Supreme Court Awards Possibly Billions of Dollars to Self-insured Plans After BCBS Appeals - ERISAclaim.com Demystifies

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On Oct. 20, 2014, the U.S. Supreme Court declined appeals on a BCBSM’s $6.1 million fraud judgment for a self-insured plan. ERISAclaim.com demystifies this high court decision, as it may have just awarded billions of dollars to all self-insured plans from all hidden fees and overpayment disputes.

On Oct. 20, 2014, the U.S. Supreme announced: “Petition DENIED”, and ultimately declined all appeals on a BCBSM’s $6.1 million fraud judgment for a self-insured ERISA plan by the U.S. Court Of Appeals for the Six Circuit, upholding the decision by the District Court for the Eastern District of Michigan. ERISAclaim.com demystifies this high court decision, as it may have just awarded billions of dollars to all self-insured plans from all hidden fees and overpayment refund disputes. http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/14-168.htm. This Supreme Court decision has multi-billion dollar impacts for all self-insured health plans,

ERISAclaim.com announced new advanced ERISA Embezzlement Recovery Programs to assist all self-insured plans to recover all hidden fees and TPA overpayment recovery, based on whether: (1) over billions of dollars of the successful TPA overpayment recoupment and offset nationwide each year are ERISA plan assets, (2) all TPA’s must refund all ERISA plan assets as ERISA prohibits all self-dealings, (3) all self-insured plan administrators are liable for fiduciary breach in failing to safeguard or recover plan assets. Therefore, it’s extremely critical for all self-insured health plans and TPAs’ to understand this Supreme Court decision against BCBSM’s $6.1 million appeals.

On October 20, 2014, the Supreme Court finalized the BCBSM’s $6.1 million fraud judgment, as decided by the Courts of the Sixth Circuit and Eastern District of Michigan.

The high court announced its decision, without comments, on October 20, 2014 that it will not review a ruling by the U.S. Court of Appeals for the Sixth Circuit in Cincinnati, concluding “BCBSM committed fraud by knowingly misrepresenting and omitting information about the Disputed Fees in contract documents”, after it affirmed a District Court decision, in May 2013, concluding that Michigan’s largest health insurer violated the Employee Retirement Income Security Act (ERISA) in ERISA prohibited transactions and ERISA fraud by concealing BCBSM’s hospital claims markup as much as 20% and pocketed the overcharge for over 20 years, according to the Supreme Court website: http://www.supremecourt.gov/Search.aspx?FileName=/docketfiles/14-168.htm.

Supreme Court Case Info:
Case No. 14-168, Title: Blue Cross Blue Shield of Michigan, Petitioner v. Hi-Lex Controls, Inc., et al., Docketed: August 14, 2014, Lower Ct: United States Court of Appeals for the Sixth Circuit, Case Nos.: (13-1773, 13-1859), Decision Date: May 14, 2014

“We are disappointed in the decision,” Helen Stojic, a spokeswoman for Blue Cross Blue Shield of Michigan, said in a statement Monday. “The access fees in dispute enabled Hi-Lex to receive substantial discounts in hospital services which resulted in millions of dollars of savings in hospital costs,” according to a Detroit News report on Oct. 20, 2014 at http://www.detroitnews.com/story/news/local/michigan/2014/10/20/high-court-refuses-hear-blues-appeal/17632669/.

“Now the Supreme Court has upheld the Sixth Circuit decision of $6.1 million award for just one self-insured plan, the immediate application would be billions of dollars for all self-insured ERISA plans, in a time when the TPAs industry has potentially recovered more than billions of dollars in overpayment recoupment and anti-fraud campaigns in the past 10 years,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on ERISA appeals and compliance.

“Form more than 6 years, ERISAclaim.com has been dedicated to ERISA plan assets audit and embezzlement recovery education and consulting. Now with Supreme Court guidance on ERISA anti-fraud protection, we are ready to assist all self-insured plans to recover billions of dollars for all hard-working Americans,” says Dr. Zhou.

On May 14, 2014, in Hi-Lex Controls, Inc. v. Blue Cross Blue Shield of Michigan, 2014 WL 1910554, a federal appeals court (Sixth Cir. 2014) upheld a district court’s $6.1 million decision for Hi-Lex, a self-insured ERISA plan against BCBSM for violating ERISA in prohibited transactions and fiduciary fraud. Sixth Cir. concludes that (1) BCBSM served as a fiduciary for self-insured because it held or controlled plan assets and exercised authority over covered assets; (2) the Hi-Lex complaint was not time-barred because BCBSM’s actions triggered ERISA six-year fraud and concealment statute of limitations; and (3) BCBSM’s use of fees by self-paying it discretionarily charged for its own account is exactly the sort of self-dealing that ERISA prohibits fiduciaries from engaging in, according to the court document. (Sixth Circuit, Case Nos.: (13-1773, 13-1859), Decision Date: May 14, 2014) http://www.ca6.uscourts.gov/opinions.pdf/14a0100p-06.pdf

The district court awarded Hi-Lex over $5 million in damages and prejudgment interest of almost $914,241. According to Hi-Lex’s allegations, BCBSM misrepresented and intentionally concealed these additional fees in contract documents and assured Hi-Lex that no fees were charged other than the administrative fee. Upon learning about the additional fees, Hi-Lex sued, claiming that BSBSM violated ERISA by engaging in self-dealing, according to the court document. (Sixth Circuit, Case Nos.: (13-1773, 13-1859), Decision Date: May 14, 2014)

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.

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ERISAclaim.com
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