Hanover Park, IL (PRWEB) October 23, 2012
On October 23, 2012, ERISAclaim.com announced the advanced Healthcare Madoff Detection and Recovery Programs, a.k.a. PPACA Healthcare Nobel Prize Project, to detect all unreported healthcare overpayment recoupment and probable health plan assets embezzlement by TPAs, in possibly up to one third of the annual healthcare expenditure for all self-insured health plans. PPACA §6402(a) provides mandatory 60 days for healthcare providers to refund all discovered overpayment, and ERISA mandates 60 days for TPAs to return the plan assets from all successful healthcare overpayment claim recoveries.
ERISAclaim.com’s PPACA Healthcare Nobel Prize Project is offered to possibly save or recover hundreds of billions of dollars for self-insured plans as the “Phase II” PPACA anti-fraud initiative, TPA’s mandatory refund, in 60 days to self-insured plans, all successful overpayment recovery from healthcare providers in “Phase I” PPACA anti-fraud initiative. This program is developed from the recent federal and state government reports, federal court documents, industry healthcare anti-fraud “Phase I” reports of TPA successful recovery of all overpayment from healthcare providers.
“If healthcare TPAs, in Anti-Fraud Phase I Initiative, successfully recovered hundreds of billions of dollars in overpayment from providers, but in Anti-Fraud Phase II Initiative, failed or refused to report and refund all recovered plan assets to self-insured plans, PPACA anti-fraud enforcement is not completed. Healthcare Madoff could be 10 times larger and more dangerous to America than Wall St. Madoff,” said Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
“While Medicare reported $4.1 billion recovery in overpayment or fraud in 2011 for public sectors, private health plans may have recovered 5 to 10 times more than public sector. More than 82% of large plans are self-insured. There has NOT been a single one industry report in the past 5 -10 years reporting that any self-insured health plan received complete refund from TPAs for all successfully recovered overpayment recoupment from healthcare providers. This is why our program is referenced with Madoff and Nobel Prize,” said the Dr. Zhou.
PPACA Healthcare Nobel Prize: 1 Healthcare Madoff (Overpayment Recoupment + Embezzlement) = 10 Wall St. Madoff?
HHS and DOL Report to Congress on 03/31/2011: 82.1% of large (>500) group health plans are self-insured. http://aspe.hhs.gov/health/reports/2011/LGHPstudy/index.shtml
DOL 2011 Annual Report to Congress on Self-Insured Group Health Plans reported that “The Department estimates that 12,000 health plans filing a Form 5500 for 2008 were self-insured and 5,000 mixed self-insurance with insurance (“mixed-insured”). These plans respectively covered 22 million and 25 million participants and held assets totaling $35 billion and $84 billion, the Department estimates.”
According to Dr. Zhou’s research, the latest DOJ and OIG reports, state government reports, and federal court documents revealed that many healthcare TPA’s and government program contractors have neither properly reported nor refunded successful recoveries. This is true for both public sectors and private sectors. Medicare program recovered $4.1 billion in overpayment and fraud in 2011. Private sectors are estimated to have recovered 3 -10 times more than public sectors in the past 5 – 10 years, as the recent federal court documents in provider overpayment class actions revealed health plan TPAs generally failed to comply with any ERISA regulation in recoupment practice. The private health plans have to litigate in federal court to recover unreported, “hidden fees”, from TPAs. The TPA’s usually go back more than several years in overpayment recovery according to a California state government report. The specific and detailed government and healthcare industry public reports will be reviewed as the basis for ERISAclaim.com’s PPACA Healthcare Nobel Prize Project.
The following topics, including but not limited to, will be discussed in ERISAclaim.com’s PPACA Healthcare Nobel Prize Project:
1. Medicare recovery of $4.1 billion in 2011: “Health Care Fraud Prevention and Enforcement Efforts Result in Record-Breaking Recoveries Totaling Nearly $4.1 Billion” http://www.hhs.gov/news/press/2012pres/02/20120214a.html
2. OIG Delaware Report on 06-28-2012: “Of the $16.29 million Medicaid overpayments collected, the State failed to report $16.27 million ($10 million Federal share).” https://oig.hhs.gov/oas/reports/region3/31100203.asp
3. DOJ Press Release on 08-23-2012: “Long Beach-Based Health Plan Pays Nearly $320 Million To Settle Allegations That It Received Overpayments For Medi-Cal Patients” http://www.justice.gov/usao/cac/Pressroom/2012/112.html
4. DOJ Press Release 04-03-2012: “Florida-Based Wellcare Health Plans Agrees to Pay $137.5 Million to Resolve False Claims Act Allegations”, in part for “knowingly retained overpayments it had received from Florida Medicaid for infant care.” http://www.justice.gov/opa/pr/2012/April/12-civ-425.html
5. Borroughs Corporation and Borroughs Corporation Employee Benefit Plan v. Blue Cross Blue Shield Of Michigan, Case No: 2:11-Cv-12557-Var-Pjk, Filed 09/07/12, United States District Court Eastern District Of Michigan Southern Division
6. CA DMHC on 07-16-2012: “DMHC Orders Anthem Blue Cross to Stop Attempting to Collect Millions from California Health Care Providers They Claim were Overpaid” http://www.hmohelp.ca.gov/library/reports/news/pr071612.pdf
7. DOL: Understanding Your Fiduciary Responsibilities Under A Group Health Plan. http://www.dol.gov/ebsa/publications/ghpfiduciaryresponsibilities.html
To find out more about PPACA Healthcare Nobel Prize Project from ERISAclaim.com:
Located in a Chicago suburb in Illinois, for over 12 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.
For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.