healthcare providers are dedicated to providing all patients with high quality and safety healthcare in out-of-network pro-choice wonderland, yet still most affordable to hard-working Americans, explains Dr. Zhou.
Hanover Park, IL (PRWEB) March 25, 2015
On March 24 2015, a federal court in Houston, Texas ruled entirely against CIGNA for an out-of-network provider, Humble Surgical Hospital (HSH), in a typical CIGNA’s state law fraud and ERISA overpayment lawsuit. In this standard CIGNA out-of-network lawsuit, CIGNA claims alleged billing, fee-forgiving deductible waiver fraud, negligent misrepresentation and unjust enrichment, and hospital physician-owner’s kickbacks from unlawful referrals. The Court granted the Hospital motion on judgment in its entirety and dismissed all of the CIGNA’s claims due to ERISA preemption, lack of ERISA fiduciary legal standing and failure to sufficiently plead remaining claims.
ERISAclaim.com announces new ERISA out-of-network specialist programs and litigation support services to assess, educate and comply with this court ERISA decision, a compliance beholder’s crystal ball for almost all alleged out-of-network fraud mysteries.
ERISAclaim.com will provide most timely, comprehensive and in-depth assessment of this landmark decision. It will demystify ERISA legalese for both non-lawyer healthcare providers and seasoned healthcare attorneys. This is a landmark federal court decision, for a typical, popular and catch-all out-of-network fraud lawsuit for overpayment recovery by a payer, alleging almost everything as fraud, against a defendant out-of-network provider, according to Dr. Jin Zhou, president of ERISAclaim.com, a national expert on ERISA compliance and appeals.
Very importantly, this court decision also provides the entire managed care and plan benefits industry with most basic yet comprehensive legal reasoning and roadmaps for this type of modern healthcare litigations. Timely education and understanding of this landmark court decision will bring peace, harmony and compliance to healthcare industry, especially when health plans are determined to contain healthcare costs and healthcare providers are dedicated to providing all patients with high quality and safety healthcare in out-of-network pro-choice wonderland, yet still most affordable to hard-working Americans, explains Dr. Zhou.
Connecticut General Life Insurance Company, et al. v. Humble Surgical Hospital, LLC, Civil Action No. 4:13-Cv-3291, on 03/24/15, in the United States District Court, Southern District of Texas.
ERISAclaim.com’s new out-of-network specialist programs will dissect and digest this landmark decision in the following sessions:
I. The Court’s summary of this typical modern out-of-network lawsuit:
“The plaintiffs, Connecticut General Life Insurance Company and Cigna Health and Life Insurance Company (collectively, “Cigna”), bring suit against the defendant, Humble Surgical Hospital, LLC (“HSH”), to recover alleged overpayments made to HSH for out-of-network services. The complaint (ECF No. 1) asserts various state common law claims sounding in tort, as well as claims for declaratory and injunctive relief. Alternatively, Cigna seeks equitable relief under the Employment Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. Pending before the Court is the defendant’s FED. R. CIV. P. 12(c) motion for judgment on the pleadings, which challenges the complaint based on theories of ERISA preemption and statutory standing (ECF No. 16). The plaintiffs filed an opposing response (ECF No. 21) and the defendant timely replied (ECF No. 31). Having reviewed the pleadings, motion, responsive documents and applicable law, the Court determines that HSH’s motion should be GRANTED in its entirety.” according to court document.
II. The Court’s conclusion of this modern managed care holy court battle:
“CONCLUSION: Based on the foregoing analysis and discussion, the Court concludes that ERISA preempts all state claims arising from Cigna’s self-funded plans and employee benefit plans. Cigna has not alleged sufficient facts to establish standing to sue under ERISA nor has it alleged sufficient facts to establish the existence of any plan from which its non-ERISA claims arise. As pleaded, Cigna’s state and federal claims are deficient. HSH’s motion for judgment on the pleadings is therefore GRANTED and Cigna’s complaint is dismissed.” according to court document.
III. The Court’s summary of what exactly CIGNA was suing for against Humble Surgical Hospital:
“Based on these allegations, Cigna asserts state law claims for money had and received, common law fraud, negligent misrepresentation and unjust enrichment. Under these theories, Cigna seeks restitution of overpayments it made to HSH for “false and excessively billed services.” Cigna also seeks injunctive relief requiring HSH to disclose the referral arrangements it has made with physicians, especially those who have an ownership interest in HSH. The injunction would also enjoin HSH from charging unreasonable fees and waiving patient responsibility for its out-of-network services. Additionally, Cigna seeks a declaratory judgment that HSH’s billing practices violate various Texas statutes and that Cigna is entitled to recoup all overpayments paid to HSH. Alternatively, Cigna seeks equitable relief under ERISA, 29 U.S.C. § 1132(a)(3), “to the extent this dispute involves the exercise of Cigna’s discretion under an ERISA plan.” according to court document.
To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
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.
For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.