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Photo of President Gerald R. Ford signing Employee Retirement Income Security Act of 1974

President Obama Signing Health Bill

on 03/23/2010

President Gerald R. Ford Signing ERISA on 09/02/1974

President Obama Signed Healthcare Reform Legislation Into the Law

to Revamp Healthcare Reimbursement Laws for

All Group Health Plans and Health Care Providers

ERISA Appeals Regulations Are Mandatory for

All Group Health Plans & Healthcare Providers

 

 

 

 

ERISAclaim.com Press Release

 

FOR IMMEDIATE RELEASE:

 

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

Will Obama's New Financial Fraud Task Force Catch The New "Trillion-Dollar Madoff" In The Widespread $1 Trillion Healthcare Overpayment Recoupment Embezzlement Crime? ERISAclaim.com Believes That Private Sectors Shall Be The Equal Partners To The Federal Government In Fighting And Preventing Another Financial Meltdown, And Must Take Proactive And Primary Roles In Conjunction With The Government Fraud Task Force To Save Our Economy And Healthcare System.

Hanover Park, IL (PRWEB) November 19, 2009 -- ERISAclaim.com announced today the new healthcare overpayment recoupment embezzlement recovery services in the wake of the new federal task force to combat healthcare fraud crisis. On Tuesday, November 17, 2009, the United States Attorney General Eric Holder announced at the Department Of Justice (DOJ) Financial Fraud Enforcement Task Force Press Conference that an Interagency Financial Fraud Enforcement Task Force was launched under President Obama's executive order to combat financial crime.

 

In order to make new Obama Financial Task force mission possible, Dr. Jin Zhou with ERISAclaim.com, with unique knowledge of industry known facts, 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.

 

The Attorney General Eric Holder said in prepared remarks that, "This task force's mission is not just to hold accountable those who helped bring about the last financial meltdown, but to prevent another meltdown from happening."

 

"Will Obama's new financial fraud task force catch the new 'trillion-dollar Madoff' in the widespread $1 trillion healthcare overpayment recoupment embezzlement crime?" commented by Dr. Jin Zhou, the President of ERISAclaim.com.

 

"We face unprecedented challenges in responding to the financial crisis that has gripped our economy for the past year", said United States Attorney General Eric Holder at the press conference.

 

This new task force is apparently a part of Obama's campaign promises for vigorous enforcement to resuscitate U.S. economy, and in the wake of economic recession and federal securities regulator's failure in one of the biggest $65 billion financial fraud in U.S. history committed by Bernard Madoff in a decades-long scheme, as observed by Dr. Jin Zhou of ERISAclaim.com.

 

"The stakes are very high for the administration, particularly with current congressional debates on the real costs to finance the new health care reform and the lack of measurement to contain health-care costs, waste and fraud", said Dr. Jin Zhou.

 

"It's not enough to prosecute fraud only after it's become widespread," Treasury Secretary Timothy F. Geithner said at the DOJ press conference. "We can't wait for problems to peak before we respond. We're seeking comprehensive financial reform to create a more stable, safer financial system and stepping up our enforcement strategy."

 

In responding to this new Obama preventative enforcement task force mission, Dr. Jin Zhou from ERISAclaim.com, an industry expert in healthcare claims and employee benefit administration, made the following statements in launching the new overpayment recoupment embezzlement recovery services:

 

Obama Administration has the right "Art of War" strategy in fighting against the financial fraud war, a superb strategy to win the war before the war breaks out, but the talking is cheap, and seeing is believing.

 

Overpayment recoupment embezzlement is a widespread financial fraud that has gripped our healthcare system in about $1 trillion healthcare overpayment recoupment embezzlement crime.

 

ERISAclaim.com believes that private sectors shall be the equal partners to the Federal Government in fighting and preventing another financial meltdown, and must take proactive and primary roles in conjunction with the government fraud task force to save our economy and healthcare system.

 

Overpayment recoupment embezzlement fraud or crime is typically committed sophisticatedly by health plan's third-party administrators (TPA) or "TPA Madoff" in the scams by initial negligent overpayment to healthcare providers from the plan assets, especially from self-insured employer-sponsored plans, and subsequent unauthorized overpayment recoupment on behalf of self-funded plans under "anti-fraud initiatives" and ultimately fraudulent embezzlement of plan assets by failing to refund or return the recouped money to the original self-funded health plans. The current overpayment recoupment embezzlement fraud is very sophisticated and complicated, as it was usually committed under anti-fraud campaign and with participation of federal and state law enforcement to the extent of the alleged healthcare provider fraud investigation and prosecution. Based on the industry reports and published numbers, it is estimated that overpayment recoupment market could well be over $1 trillion as most recoupment actions have gone back two to six years with $2.5 trillion health expenditure annually and $6 trillion in denied claims annually. This "trillion-dollar Madoff" will overshadow the "billion-dollar Madoff".

 

Unless with in-depth industry knowledge and intimate know-how, it is extremely difficult for the ordinary plan sponsors to decipher this kind of trillion-dollar recoupment embezzlement scam, that is why Bernard Madoff's billion-dollar scam was harder to be discovered for decades than those million-dollar or thousand-dollar financial or health care fraud.

  

"A successful enforcement and recovery from $1 trillion overpayment recoupment embezzlement market may very well finance the most, if not entire, healthcare reform, as the House Bill passed last week will provide coverage to 96% of Americans under $900 billion threshold outlined by President Obama", said Dr. Jin Zhou, the president of ERISAclaim.com.

 

"Whether or not Obama's new task force will catch real "trillion-dollar Madoff" soon enough or only afterwards remains to be seen", as cautioned by Dr. Jin Zhou.

 

For more information or to arrange an interview, please visit http://erisaclaim.com/Embezzlement_Recovery.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

 

 

 

 

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

bullet

Summary of Final Health Care Reform Law (.pdf)

Download a printable comparison of the new health reform law (the Patient Protection and Affordable Care Act), the House-passed Health Care and Education Reconciliation Act of 2010, and last year's House-passed bill (.pdf)
Download a printable version of the three Congressional authorizing committee proposals (.pdf)
Download a printable side-by-side comparison of all proposals and topics (.pdf)

 
 

 

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."

 

Department of Labor

 
"A group health plan is an employee welfare benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.

Most private sector health plans are covered by the

 Employee Retirement Income Security Act (ERISA). Among other things, ERISA provides protections for participants and beneficiaries in employee benefit plans (participant rights), including providing access to plan information. Also, those individuals who manage plans (and other fiduciaries) must meet certain standards of conduct under the fiduciary responsibilities specified in the law."

 

 

$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.
 

  1. Federal and state mandates and the patient’s benefit document take precedence over these policies.

  2. 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."

 

 

 

Statutes (United States Code) 
ERISA - Title 29, Chapter 18. 

        Selected links:

Sec. 1002.
Definitions

Sec. 1003.
Coverage

Sec. 1022.
Summary plan description

Sec. 1027.

Retention of records
Sec. 1104.
Fiduciary duties

Sec.1106.

Prohibited transactions

Sec. 1140.
Interference with protected rights

Sec. 1141.
Coercive interference

part 7
group health plan requirements

 

 

Code of Federal Regulations

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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