Defendant argues that this case could have been brought under ERISA and is thus subject to federal jurisdiction. The Court agrees.
Hanover Park, IL (PRWEB) March 29, 2010
As an industry leader in compliance and reimbursement, ERISAclaim.com announced the special free Webinars in the wake of the latest and first federal court ruling on March 18, 2010 that that a PPO participating provider's lawsuit against Anthem BCBS, for the alleged wrongful overpayment recoupment and even withholding from different patients, is completely governed by federal law, ERISA, rather than PPO contracts and state laws. The Court decision was mainly relied upon the U.S. Supreme Court rulings. The healthcare overpayment recoupment and withholding crisis, with or without fraud allegations, has been the most expensive and detrimental financial crisis for most healthcare providers, yet embraced by health plans and every managed care entities, for a potential market as large as $6 trillion in dispute, as many health plans or TPA's are going back 5 - 6 years for allegedly overpaid claims, especially from ERISA plans. The stake is extremely high for every one. The industry has been in total chaos without clear legal guidance to follow as the governing laws for this $6 trillion market. At the same time, historical new Obama Health Reform Laws now require all group health plan and health care providers to comply with ERISA Appeals Regulations for all claims disputes.
The new overpayment Webinars will discuss in details the Federal Court ruling, and its profound impact to providers and health plans as well as managed care entities, especially the U.S. Supreme Court ruling upon which the court made its final decision. The Webinar will also review the new Obama Healthcare Reform Law mandates in claims appeals and reviews. The ERISAclaim.com webinars are free to public, providers, health plans and TPA's, starting the first webinar on April 2, 2010, at 1:30 pm CST for 30 minutes each session. More dates, schedules and registration can be found at http://www.erisaclaim.com/Free_ERISA_Webnars.htm.
"It is extremely important for all health plans, TPA's, managed care operators and healthcare providers to comply with governing federal laws in resolving and prevailing all overpayment claims disputes and overpayment recoupment and withholding," said Dr. Jin Zhou, President of ERISAclaim.com, a national ERISA expert, and reimbursement compliance consultant.
In the case of Porter v. Anthem Health Plans Of Kentucky, Inc, a PPO participating provider sued the Anthem BCBS for alleged wrongful overpayment recoupment in the state court. "Defendant argues that this case could have been brought under ERISA and is thus subject to federal jurisdiction. The Court agrees." The Federal Court reasoned that "Plaintiffs' claim sounds in ERISA. Absent ERISA, there would be no obligation between the parties. Of note in this regard is United States Supreme Court decision ....Aetna Health, Inc. v. Davilla, 542 U.S. 200 (2004). ….As in Davilla, that Porter and his practice have a provider contract with Anthem does not, in and of itself, create an independent legal duty for Anthem to make payments to Porter. What is payable, and, more importantly, what is not is defined by the terms of the benefit plans and, thus, governed by ERISA."
An official copy of the Federal Court record with decision for Porter v. Anthem Health Plans Of Kentucky, Inc is available at:
Civil Action No. 10-8-HRW, March 18, 2010.
DWAIN P. PORTER, D.C., and PORTER CHIROPRACTIC PLLC, Plaintiffs, v. ANTHEM HEALTH PLANS OF KENTUCKY, INC. d/b/a/ANTHEM BLUE CROSS AND BLUE SHIELD, Defendant.
United States District Court, E.D. Kentucky, Northern Division, Ashland.
On March 23, 2010, President Obama signed into law the Senate Bill passed in the House of Representatives, making this year-long debated healthcare legislation into the law of land for more than 95% of Americans, with most significant overhaul to U.S. healthcare delivery system and reimbursement laws.
According to Dr. Jin Zhou, contrary to popular misinformation, the Obama health law, Patient Protection and Affordable Care Act, has established significant consumer protections and plan claim processing and appeal simplification to reduce administrative costs and enhance provider reimbursement rights and patient protections. New Obama health law incorporates or adopts existing ERISA claim regulation in its entirety as internal ERISA appeal mandates, and Uniform External Review Model Act promulgated by the National Association of Insurance Commissioners as external ERISA appeal mandates as final and binding authority to all parties, in absence of judicial appeals.
"After the legislation becomes the law of land for America health care, it is time for everyone who truly cares about reimbursement and compliance to forget about yesterday's legislation enthusiasm, set aside personal emotions and political preferences, to get hands on today's new reality, statutory and regulatory compliance and reimbursement by learning and mastering new rule of the game for health care reimbursement through compliance", said Dr. Jin Zhou.
In the past 10 years, 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, president ERISAclaim.com has been regarded as the Godfather of ERISA claims for healthcare providers by some in Professional billing and coding industry.
For more information or to arrange an interview, please contact Dr. Jin Zhou, president of ERISAclaim.com at 630-808-723 or visit: http://www.erisaclaim.com/Free_ERISA_Webnars.htm