Hanover Park, Illinois (PRWEB) March 06, 2013
On 02-25-2013, federal court in New Jersey dismissed a hospital’s $39 million lawsuit against Aetna, two days later, on 02/27/2013, the same federal judge dismissed a surgical center’s lawsuit against Horizon with the identical legal reasoning: lack of valid ERISA assignment, also known as “ERISA License to Sue”. More significantly, on January 16, 2013, the same federal judge finally dismissed a class certification for all patients, after all physicians’ class action lawsuit was dismissed on Sept. 23, 2011, for the identical legal reasoning, lack of valid ERISA assignment, in a landmark ERISA class action lawsuit against CIGNA over the out-of-network UCR reimbursement dispute filed for all physicians and patients.
ERISAclaim.com announces comprehensive legal reviews on these astounding avalanche legal developments affecting all hospitals, physicians and patients as well as reimbursement professionals, and practical solutions to immediately end this healthcare reimbursement insanity as defined by Einstein: doing the same thing over and over again without a valid ERISA assignment but expecting different results with reasonable payments from any health plans. Every healthcare provider must obtain a valid ERISA and PPACA assignment of benefits as interpreted by these federal court decisions in order to avoid another loss of $39 million, or $39 billion nationally.
“The hospital’s huge $39 million loss could have been easily fixed by a $.39 printing of a valid ERISA assignment on the Patient Intake Form as guided by the federal district judge for every physician and hospital. It is definitely insane to save $.39 in order to lose $39 million,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert in ERISA and PPACA appeals and compliance.
New healthcare reform law, PPACA, Patient Protection And Affordable Care Act, mandates ERISA claim regulation as the minimum internal appeal standards for all ERISA plans and non-ERISA plans. ERISAclaim.com announces this special session of “ERISA License to Appeal or Sue” for all healthcare executives and reimbursement professionals, as a part of ERISAclaim.com’s flagship reimbursement compliance programs: ERISA and PPACA Claim Specialists, and Certified ERISA and the PPACA Claims Specialists.
All of these cases were decided by the same federal district judge, STANLEY R. CHESLER, Federal District Court of New Jersey:
MHA, LLC v. AETNA HEALTH, INC., February 25, 2013, Civil Action No. 12-2984 (SRC).
MIDDLESEX SURGERY CENTER v. HORIZON, February 27, 2013, Civil Action No. 13-112 (SRC).
FRANCO v. CONNECTICUT GENERAL LIFE INSURANCE CO. January 16, 2013, Case No. 07-cv-6039 (SRC) (PS)
FRANCO v. CONNECTICUT GENERAL LIFE INSURANCE CO. September 23, 2011, Civil Action No. 07-cv-6039 (SRC) (PS)
According to the court document in the $39 million lawsuit, MHA, LLC v. AETNA HEALTH, INC., Aetna typically pays hospital 0-15% of the billed charges:
“Since the sale of Meadowlands Hospital, Aetna has continued to reimburse MHA at the INET rates provided in the MCA. Plaintiff claims that it should be reimbursed as an ONET provider. According to Plaintiff, the INET rates are drastically lower than what MHA receives from health insurers and other payors for the same services, typically consisting of 0-15% of the billed charges. Plaintiff maintains that, since the onset of this dispute, Aetna has under reimbursed MHA by over $39 million. For its part, Aetna contends that MHA is legally bound to provide services as an INET provider and has refused to reimburse MHA for claims that exceed those allowed by the MCA fee schedule for INET providers.”
The hospital filed this $30 million lawsuit with a invalid ERISA assignment, according to the court records:
“I authorize payment directly to Meadowlands Hospital Medical Center for hospital medical insurance benefits (from Medicare, Medicaid, commercial insurance, worker's compensation, auto insurance, etc.) that I may be entitled to for the charges of the care/treatment provided to me.”
In dismissing the hospital’s $39 million lawsuit with prejudice ($0 payment), the federal judge explains on a valid ERISA assignment, according to the court records:
“……this Court concludes that the authorization provision in this case does not rise to the level of an assignment of rights under ERISA. According to Black's Law Dictionary (9th ed.2009), "assignment" is a term of art meaning the "transfer of rights or property." The Third Circuit, providing a statement of New Jersey law, held that "[a]n assignment of a right is a manifestation of the assignor's intention to transfer it by virtue of which the assignor's right to performance by the obligor is extinguished in whole or in part and the assignee acquires right to such performance."……. To determine the patient-assignor's intent, the Court applies an objective standard and properly looks to the language of the intake form provision as the "strongest objective manifestation of intent."”
The identical court legal reasoning, lack of a valid ERISA assignment, was also used by the same judge to dismiss the surgical center lawsuit for medical necessity denial and the national provider class action for out-of-network UCR lawsuits, says Dr. Joe (Zhou).
To find out more about PPACA Claims and Appeals Compliance Services 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.