Supreme Court Awards Possibly Billions of Dollars in TPA Refund to More Self-insured Plans - ERISAclaim.com Demystifies

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On November 5, 2014, District Court reopened more identical cases after the U.S. Supreme Court, On Oct. 20, 2014, declined BCBSM’s appeals on a $6.1 million fraud judgment for a self-insured plan. ERISAclaim.com demystifies this high court decision with 2015 ERISA TPA Recovery Programs.

“In accordance with the Supreme Court Hi-Lex decision, all self-insured health plans nationwide must receive annually, for the past 10 years, at least $30 billion to $45 billion in refund of the plan assets ...." says Dr. Zhou

On November 5, 2014, a federal district court in Michigan reopened a separate but identical case after the U.S. Supreme Court, on Oct. 20, 2014, declined BCBSM’s appeals on a $6.1 million fraud judgment for a self-insured plan. This Supreme Court decision’s multi-billion dollar impact will definitely benefit all self-insured health plans. In demystifying these high court decisions, ERISAclaim.com announced new 2015 ERISA Fiduciary TPA Auditing & Plan Assets Recovery Programs, in order to possibly assist in the recovery of billions of dollars in similar TPA/ASO hidden fees for self-insured plans in order to possibly avoid lengthy and costly litigations.

On November 21, 2014, ERISAclaim.com announced advanced 2015 ERISA Fiduciary TPA Auditing & Plan Assets Recovery Programs, so specially designed to demystify these important court decisions, in order to assist all self-insured plans to recover all hidden fees in TPA overpayment recovery and managed care savings, based on the high court’s new interpretation of ERISA plan assets, fiduciary and the ERISA prohibited transactions and self-dealings in managed care industry and ASO contracting practice. Every ERISA self-insured plan sponsor or fiduciary is required to audit every TPA’s successful overpayment recovery and managed care savings, in order to determine 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 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.

On November 5, 2014, only 15 days after the high court decision on October 20, 2014, the federal district court in Michigan lifted a previous stay order for one of the more than similar 50 cases pending in the same court, in Fisher & Company, Inc. et al v. Blue Cross and Blue Shield of Michigan, U.S. District Court, Eastern District of Michigan (Detroit), CIVIL DOCKET FOR CASE #: 2:13-cv-13221-GER-MAR.

Supreme Court Case Info:
Title: Blue Cross Blue Shield of Michigan, Petitioner v. Hi-Lex Controls, Inc., et al., Case No. 14-168, 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

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.

On November 5, 2014, the district court explained its decision to reopen the pending case:

“On May 14, 2014, the U.S. Court of Appeals for the Sixth Circuit issued its opinion in the Hi-Lex Conrols matter, affirming the district court's judgment. Hi-Lex Controls, Inc. v. Blue Cross Blue Shield of Mich., 751 F.3d 740 (6th Cir. 2014). BCBSM timely filed a petition for a writ of certiorari to the United States Supreme Court on August 12, 2014, and the Supreme Court denied the petition on October 20, 2014. Blue Cross Blue Shield of Mich. v. Hi-Lex Controls, Inc., cert. denied, 83 U.S.L.W. 3109, 2014 WL 3965217 (U.S. Oct. 20, 2014) (No. 14-168)….Accordingly, IT IS HEREBY ORDERED that Plaintiffs' Motion to Lift Stay (Dkt. # 19) is GRANTED and that this matter is REOPENED.” according to court document.

“In accordance with the Supreme Court Hi-Lex decision, all self-insured health plans nationwide must receive annually, for the past 10 years, at least $30 billion to $45 billion in refund of the plan assets from all successful TPA’s anti-fraud recovery and managed care savings in private sectors, pursuant to the HHS OIG and the National Health Care Anti-Fraud Association’s conservative estimates that at least 3 percent—or more than $60 billion each year—is lost to fraud, in the current $3 trillion annual healthcare expenditure,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert in ERISA compliance and appeals.
http://www.hhs.gov/asl/testify/2009/05/t20090506d.html

“Failure to safeguard the plan assets is definitely a fiduciary breach under ERISA, and now the Supreme Court has given us a legal formula for the plan assets recovery, a timely and true resolution to today’s U.S. healthcare crisis,” says Dr. Zhou.

To find out more about ERISAclaim.com’s 2015 ERISA Fiduciary TPA Auditing & Plan Assets Recovery Programs: 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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Jin Zhou, President
ERISAclaim.com
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