......but for self-insured health plans, the No. 1 health plan hidden costs are consequently overpayment recoupment and plan assets embezzlement. The Sixth Circuit Court BCBSM decision might be the No. 1 solution to US healthcare crisis,” says Dr. Zhou.
Hanover Park, Illinois (PRWEB) July 06, 2014
On May 14, 2014, a federal appeals court upheld a district court’s $6.1 million decision for a self-insured ERISA plan against Blue Cross and Blue Shield of Michigan (BCBSM) for violating ERISA in prohibited transactions and fiduciary fraud. ERISAclaim.com demystifies this new groundbreaking federal overpayment law for all self-insured ERISA plans in all TPA’s overpayment recoupment and offsetting actions, because the federal courts ruled that federal ERISA law prohibits BCBSM’s TPA self-dealing as a ERISA fiduciary by withholding all hidden fees or overpayment recovery, despite a prior state court decision upholding the enforceability of BCBSM’s TPA/ASO agreement.
On 4th of July, 2014, in the wake of this new groundbreaking federal self-insured overpayment decision, ERISAclaim.com announced a serious of new executive brainstorming programs as a part of its ERISAclaim.com Overpayment Recoupment and Embezzlement Recovery Services (ORERS) for all self-insured ERISA health plans. http://erisaclaim.com/Embezzlement_Recovery.htm
For the first time, the federal courts ruled for a self-insured plan: (1) ERISA prohibits BCBSM TPA self-dealing by retaining or withholding from plan assets regardless of BCBSM TPA/ASO agreement; (2) ERISA prohibits BCBSM TPA fraudulent concealing or misrepresenting the plan claim hidden fees and TPA recoveries/savings, (3) ERISA mandates BCBSM to refund self-insured plan assets for $6.1 million, according to the Sixth Circuit Court document.
The court case info: Hi-Lex Controls, Inc. v. Blue Cross Blue Shield of Michigan, NOS. 13-1773/1859. United States Court of Appeals, Sixth Circuit, Decided and Filed: May 14, 2014.
In compliance with new federal appeals court decision for self-insured plans, ERISAclaim.com announces timely and critical solutions to the nation’s No. 1 health care costs for all self-insured plans: health claim overpayment recoupment/upset and plan assets embezzlement under ERISA.
“These new federal court decisions are extremely important for all self-insured health plans, because almost every TPA for self-insured plans have engaged in the successful overpayment recoupment and offsetting from healthcare providers in today’s multibillion-dollar overpayment market. This is the first timely appellate court decision to protect self-insured health plans and millions of hard-working American workers and their families,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert in ERISA compliance and overpayment recoupment plan assets recovery.
The Six Circuit Opinion: “SILER, Circuit Judge. The Hi-Lex corporation, on behalf of itself and the Hi-Lex Health & Welfare Plan, filed suit in 2011 alleging that Blue Cross Blue Shield of Michigan (BCBSM) breached its fiduciary duty under the Employee Retirement Income Security Act of 1974 (ERISA) by inflating hospital claims with hidden surcharges in order to retain additional administrative compensation. The district court granted summary judgment to Hi-Lex on the issue of whether BCBSM functioned as an ERISA fiduciary and whether BCBSM’s actions amounted to self-dealing. A bench trial followed in which the district court found that Hi-Lex’s claims were not time-barred and that BCBSM had violated ERISA’s general fiduciary obligations under 29 U.S.C. § 1104(a). The district court also awarded pre- and post-judgment interest. We AFFIRM.” according to the Sixth Circuit Court document
In particular, Sixth Circuit noted: “Furthermore, after a nine-day bench trial, the district court ruled that BCBSM had violated its general fiduciary duty under § 1104(a) and that Hi-Lex’s claims were not time-barred. The court awarded Hi-Lex $5,111,431 in damages and prejudgment interest in the amount of $914,241.” according to the Sixth Circuit Court document.
In finding against BCBSM fiduciary fraud, the Sixth Circuit states: “BCBSM committed fraud by knowingly misrepresenting and omitting information about the Disputed Fees in contract documents. Specifically, the ASC, the Schedule As, the monthly claims reports, and the quarterly and annual settlements all misled Hi-Lex into believing that the disclosed administrative fees and charges were the only form of compensation that BCBSM retained for itself. BCBSM also “engaged in a course of conduct designed to conceal evidence of [its] alleged wrong-doing…… Finally, according to BCBSM’s own survey of its self-insured customers, a substantial majority – 83% – did not know the Disputed Fees were being charged.” according to the Sixth Circuit Court document.” according to the Sixth Circuit Court document.
In concluding against BCBSM self-dealing withholding, the Sixth Circuit concludes: “A fiduciary with respect to an ERISA plan “shall not deal with the assets of the plan in his own interest or for his own account.” 29 U.S.C. § 1106(b)(1). As interpreted by this court, that statute contains an “absolute bar against self dealing.” Brock v. Hendershott, 840 F.2d 339, 341 (6th Cir. 1988). Because this case involves the same ASC, same defendant, and same allegations, our decision in Pipefitters IV controls with respect to the § 1106(b)(1) claim. See Pipefitters IV, 722 F.3d at 868 (holding that BCBSM’s use of fees it discretionarily charged “for its own account” is “exactly the sort of self-dealing that ERISA prohibits fiduciaries from engaging in”).” according to the Sixth Circuit Court document.
“For healthcare providers, the No. 1 claim denial in USA Today is the overpayment recoupment and claims-offset, but for self-insured health plans, the No. 1 health plan hidden costs are consequently overpayment recoupment and plan assets embezzlement. The Sixth Circuit Court BCBSM decision might be the No. 1 solution to US healthcare crisis,” says Dr. Zhou.
To find out more about ERISAclaim.com’s Overpayment Recoupment and Embezzlement Recovery Services (ORERS): http://erisaclaim.com/Embezzlement_Recovery.htm
Located in a Chicago suburb in Illinois, for over 15 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, the unique knowledge and experience for overpayment plan assets recovery.
For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.