart surgeon you "kidnapped" last time
has been out on strike for medical malpractice tort reform.
The Employer: We have
just switched to a new HSA consumer driven plan.
HMO Insurance: If we
let your son live,
that will increase healthcare costs,
HMO premiums and
more uninsured.
Supreme Court:
All nine of us read ERISA last night, and
found Davila guilty,
it's up to
Congress.
The President:
I'm the only one to protect you, but ERISA is
tough, I must take it back.
Congress: Patient's
Bill Of Rights (+R) + Medical
Malpractice Tort Reform (-R) = Ground
Zero (0), Adjourned.
John Q.:
HMO and Congress under new management, put my son on donor's list
and no one gets hurt or ....
John Q.'s Neighbors and Co-workers:
John, we are with you....
|
HMOs Earn $10.2 Billion in 2003,
Nearly Doubling Profits, According to Weiss Ratings; Blue Cross Blue
Shield Plans Report 63% Jump in Earnings
(BUSINESS WIRE)--Aug. 30, 2004
Release
Date: 10/21/2004
"EBSA closed 4,399 civil investigations in
FY 2004. Nearly 70% of those investigations resulted in correction
of violations under the Employee Retirement Income Security Act
(ERISA). Criminal investigations led to
the indictment of 121 individuals. In addition, EBSA received a
record 474 applications to participate in its compliance assistance
program to help employers and plan officials to voluntarily correct
specific violations of the law."
EBSA Achieves Record $3.1 Billion in Fiscal Year 2004
Results •
Press Release
|
|
INVESTIGATION REVEALS WIDESPREAD CORRUPTION IN
INSURANCE INDUSTRY
 |
Department of Law
120 Broadway
New York, NY 10271
|
Department of Law
The State Capitol
Albany, NY 12224
|
| |
For More Information:
(212) 416-8060 |
For Immediate Release
October 14, 2004 |
|
|
INVESTIGATION REVEALS WIDESPREAD
CORRUPTION IN INSURANCE INDUSTRY
|
|
Leading Brokerage Firm Sued for Fraud and
Antitrust Violations; Insurance Company Executives Plead Guilty;
Major Insurance Firms Implicated |
"Attorney General Eliot Spitzer today sued the
nation's leading insurance brokerage firm, alleging that it steered
unsuspecting clients to insurers with whom it had lucrative payoff
agreements, and that the firm solicited rigged bids for insurance
contracts."
Attachments:
|
|
|
Happy or Sad
30th Birthday To ERISA?
(Copyright
© 2004
by
Jin Zhou, ERISAclaim.com)
Sept. 2, 2004
On Sept. 2, 1974, exactly 30
years ago today, ERISA, The Employee Retirement Income Security Act,
was signed into law by President Gerald R. Ford. The congressional intent in enacting ERISA was to protect employees in pension and
welfare plans, to provide uniform federal protections in response to
the failure of the Studebaker Co. in December 1963, with thousands
of long-service employees cheated out off their promised pensions,
and to preempt any state laws when the employees pension and welfare
benefits were threatened. 30 years later, ERISA Failure in its
compliance and enforcement left thousands of retirees without
medical benefits, and resulted in a skyrocketing national healthcare expenditure explosion with 45 million uninsured and a possible national pension bailout.
ERISA Failure Syndrome
U.S. Healthcare Crisis
Trilogy
Jin Zhou Identifies "ERISA Failure" That Killed
U.S. Healthcare
"Failure of Imagination"
Again?
|
|
ERISA Celebrates 30th Anniversary As Trouble Brews For the Pension
Insurance Program (Spencer Benefits Reports)
Excerpt: "The seed for ERISA
was planted with the failure of the Studebaker Company in December
1963, leaving thousands of long-service employees without their
promised pensions."
A Hard-to-Swallow Lesson on Pensions
and Promises and ERISA
(The New York Times; one-time
registration required)
Excerpt: "Hundreds of people
here in western New York, all
closing in on retirement, have
learned a bitter lesson about
pensions and the law that
guarantees them. Two years ago,
their employer, ... unexpectedly
started urging them to take their
pensions early, warning that they
would otherwise lose their right
to take their benefits in a single
check. The workers signed up to
receive their money right away,
but the money was much less than
they had earlier been told they
had coming."
The Economic Downturn and Changes in Health Insurance Coverage,
2000-2003, (Kaiser
Commission on Medicaid and the Uninsured)
 Executive
Summary (.pdf)
 Report
(.pdf)
"EXECUTIVE SUMMARY
The number of uninsured Americans under age 65
increased by 5.1million between 2000-2003 largely driven by continuing
declines in employer sponsored insurance. ....."
The Supreme Court and Employee Health
Insurance (FindLaw's
Writ - Sebok)
"What Americans
generally don't know, however, is
that this issue isn't restricted to
the Congress or the Executive. To
the contrary, the U.S. Supreme Court
has been nationalizing one important
aspect of health care in this
country: the administration of
medical health insurance offered by
employers to their employees.
This creeping
nationalization has been achieved
slowly and surely by the expansion
of the court's interpretation of an
important federal law: the Employee
Retirement Income Security Act
(ERISA)."
Inquiry on Medicare Finds Improper Limits on
Choices of Health Care Providers (The New York Times;
one-time registration required)
Excerpt: "Federal investigators
said Monday that the Bush
administration had improperly allowed
some private health plans to limit
Medicare patients' choice of health
care providers, including doctors,
nursing homes and home care agencies."
Medicare Demonstration PPOs: Financial and Other
Advantages for Plans, Few Advantages for Beneficiaries
GAO-04-960, September 27, 2004
Abstract
Highlights-PDF
PDF
|
|
Post Supreme Court Davila
Scoop:
ERISA
Pre-emption of State Laws in Healthcare
CICIO v VYTRA HEALTHCARE
Cicio
v. Vytra Healthcare (pdf)
Cicio v. Vytra Healthcare
2nd Cir. 09/24/2004
"DISCUSSION
The facts of this case are set forth in detail in our earlier opinion. We
need not rehearse them here.
In Aetna Health Inc., the Supreme Court declared that "any state-law cause
of action that duplicates, supplements, or supplants the [Employee
Retirement Income Security Act of 1974 ("ERISA")] civil enforcement remedy
conflicts with the clear congressional intent to make the ERISA remedy
exclusive and is therefore pre-empted." 124 S. Ct. at 2495. "Congress'
intent to make the ERISA civil enforcement mechanism exclusive would be
undermined if state causes of action that supplement the ERISA § 502(a)
remedies were permitted, even if the elements of the state cause of action
did not precisely duplicate the elements of an ERISA claim." Id. at
2499-2500......
CONCLUSION
Accordingly, we vacate our previous decision
in this matter and affirm the district court's dismissal of Ms.
Cicio's complaint."
Barber v. Unum Life Ins Co
3rd Cir. 09/07/2004
"Because we hold 42 Pa. C.S. § 8371 is conflict
preempted by ERISA, or alternatively expressly preempted under ERISA §
514(a), we will reverse the judgment of the District Court and remand with
instructions to dismiss Barber’s bad faith claim."
Overview: 3rd Circuit Boots Theory
Allowing Bad-Faith ERISA Litigation
(Law.com)
LAND v CIGNA HEALTHCARE OF
FLORIDA
[07/30/03, 11th Cir.]
Robbie Lee Land v. Cigna
Healthcare of Florida
11th Cir.
(August 27, 2004)
"ON REMAND FROM THE SUPREME COURT
OF THE UNITED STATES
Before MARCUS and WILSON, Circuit Judges, and RESTANI ,
Judge. *
PER CURIAM:
After we issued our decision in this
case on July 30, 2003, Land v. CIGNA Healthcare of Florida, 339
F.3d 1286 (11th Cir. 2003), the Supreme Court
vacated and remanded for further consideration in light of
its recent decision in Aetna Health Inc. v.
Davila, 542 U.S. ----, 124 S. Ct. 2488
(2004). After carefully reviewing Davila, we find that Land’s state
law malpractice claims against his
health maintenance organization (“HMO”) were preempted by Section 502 of
the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §
1001-1461."
Eleventh Circuit Court Nixes
State Malpractice Lawsuit Against ERISA HMO
(RIA Pension & Benefits Week)
US Health Care
Gaps Kill 79,000 People a Year, Report
Shows
(Bloomberg
- United States)
"Sept. 23 (Bloomberg) -- Disparities
in the U.S. health-care system result
in up to 79,000 premature deaths each
year because of a lack of preventative
treatments and care for chronic
conditions like diabetes, according to
the National Committee for Quality
Assurance."
The
State of Health Care Quality, 2004:
Industry Trends and Analysis (PDF)
(National Committee for Quality
Assurance)
61 pages. Excerpt: "NCQA's annual
State of Health Care Quality report
... found that nearly 66.5 million
avoidable sick days and more than $1.8
billion in excess medical costs can be
traced to the health care system's
routine failure to provide needed
care."
|
|
|
