The previous Administration focused on compliance assistance
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://erisaclaim.com/Embezzlement_Recovery.htm, or contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.