“The court fined United $99,000 in ERISA penalty, almost 3 times of medical denials in $35,724.80, for failure to disclose medical treatment guidelines.
Hanover Park, IL (PRWEB) October 25, 2013
On Sept 30, 2013, a federal court in Tennessee fined United Healthcare of Tennessee, Inc (United) for $99,000 in ERISA penalty for failing to provide a patient plaintiff with United Treatment Guidelines (Medical Policy) for 900 days, after the court ordered United to pay $35,724.80 plus pre-judgment interest for United medical necessity denials. The court also ordered United to pay Plaintiff attorney fees. ERISAclaim.com offers new seminars and webinars to demystify this landmark ERISA decision for all medical necessity denials.
The court case info: Butler v. United Healthcare of Tennessee, Inc., United States District Court Eastern District Of Tennessee At Knoxville, No. 3:07-CV-465, Filed 09/30/13.
As a result of this court decision, ERISAclaim.com also offers advanced ERISA compliance and medical necessity appeals training for both participating and non-participating hospitals, ASC’s and all providers, to appeal all medical necessity denials under this court guidance in compliance with ERIA and PPACA regulations.
“The court’s ERISA United decision provides the most powerful protections for all patients and providers with ERISA $110 per-day statutory penalty for all medical necessity denials”, says Dr. Jin Zhou, president of ERISAclaim.com and national expert on ERISA appeals and compliance.
“The court fined United $99,000 in ERISA penalty, almost 3 times of medical denials in $35,724.80, for failure to disclose medical treatment guidelines. ERISA is much more powerful than all state laws in this regard”, says Dr. Zhou.
According to the court document, “ERISA authorizes the court to impose statutory penalties in certain circumstances. Here, an administrator who fails to furnish, upon a participant’s request, any internal rule, guideline, or similar criterion that was relied upon to make the adverse determination may be liable for up to $110 per violation (i.e. per day). 29 U.S.C. § 1132(c)(1)(B); 29 C.F.R. § 2575.502c-1 (2013). The calculation of the penalty begins thirty days after the participant’s request for such information.”
The court ordered: “United was required to provide a copy of the Guidelines upon request. Mr. Butler requested those Guidelines on February 10, 2006 (see AR 164), but he did not receive those Guidelines until July 30, 2008, when United filed the administrative record. That filing came 900 days after Mr. Butler formally requested the Guidelines. Given the length of time during which the Guidelines were not disclosed, and the negative effect such non-disclosure had on Mr. Butler to present his appeal, the court awards the maximum penalty for each day of delay, which amounts to $99,000.00.” according to the court document.
“Since ObamaCare, PPACA, adopted ERISA claim regulations for all health plans, for both ERISA plans and non-ERISA plans, this court decision is more important and instrumental for all providers”, explains Dr. Zhou.
To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
Located in a Chicago suburb in Illinois, for over 14 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.