The New ERISA Overpayment Appeals And Anti-Fraud Services Announced For Healthcare Providers Through ERISA Appeals And Anti-Fraud Compliance

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In Light of Increasing Frivolous And Debilitating Overpayment Refund Demand From Payers, 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

the Godfather of ERISA Claims 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. 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, 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.'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. 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). 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, 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 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, 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 has been referred to as "the Godfather of ERISA Claims" for providers in the healthcare industry. 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, or contact Dr. Jin Zhou, president of, at 630-808-7237.


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