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We Are Seeking New Strategic Partners
Our sister website,
SleepApneaUSA.net,
is finally here, and improving, updating every date.
Welcome
ERISAclaim.com (also now
"USHealthcareCrisis.com") with its
principal and founder, Dr. Jin Zhou, is committed to providing
unique and practical solutions to our nation's
health care crisis, in case the
Congress and the President of the United
States
fail to stop our
health-care
crisis,
probable health care crash and
future federal budget deficits of $44.2 trilion;
We will provide
educational and consulting
solutions to
healthcare providers, clinics
and hospitals for maximum reimbursement or crisis
turnaround only through
compliance of ERISA;
We will provide educational and consulting solutions to
employers/plan sponsors,
insurers and TPA's with
compliance assistance
to minimize administrative costs and risks
through compliance of ERISA;
We will
provide
educational and consulting solutions to the nation to
establish or restore the hope,
faith and
the Law
&
Order for
our health-care system through
education and
compliance of ERISA, the federal law designed to regulate about 80% of the health-care claims and 60% of the U.S.
health-care expenditure,
ERISA is the only "nuclear power" capable of
stopping our escalating health-care costs. Compliance is the
only common
ground for everyone, and it is the only way
that we can bail out of
our worst health-care crisis since World War II.
Our strategy is to solve US
health-care crisis through:
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Scientific identification of the
most accurate causation for
skyrocketing medical inflation and fundamental failure of US health care
delivery system - ERISA Failure;
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Identification of
common ground for everyone involved,
governing federal law for employer-sponsored
health-care system that has been already on the book
for the past 30 years - ERISA; and
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Providing
a solution to
ü Establish Prudent
"Personal Responsibility" without Eliminating Employer-Sponsored
Health-Care System and without "Skipping Necessary Health Care" and
"Personal Bankruptcy";
ü
Keep Employer-Sponsored
Health-Care System with Quality Health Care but without Skyrocketing
Medical Cost Disaster.
Our mission is to prevent another
"Failure of Imagination" in
US healthcare crisis triggered economic
recession or even disaster, and
"John Q. ERISA
Enforcement"!
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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."
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Health-Care 9/11 Report of 2005
Health-care WMD
by Jin Zhou,
02/05/2005
© 2005,
Jin Zhou,
ERISAclaim.com |
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Unanimous US Supreme Court: |
Employer-Sponsored Health-Care Is
Completely Governed by ERISA laws and rules;
Aetna Health Inc. v. Davila, 06/21/04 |
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Congressional Leaders: |
One
Administration = One Voice = ERISA Self Enforcement only, or
No Enforcement? |
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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. |
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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: |
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Personal Bankruptcy
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GM Chapter 11,
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National healthcare expenditure $$1,9 trillion
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One nation under debt
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GAO Report: Tax
Expenditures Represent a Substantial Federal Commitment and Need to
Be Reexamined (PDF) (U.S. Government Accountability Office)
Abstract Highlights-PDF PDF
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| 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"??? |
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Congressional conclusion 2008:
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"Failure of Imagination" Again,
with No One's Responsibility and Accountability. |
Title 29 U.S.C. § 1141 states:
"It shall be unlawful for any
person through the use of fraud, force, violence, or threat of
the use of force or violence, to restrain, coerce, intimidate,
or attempt to restrain, coerce, or intimidate any participant or
beneficiary for the purpose of interfering with or preventing
the exercise of any right to which he is or may become entitled
under the plan, this title, section 3001, or the Welfare and
Pension Plans Disclosure Act. Any person who willfully violates
this section shall be fined $10,000 or imprisoned for not more
than one year, or both. The amount of fine is governed by 18
U.S.C. § 3571. The U.S. Sentencing Guidelines address 29 U.S.C.
§ 1141 under the guidelines for "Fraud and Deceit" (U.S.S.G. §
2F1.1) or for "Extortion by Force or Threat of Injury or Serious
Damage (U.S.S.G. § 2B3.2)......"
"For example, Section 1141
would reach the use of deception directed
at misleading a welfare plan beneficiary as to the amount of
health benefits owed to the beneficiary under the terms of the
plan or at misleading a pension plan participant as to
the amount of retirement benefits to which he would become
entitled under the plan upon his retirement."
ERISA in the United States Code
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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?
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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."
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Denials +
Recoupment =
Inflation +
Fraud or
Cost-Sharing?
Rx =
Compliant Denials & Appeals! |
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Forbes.com: "Roughly one in seven Americans has
no health insurance. That hurts HCA Inc. (nyse:
HCA -
news
-
people), the largest U.S. hospital chain, which
last year wrote off $2.21 billion
of revenue because patients couldn't pay their
bills."
The American Hospital Association (AHA): "Hospitals today are faced with the challenge of managing their
limited resources, while continuing to deliver the highest standard of care.
According to health care experts, the cost of clinical
denials to individual healthcare organizations averages
$3.3 million
annually. However, many hospitals do not have the resources or the
expertise needed to avoid unpaid days at the end of admissions and lead the
denial-appeals processes."
Payments Go Under a Microscope (washingtonpost.com)
"MAMSI and CareFirst recoup overpayments to doctors by making
deductions from future reimbursements.
Doctors can appeal insurers' decisions.
But, in the end, they usually pay up, doctors and insurers agree."
U.S.
FILES COMPLAINT AGAINST NATIONAL ACCOUNTING FIRM UNDER FALSE CLAIMS ACT
(DOJ
Press Release) "January 5, 2004
- PHILADELPHIA –
United States Attorney Patrick L. Meehan announced today the filing of the
Government's
complaint against national accounting firm Ernst & Young.
According to the complaint, nine hospitals paid Ernst & Young for billing
advice – advice which later caused the submission of false claims to the
Medicare program."
USATODAY.com - Hospitals Sock Uninsured with Much Bigger Bills
GM to Report $60B in Future Health-Care Obligations
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Survey: Americans More Worried About Healthcare Costs Than Terrorist
Attacks (The Henry J. Kaiser Family Foundation)
Excerpt: "We were
surprised to find in our latest tracking poll that more Americans are
worried about health care costs than about losing their job, paying
their rent or mortgage, losing money in the stock market, or being a
victim of a terrorist attack.
Nearly four in 10
Americans (38%) say they are very worried that the amount they pay for
health care services or health insurance will increase, and a similar
share (37%) is very worried that their income might not keep up with
rising prices over the next six months."
Problems and Priorities (pollingreport.com)
82% of Americans rank
healthcare among their top issues, according to
Gallup Poll.
Are All
Consultants Corrupt? (Fast Company)
Excerpt: "That's one possible conclusion in the wake of the
Enron scandal.
According to David Maister, who's been studying professional-services firms
for more than 20 years, it's time to clear the air."
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HEALTH COSTS--The
Breaking Point (FORTUNE.com)
"Worker health costs
will rise a staggering 24% this year. Companies can no longer afford to
pick up the bill. The battle is here."
Law Professor Looks at
Criminal Prosecution for HMO Treatment Denial (Prof.
John A. Humbach published by the Health Administration
Responsibility Project (harp.org))
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 |
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Codified in Title 29 of the
Code of Federal Regulations:
Regulations
Selected links:
2520.102-3 Contents of summary plan description.
2560.503-1 Claims procedure. |
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ERISA &
Claim
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ERISA Laws/Rules
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ERISA in US CODE
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Opinion: The Coming Crash in Health Care (Fortune.com)
"Thus it may come as a surprise to
learn that the managed-care industry is dying. Oops, did we spill the
beans so soon? Well, so be it. Managed care is on the way out."
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HIPPA Final
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