any common sense CFO would have no problems in seeing that the 82% of self-insured plans must be entitled to millions of dollars in savings, especially from those previous TPA’s”, simplified by Dr. Zhou.
Hanover Park, Illinois (PRWEB) September 02, 2013
On September 2, 2013, ERISAclaim.com announced “Self-Insured CFO Only (SICO)” Services, intended for self-insured health plans to recover significant savings from the billions of dollars in successful TPA’s anti-fraud recoveries, based on the recent federal court orders and public records from the industry TPA’s PPACA Medical Loss Ratio(MLR) & anti-fraud strategies. Both the industry TPA anti-fraud successful recovery reports and federal court documents revealed more than billions of dollars in successful anti-fraud recovery. On July 29, 2013, a federal court in Detroit, Michigan ordered a TPA to pay back a self-insured plan “$5,111,431, together with $914,241 in pre-judgment interest, and costs, post-judgment interest, and attorney fees”, after the court finds that the TPA engaged in ERISA prohibited transactions in violation of ERISA fiduciary duties, by concealment, fraudulent conducts and failing to return “hidden fees” or “PPO saving”. (Hi-Lex Controls Inc v. Blue Cross and Blue Shield of Michigan, case #: 2:11-cv-12557-VAR-PJK, filed on 05/23/13 and 07/29/13, United States District Court Eastern District of Michigan.)
ERISAclaim.com’s “Self-Insured CFO Only (SICO)” Services are immediately available in three levels: (1) free confidential webinar on general and basic information; (2) executive consulting and training at $150,000 base fees; (3) contingency-based plan assets recovery services. “Monitoring a service provider” and safeguarding plan assets are essential fiduciary duties according to the DOL Fiduciary Guidance: “Understanding Your Fiduciary Responsibilities Under a Group Health Plan”. http://www.dol.gov/ebsa/pdf/ghpfiduciaryresponsibilities.pdf
“According to the industry estimates, up to 30% of the $3 trillion annual healthcare expenditure may be due to fraud, abuse and waste. The federal court records and industry TPA’s self-claimed anti-fraud recoveries are in the billions of dollars. About 82.5% of the large health plans are self-insured per DOL. Now a federal court concludes that a TPA is prohibited under ERISA from concealing and retaining anti-fraud recoveries on behalf of the plan,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert in ERISA compliance and overpayment appeals.
(Hi-Lex Controls Inc v. Blue Cross and Blue Shield of Michigan, case #: 2:11-cv-12557-VAR-PJK, filed on 05/23/13 and 07/29/13, United States District Court Eastern District of Michigan.)
“While the healthcare industry is moving to amend PPACA MLR laws to exempt anti-fraud initiatives or savings, any successful anti-fraud recovery on behalf of the self-insured plans are always the ERISA plan assets regardless of ObamaCare MLR legislation outcome”, says Dr. Zhou.
“As revealed in the court documents in Michigan federal court, the real challenge is how to identify “hidden fees” if a TPA may change TPA/ASO contract terminology six times a year since 1994. After this unprecedented court decision on the rightful owner of the common “PPO savings”, any common sense CFO would have no problems in seeing that the 82% of self-insured plans must be entitled to millions of dollars in savings, especially from those previous TPA’s”, simplified by Dr. Zhou.
ERISAclaim.com’s “Self-Insured CFO Only (SICO)” Services free webinars will cover the following industry facts:
1. Google Search Results: Private industry TPA SIU (Special Investigation Unit) anti-fraud successful recoveries in billions of dollars. https://www.google.com/search?hl=en&gl=us&tbm=nws&authuser=0&q=anti-fraud+unit+recovered+millions&oq=anti-fraud+unit+recovered+millions&gs_l=news-cc.12...0.0.1.163.0.0.0.0.0.0.0.0..0.0...0.0...1ac.1RRTLZBR1wo#authuser=0&gl=us&hl=en&q=SIU+anti-fraud+unit+recovered+millions
2. Parallel Public-Sector Anti-Fraud Recovery: Medicare Anti-fraud Recovered $19 Billion. http://www.prweb.com/releases/2013/3/prweb10501376.htm
3. CMS Press Release: “Government Teams Recovered $4.2 Billion in FY 2012”. http://www.hhs.gov/news/press/2013pres/02/20130211a.html
4. HHS OIG: “Health Care Fraud and Abuse Control Program Report”. https://oig.hhs.gov/reports-and-publications/hcfac/index.asp
5. “In 2011, United recovered approximately $430 million in overpayments to providers. 58% of the $430 million was recovered as a result of providers’ voluntarily sending a check to United, while 42% was recovered through offsets”, according to the court document. Premier Health Center, P.C., et al. v. UnitedHealth Group, et al., Case #: 2:11-cv-00425-ES-SCM, Filed 08/01/13, United States District Court for the District of New Jersey.
6. “IT IS ORDERED that Judgment enter in favor of Plaintiffs in the amount of $5,111,431, together with $914,241 in pre-judgment interest, and costs, post-judgment interest, and attorney fees”, according to the court document. Hi-Lex Controls Inc v. Blue Cross and Blue Shield of Michigan, case #: 2:11-cv-12557-VAR-PJK, filed on 05/23/13 and 07/29/13, United States District Court Eastern District of Michigan.
7. HHS Report to the Congress on a Study of the Large Group Market”: 82.5% of large (>500) health plans are self-insured. http://aspe.hhs.gov/health/reports/2011/LGHPstudy/index.shtml
“From the Michigan federal court order, up to 80% of the billions of dollars in private industry anti-fraud recoveries must be returned to the self-insured plans and working-class Americans, because it is prohibited transaction under ERISA for TPA’s to keep any of the billions of dollars in plan assets. This is simply why we now offer Self-Insured CFO Only Services”, explains Dr. Zhou.
To find out more about “Self-Insured CFO Only” 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.