ERISAclaim.com Press
Release
FOR
IMMEDIATE RELEASE:
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
In Light of Increasing Frivolous And
Debilitating Overpayment Refund Demand From Payers, ERISAclaim.com
Announced The Nation’s First ERISA Overpayment Appeals and Anti-Fraud
Services to Help Healthcare Providers to Effectively Appeal All
Alleged Overpayment Denials in Essence of Retrospective Benefits
Denials and Increase Fraud and Abuse Prevention ‘Compliance, As
Federal Law ERISA Governs All Denials of Benefits From ERISA Plans and
Prohibits Fraudulent Interference with ERISA Rights
Hanover Park, IL (PRWEB)
Feb. 08, 2010 – ERISAclaim.com announced nation’s first ERISA
overpayment appeals and anti-fraud services to help healthcare
providers battling and appealing endless and frivolous alleged
overpayment refund demand and withholdings from payers. Sometimes,
these overpayment refund demands are under the color of anti-fraud
initiatives, when in essence the alleged overpayment demands are
purely retrospective or retroactive benefits denials under ERISA, by
payers without any compliance of federal law. ERISA mandates all both
self-insured and fully-insured health plans for 180 days for a
claimant to file an appeal for full and fair reviews under ERISA for
any denied claims, adverse benefits determination, any plan payment
after refund is less than 100% of the claims submitted originally.
Federal Law, ERISA, prohibits any fraudulent interference by anyone
with ERISA rights in overpayment disputes. ERISAclaim.com also
promotes education and compliance for fraud and abuse prevention for
healthcare providers and payers equally.
“While it is positive
and necessary for all payers and the government to fight against any
and all fraudulent claims by any healthcare providers, suppliers and
patients, as President Obama outlined last month in his State of the
Union Address, the majority of healthcare providers are honest and
dedicated to healthcare delivery and compliance. Failure to recognize
the clear difference between a criminal act in healthcare fraud and
pure health benefits claim disputes will backfire on the real
antifraud initiative and destroy U.S. healthcare system ultimately. A
fraudulent payer, TPA or PPO operator, who fraudulently deprived hard
working Americans off legitimate benefits by violating ERISA, is
equally or more dangerous than a fraudulent healthcare provider to
U.S. economy and healthcare system.” said Dr. Jin Zhou, the President
of ERISAclaim.com, a national expert in ERISA compliance and fraud and
abuse prevention.
Under the name of the
legitimate antifraud campaign, many innocent healthcare providers,
large or small, are faced with disrupting and debilitating overpayment
refund demand or harassment by noncompliant payers and TPA’s when the
overpayment refund demands are purely ERISA retrospective claim
denials in absence of any fraud or abuse. Due to the lack of ERISA
knowledge and professional representation, many providers are going
through financial and emotional heart attacks, in turn, their patients
have to suffer from the same nightmares, as witnessed by Dr. Jin Zhou
from his clients in the past 10 years.
According to Dr. Jin
Zhou, U.S. Supreme has repeated ruled that ERISA governs any and all
benefits claim disputes and lawsuits brought to remedy only the denial
of benefits under
ERISA-regulated benefit plans, and ERISA completely pre-empts any
and all state laws for only denial of benefits from ERISA plans
prospectively or retrospectively. Federal ERISA law, 29 U.S.C. § 1141,
prohibits any deceptive and fraudulent interference for the purpose of
interfering with or preventing the exercise of any right to which a
claimant is or may become entitled under the plan. As same as provided
for Medicare overpayment appeals process, ERISA provides very specific
appeals process for all denied claims, adverse benefits determination,
both prospectively and retrospectively.
As repeatedly observed
by Dr. Jin Zhou, a provider’s failure to timely appeal or respond to
the payer’s overpayment demand will most likely result in automatic
withholding, denials of the provider’s future claims, and /or all
future claims subject to pre-payment reviews, and possibly referrals
to the federal and state regulatory and law enforcement agencies, and
professional license board for investigation and punitive actions, if
indicated, correctly or incorrectly deemed by a payer.
ERISAclaim.com’s ERISA
Overpayment Appeals and Anti-Fraud Services will assist healthcare
providers, on-site or off-site, with ERISA assessment of the
overpayment refund demand (retrospective EOB), CCI compliance, PPO
Medical Policy and Documentation compliance as well as the assessment
of potential provider claim risks. ERISAclaim.com will assist
providers with timely appeals, based on the correct and truthful facts
of the claims, ERISA claim regulation, relevant plan coverage
documents and plan Summary Plan Description (SPD). ERISAclaim.com will
also provide specific education on healthcare fraud and abuse
prevention, Corporate Compliance Initiative in billing, coding and
documentation, as a compliance and risk management for healthcare
providers. When necessary, ERISAclaim.com will refer to the healthcare
attorneys of the client choices for further professional guidance and
representations, in addition to the litigation support services
provided by ERISAclaim.com.com. The costs for these ERISA Appeals and
Fraud Prevention Services will depend upon the nature and size of the
overpayment refund demands and claims.
In the past 10 years
in USA, ERISAclaim.com has been the only ERISA Specialized Company
offering the most practical and comprehensive ERISA education,
consulting and publishing services for healthcare providers in
administrative ERISA appeals for real problem oriented denials under
the most mysterious 35-year-old federal law, ERISA. Dr. Jin Zhou, the
president of ERISAclaim.com has been referred to as “the Godfather of
ERISA Claims” for providers in the healthcare industry.
ERISAclaim.com is
dedicated to helping healthcare providers with compliant ERISA appeals
to get paid legally, for what the working class Americans and their
families are legally entitled to under federal law ERISA and health
plan provisions, to eliminate billions of dollars in uncompensated
care costs for healthcare providers and prevent working American
family from bankruptcies as a result of unpaid medical bills, and to
minimize revenue cycle outsourcing dilemmas for healthcare providers
already in financial respiratory failures.
For more information, please visit
http://www.erisaclaim.com/overpayment_refund.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 Links:
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)."
