"This Supreme Court decision may have officially started a 2015 new countdown for a legal and economical death penalty for the USA managed-care business model since middle 70s.", says Dr. Jin Zhou
Hanover Park, IL (PRWEB) November 24, 2014
On November 24, 2014, ERISAclaim.com announced its 2015 CFO-911 ERISA Brainstorming Project to demystify and comply with a recent Supreme Court managed-care decision in Hi-Lex v. BCBSM, a possible annual $1 trillion verdict for the managed-care business model with “Hidden Fees”, post-EOB discounts or TPA markup, overpayment recoupment or offset and even criminal restitution through DOJ from all successful anti-fraud criminal and civil enforcement, in order to restore and recover or otherwise proactively safeguard the ERISA plan assets in healthcare managed-care waste, abuse and ASO/TPA fraud.
ERISAclaim.com’s 2015 CFO-911 Brainstorming Class Project is immediately available to all self-insured plans. The Project length is one-week long, and the Project costs are $250,000 per plan for the private, on-site sessions only.
This Supreme Court decision may have officially started a 2015 new countdown for a legal and economical death penalty for the USA managed-care business model since middle 70s.
On Oct. 20, 2014, the U.S. Supreme announced: “Petition DENIED”, and ultimately declined all appeals on a BCBSM’s $6.1 million managed-care 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. Blue Cross Blue Shield of Michigan v. Hi-Lex Controls, Inc., et al., Case No. 14-168
“The Supreme Court BCBSM decision could be an ERISA $1 trillion verdict and a death penalty for the managed-care business model in the USA. An ERISA fiduciary CFO must not keep doing the same thing over and over again but expect different results”, says Dr. Jin Zhou, president of ERISAclaim.com, a national expert in ERISA compliance and appeals.
“A golden test from our CFO-911 Fiduciary Project under the Supreme Court BCBSM decision is whether a fiduciary has failed to restore and safeguard ERISA plan assets in the past 10 years from all ASOs / TPAs for all criminal restitutions on behalf of a self-insured health plan, EVEN after the restitution was announced by the DOJ and HHS Criminal and Civil Enforcement,” says Dr. Zhou.
ERISAclaim.com’s 2015 CFO-911 Brainstorming Class Project was designed for all CFO’s, COO’s & CEO’s of all self-insured ERISA plans to evaluate (1) the most critical Supreme Court decision for managed-care business model under ERISA and PPACA; (2) the actual economic dollar amounts and percentage in hidden fees and the length of the time within which the hidden fees were discovered; (3) the nature and manner of potential ERISA plan assets embezzlement in hidden fees labeled as managed-care saving; (4) ERISA fiduciary duties to monitor and safeguard plan assets with the Supreme Court clear and definitive guidelines, as an urgent and practical solution to your company’s healthcare crisis and ultimate managed-care business model failure in more than 30-year trials since middle 70s; (4) the immediate potential and actual health care savings in dollars and cents from ERISA plan assets monitoring and auditing, including but not limited to, all hidden fees and/or managed-care markups by TPAs as identified in the Hi-Lex v. BCBSM decision upheld by the Supreme Court, post-EOB discounts or embezzlement, and all successful overpayment recoupment or offset, TPA civil litigation judgment or settlement on behalf of the self-insured plans, all restitutions from the criminal enforcement through DOJ / HHS and all others.
As demonstrated in the court documents, a managed-care TPA for a self-insured plan marked up hospital claims for as much as 22% and kept the markup for 20 years. Additionally over 83% of the self-insured plans do not know anything about this kind of markup, or alleged “managed-care savings”, the money the hospitals never have received, according to court documents.
On October 20, 2014, The Supreme Court announced its decision, without comments, that it will not review a ruling by the U.S. Court of Appeals for the Sixth Circuit on December 10, 2013 in Cincinnati, concluding “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 Sixth Circuit Court document.
Blue Cross Blue Shield of Michigan, Petitioner v. Hi-Lex Controls, Inc., et al. Case Nos.: (13-1773, 13-1859).
United States Court of Appeals for the Sixth Circuit, Decision Date: May 14, 2014.
On May 23, 2013, District Judge Victoria A. Roberts signed the Findings of Fact and Conclusions of Law. BCBSM marked up employee hospital claims by as much as 22 percent and kept the markup for 20 years. Reports provided to Hi-Lex did not disclose the hidden fees. Internal company e-mails showed that BCBSM's managers knew customers were unaware of the markups, and that employees were trained to "downplay" the hidden fees if any customers discovered them, according to district court document.
Hi-Lex Controls Incorporated et al v. Blue Cross and Blue Shield of Michigan, U.S. District Court Eastern District of Michigan, Case #: 2:11-cv-12557-VAR-PJK, Doc #: 246, Filed 05/23/13.
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.