|
|
|
|
ERISAclaim.com Press
Release
FOR
IMMEDIATE RELEASE:
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 is offering a unique
ERISA recovery service for midsized and large sized employer-sponsored
ERISA health plans from potential or probable embezzlement, kickback,
concealment and negligence as well as mismanagement from TPAs and ASOs
to recoup potentially hundreds of millions of dollars from current
healthcare industry overpayment practice and mismanagement.
ERISAclaim.com has gained its unique industry in-depth knowledge and
expertise from working with every segment of health care industry in
more than 10 years. With unique knowledge of the industry known facts,
ERISAclaim.com is dedicated to helping large ERISA plans to recover
millions of dollars on a complete contingency basis."
Hanover Park, IL (PRWEB) October 23, 2009 -- In light of new 2010 DOL
ERISA regulatory enforcement drastic changes from "The previous
Administration focused on compliance assistance" to the "New Sheriff"
prioritized vigorous and "strong enhancement" to prosecute
"embezzlement of plan assets", effective on October 23, 2009,
ERISAclaim.com is offering a unique ERISA recovery service to midsized
and large sized employer-sponsored ERISA health plans from potential
or probable embezzlement, kickback, concealment and negligence from
TPAs and ASOs to recoup potentially hundreds of millions of dollars
from current healthcare industry overpayment practice and
mismanagement of healthcare claim administration on behalf of the
ERISA plans, although in the recent years DOL has helped a limited
number of ERISA plans with recovery of millions of dollars.
ERISAclaim.com has gained its unique industry in-depth knowledge and
expertise from working, directly or indirectly, with every segment of
health care industry in more than 10 years. Due to the complexity of
ERISA statutory framework and inherited difficulties in the insurance
and medical industry, almost every ERISA plan, even those large
employer-sponsored plans, have been powerless and clueless in health
care funding and medical costs control in this skyrocketing health
care market evidenced by the inevitable failures from every strategy
entertained over the past 20 years. With unique knowledge of industry
known facts, ERISAclaim.com has launched the nation's first unique
embezzlement recovery service to help midsized and large sized ERISA
plans to recover millions of dollars on a complete contingency basis,
to recoup as much as possible from the recoverable but overpaid
healthcare dollars to the original payers and owners who initially
paid out overpaid claims by TPAs and ASOs and are now entitled to the
ownership for and the possession to an estimated billions of dollars
in the $6 trillion dollar healthcare denial management market.
U.S. health expenditure has been steadily skyrocketing to $2.4
trillion for 2008 and $2.5 trillion for 2009, about 16-17% of the GDP,
about 50% of which were funded by private sectors, mostly from the
employer-sponsored health plans for 74% of civilian workers among an
estimated of 170 million Americans. It is well known that General
Motor's bankruptcy is partially due to its $5.6 billion health
expenditure per year and huge pension liabilities. It is not well
known that a significant portion of health expenditure was consumed
not only by legitimate health expenses but also by preventable and
recoverable fraud, waste, inflation and mismanagement from every
segment of health care and benefit industry. American employers
sponsored and financed healthcare plans for working Americans and
their families under the federal law, ERISA, Employee Retirement
Income Security Act of 1974, by retaining another industry to manage
and administer this unique trillion dollar industry with an almost
complete hands-free corporate mentality. It is estimated that up to
50% of U.S. health expenditure might be due to medical inflation,
health care fraud and waste, unnecessary administrative expenses and
well known but little resolved potential embezzlement, kickback,
concealment or mismanagement and negligence by the most sophisticated
and trusted contractors, the TPA and ASO claim administrators.
ERISAclaim.com is the first company in the U.A. with missions to save
the employer-sponsored health care infrastructure to curb fraud and
abuse from the most powerful and vulnerable TPA/ASO benefit industry,
in addition to its ERISA litigation support and provider education
services. The embezzlement from overpayment recoupment is estimated to
be much larger than nationwide "benefits broker fraud" discovered and
prosecuted by former New York attorney general several years ago.
ERISA, Employee Retirement Income Security Act of 1974, is a federal
law that governs and regulates healthcare claims for estimated more
than 170 million Americans who obtained health insurance or benefits
from employment in private sector, for both self-insured and
fully-insured (through purchase of insurance) health plans. ERISA law
completely (100%) preempts all state laws and private managed-care
contracts as well as all disputes over the denial of benefits from an
ERISA plan. ERISA regulates and governs healthcare claims which
include the paid ERISA healthcare claims in more than 50% of $2.4
trillion, 16.6% of GDP, of the national health expenditure in 2008,
and also include the denied healthcare claims, legitimately or wrongly
for appealable claims, in more than 50% of $5 trillion in the
aggregated denied healthcare claims in 2008. More than 60-70% of
healthcare claim denials from insurance companies and managed-care
third-party payers by employer-sponsored plans are due to ERISA
regulated plan or policy coverage, limitations and exclusions rather
than traditional billing, coding, medical necessity and managed care
contracting or participation dispute. Therefore all of the industry
recovered "overpayment" health care dollars are ERISA plan assets.
Plan sponsors and plan administrators from self-funded plans have
fiduciary duties under ERISA to safeguard and to claim ownership for
all plan assets. With forthcoming Obama health care reform and new DOL
2010 enhancement goals announced last month, new DOL EBSA boss,
Assistant Secretary of Labor Phyllis Borzi laid out a new and vigorous
plan for the Employee Benefits Security Administration (EBSA) that she
now heads. It was clear that enforcement of the law and promises made
by Obama in his campaign will be a driving focus. "The previous
Administration focused on compliance assistance," she noted, "but
that's only good if it is combined with strong enforcement", as an
example, Borzi identified "embezzlement of plan assets" as "the most
egregious and persistent violations" of ERISA that EBSA has initiated
a criminal project to prosecute.
ERISAclaim.com, located in northwestern suburb of Chicago, Illinois,
is an online publisher, consultant and educator for ERISA claim
education, training and consulting as well as claims recovery for
ERISA healthcare claims. It also provides ERISA litigation support,
research assistance and fraud and abuse prevention. In addition to
ERISA, ERISAclaim.com also provides consulting and education for
Medicare Claim Appeals Specialist, for Medicare RAC overpayment
appeals, fraud and abuse prevention.
Dr. Jin Zhou, the president of ERISAclaim.com, has gained most
comprehensive and unique practical experience in training and
consulting in ERISA claims for healthcare providers and assisting
trial lawyers frequently for more than 10 years. Dr. Jin Zhou was
sometimes referred to as the "Godfather of ERISA Claims" for
healthcare providers by some industry experts.
For more information or to arrange an interview, please visit
http://www.erisaclaim.com/PR0005.htm, or 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 Press Release links:
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
|
| |
|
|
ERISA &
Claim Denials
|
|
Aetna Video Shows ERISA Patients Mistreated
"According to the video, when faced with claims for identical
medical problems, Aetna separates the claims where no damages
are available - those subject to the federal Employee Retirement
Income Security Act, or ERISA - from non-ERISA claims, where
consumers can sue.1 2" |
|
 |
|
ERISA &
Health Claim |
|
What Is
ERISA and How Does It Affect Patient Rights?
"ERISA was enacted in 1974 to protect the pension and welfare
benefits that employers provide their workers. It currently
covers about 2.5 million health plans and 125 million workers,
retirees, and dependents." |
|
 |
|
$10,600 ERISA Claim
|
| Recent Federal Court Ruling in a Case with
$10,600 medical claim, insurance Co. refused to pay, provider
made numerous demand for payment in almost one year, but no
appeals filed, the court dismissed the lawsuit because provider
failed to exhaust administrative remedy, as required under ERISA,
by filing ERISAclaim appeals. This situation is so popular
in health-care community.
|
|
 |
| |
|
|
|
|
Agree to terms and conditions
"Each
benefit plan defines which services are covered, which are
excluded, and which are subject to dollar caps or other limits.
Members and their providers will need to consult the member's
benefit plan to determine if there are any exclusions or other
benefit limitations applicable to this service or supply."
CIGNA - Coverage Positions/Criteria
"The terms of a participant's particular benefit
plan document [Group Service Agreement (GSA), Evidence of
Coverage, Certificate of Coverage,
Summary Plan Description (SPD) or similar plan
document] may differ significantly from the standard benefit
plans upon which these Coverage Positions are based.
If
these Coverage Positions are inconsistent with the terms of the
member's specific benefit plan, then the terms of the member's
specific benefit plan always control."
UnitedHealthcare Medical Policies
"By clicking "I agree," you agree to be bound by
the terms and conditions expressed below, in addition to our
Site Use Agreement.
UnitedHealthcare medical policies have been made available to
you as a general reference resource. When reading these policies
you agree that:
Our Medical Policy is not your patient's Benefit Plan.
Your patient's medical
benefits are governed and determined by a benefit document,
either a Certificate of Coverage or a
Summary Plan Description. You should not rely on
the information contained in this Web site section to determine
your patient's medical benefits.
-
Federal and state mandates and the patient’s
benefit document take precedence over these policies.
-
The patient’s benefit document lists the specific
services that have coverage limits or exclusions.
Our Medical Policy does not address every situation and
individuals should always consult their physician before making
any decisions on medical care."
|
|
 |
|
|
|
|
|
|
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. |
|
|
 |
|