New Federal Court Winnings Against BCBS Prompting Provider Association To Be Certified Under New Federal Claims And Appeals Laws

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In Wake Of Recent Federal Court Favorable Rulings, The Ohio State Chiropractic Association (OSCA) And Entered Agreement For Claims Specialists Certification Training Under New Federal Health Claims And Appeals Laws. As The First Healthcare Provider State Association In The Nation, OSCA Will Effectively Guide Its Members In Fighting Against Abusive And Discriminatory Claim Denials And Solving Overpayment Recoupment Crisis.

As a part of our mandatory compliance with new federal claims and appeals laws, we will have no other choice but become an expert of ERISA and PPACA. Now federal courts have rewarded our compliance efforts for doing ERISA appeals from some of our members

In the wake of two latest Federal Court favorable rulings for the class action lawsuit against Blue Cross Blue Shield entities in all 50 states and in defending a lawsuit from BCBSRI over the alleged overpayment recoupment, and in light of new federal health claims and appeals law, effective September 23, 2010, the Ohio State Chiropractic Association (OSCA) has entered an agreement with, a leading national ERISA and PPACA consulting firm, in order to be certified as ERISA- PPACA Claim Specialists under new federal health claims and appeals laws. This partnership for appeals compliance will enable OSCA to effectively guide its members to fight against abusive and discriminatory claim practice. The first of series of certificate classes will be held on November 18, 2010 in Columbus Ohio for OSCA’s ERISA-PPACA Committee members and leadership.

New federal health claims and appeals law, Patient Protection and Affordable Care Act, PPACA, was signed into law by President Obama on March 23, 2010, and went into effect on September 23, 2010 bring the most significant changes in US healthcare history in the past 45 years since Medicare was created.

“OSCA will be the first provider State Association to be trained as the ERISA-PPACA Claims Specialists under the new federal health claims and appeals laws, effective September 23, 2010, for all health plans and individual policies nationwide” said Dr. Jin Zhou, President of, a national expert on ERISA and PPACA compliance and claims appeals.

“With about 87% of employer-sponsored health plans providing coverage for chiropractic services, an essential healthcare benefit for American people, the Chiropractic Profession is now recognized and used as the #1 alternative healthcare provider in the USA. Yet we have experienced the most discriminatory claims reimbursement abuses from the payers. With the recent federal court victories solely based on federal ERISA law, we are finally convinced that new federal appeals law, PPACA, and existing federal ERISA law will help protection for our profession’s fair compensation in the healthcare market” declared Dr. Otto J. Schmidt, DC, OSCA 2011 President elect.

“Our members and chiropractic providers have been struggling and in need of urgent and effective guidance for prompt and optimal reimbursement for decades. The ERISA-PPACA Committee, a part of OSCA’s Insurance Committee, will receive the best education and training from on ERISA and PPACA, and will serve as a compliance and reimbursement team to coach members across the state. Core benefits for OSCA membership will be practical and effective hands-on assistance to advocate medically appropriate chiropractic care, to appeal any and all claim denials and delays under applicable federal laws, on behalf of hard-working Americans, to establish a statewide databank for insurance coverage and policies, Summary Plan Description (SPD) for OSCA members to share for insurance coverage verification. These will be our preprimary goals”, declared Bharon Hoag, Executive Director of OSCA.

“As a part of our mandatory compliance with new federal claims and appeals laws, we will have no other choice but become an expert of ERISA and PPACA. Now federal courts have rewarded our compliance efforts for doing ERISA appeals from some of our members”, elaborated Dr. Judson G. Sprandel II, DC, OSCA Past President and proponent of this Agreement.

OSCA’s new initiative is well supported by recent federal court favorable ERISA rulings. On May 17, 2010, under ERISA law, the federal court in Chicago ruled to permit a national class-action lawsuit by chiropractors, some of them are members of OSCA, to proceed against 23 Blue Cross Blue Shield entities over the alleged overpayment recoupment in violation of federal law ERISA, in PCA et al v. BCBSA et al, Case # 1:09-cv-05619. On October 27, 2010, a federal court in Rhode Island ruled against Blue Cross Blue Shield of Rhode Island over its overpayment and fraud claims against two healthcare providers. The court ordered that federal law ERISA completely preempts BCBSRI’s state law claims for breach of PPO contract and fraud, and ERISA limits BCBSRI potential recoveries, in BCBSRI v. Jay Korsen, Case#: 1:09-cv-00317-L-LDA. Both of these lawsuits are represented by the top class-action law firm, the Pomerantz Firm in NY, a leader in the fight against abusive health insurance practices. provided compliance assistance and litigation support in administrative appeals and judicial proceedings for both cases.

Located in Columbus, OH, the Ohio State Chiropractic Association (OSCA) is the leading Chiropractic State association with hundreds of Doctor Members statewide. OSCA represents its members through advocating and promoting chiropractic science and healthcare services, supporting and protecting its members through compliance assistance in claims educational guidance and appeals, and patient advocacy. OSCA provides accurate information and advice to the state legislators and prospective patients in the State of Ohio., located in Chicago suburb in Illinois, is a leading and only national firm in the past 10 years, exclusively for healthcare providers. Providing comprehensive and unique ERISA and PPACA educational and consulting services, Dr. Jin Zhou, President of, regarded as the Godfather of ERISA claims for providers in the industry, published ERISA and PPACA appeals systems and CD Book, website, and hundreds of educational articles and seminars. offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as litigation support.

For more information on how to become an ERISA-PPACA Claims Specialist under new and existing federal appeals regulations:

For any questions, please contact Dr. Jin Zhou, president of, at 630-808-7237.

Information regarding the OSCA can be accessed at or by contacting Executive Director, Bharon Haog at 614.229.5307.

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