Posts Tagged ‘Federal’
Florida criticized for low KidCare enrollment as federal health bonus goes unused
Officials say this can help children receive needed care more quickly. But the bill died in committee, and Rich said it would be "very difficult" to get such measures passed this year with the current economic and political climate. …
Read more on Tampabay.com
Medical groups pushing Legislature to reduce liability of emergency doctors
The nursing home industry, represented by the Florida Health Care Association, will have people in Tallahassee every Wednesday to lobby against potential Medicaid cuts, said Nancy Zant, administrator of HealthPark Care Center, a 112-bed nursing home …
Read more on Naples Daily News
Anti-abortion measures gaining traction in Ohio
Another target, House Bill 79, is a bit more complex. In December, Gov. John Kasich signed the measure that would keep health care plans that participate in the state's new health insurance exchange from offering abortion coverage. …
Read more on Marion Star
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Hanover Park, IL (PRWEB) January 15, 2012
As a part of new PPACA & ERISA enforcement in 2012, and in the wake of the Supreme Courts new decision, CIGNA v. Amara (No. 09804), the U.S. Department of Labor (DOL) created a new Consumer Complaint Webpage on Nov. 10, 2011. The DOL will respond to complaints, in 3 business days, against health plans for improperly denied health claims. The various PPACA & ERISA informed providers of ERISAclaim.com have seen the most effective, responsive and timely DOL enforcement and investigations into the alleged wrongful claim denials. ERISAclaim.com offers new Webinars and workshops to assist healthcare providers in understanding the new healthcare reform laws, PPACA claims regulations, being fully enforced in 2012 by the federal Department of Insurance (DOL), and effective and compliant filing of Complaints with DOL for all improperly denied health claims, in order to get paid quickly at the minimum costs.
The next ERISAclaim.com ERISA & PPACA DOL Complaint Program will be held on Jan 23 & 24, 2012 in the greater Houston area, Texas in private sessions.
The Federal Department of Insurance (DOL) may help you in 3 business days when the State Department of Insurance (DOI) could not in 3 years, because the State DOI doesnt have jurisdiction over the ERISA claims, for both self-insured and fully-insured health plans, says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
In accordance with the Supreme Courts new decision in CIGNA v. Amara, the DOL filed a Kenseth Amicus Brief (No. 11-1560) in support of patient, argued that CIGNA has dramatically changed the legal landscape of managed care industry, because ERISA now provides patients with the make-whole remedy of surcharge and other equitable monetary awards under ERISA section 502(a)(3). (http://www.dol.gov/sol/media/briefs/kenseth(A)-6-13-2011.htm)
To enforce the new ERISA after Cigna v. Amara, and the PPACA as healthcare reform laws, a DOL News Release on Nov. 10, 2011 announced the new Consumer Assistance / Compliant Web Page. (http://www.dol.gov/opa/media/press/ebsa/EBSA20111627.htm)
“Helping retirement and health plan participants find answers to questions about their benefits and providing assistance when they believe their benefits have been improperly denied is one of our most important responsibilities,” said EBSA Assistant Secretary Phyllis C. Borzi. “The new consumer assistance Web page and electronic inquiry/complaint process will provide quick answers to the most frequently asked questions and connect workers to experienced benefits advisers if assistance is needed.”
The page includes links to various tools and publications with information on benefit plans, as well as answers to questions about “hot topics.” Users also have the option to submit a question, file a complaint or report a problem with their plan. Inquiries and complaints submitted are sent directly to EBSA benefits advisers, who will respond as soon as possible but no later than three business days. Additionally, the system automatically routes the requests to the appropriate EBSA regional office based on users’ ZIP codes.
In 2010 alone, DOL EBSA has helped 230,000 consumers and obtained more than $ 478 millions in benefits that had been wrongly denied to 173,000 participants.
DOL response time of 3 days should inspire providers to use the Consumer Complaint Webpage, says Mark Floes, a certified PPACA & ERISA Claim Specialist, Director of Healthcare Revenue & Consulting, YF Corporation in Los Angeles, CA.
ERISAclaim.com will demystify the most important steps for successful DOL Complaints for wrongfully denied claims: (1) Become a PPACA Claimant with valid designation of authorized representative (DAR). Your traditional assignment of benefits (AOB) may be limited or insufficient; (2) Get your facts straight; (3) first submit timely WRITTEN appeals under PPACA & ERISA; (4) then file DOL Complaint with clear facts, focusing on the specific plan / payers violations of PPACA & ERISA regulations, avoid arguing medical or coding merits, as DOL doesnt decide medical necessity or billing and coding disputes; (5) Complain against both TPA and Plan Administrator.
ERISAclaim.com ERISA & PPACA DOL Complaint Programs are immediately available and will cover the following topics:
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Hanover Park, IL (PRWEB) January 01, 2012
ERISAclaim.com Offers Webinars To Examine A New Federal Court Ruling For Aetna In Its ERISA Defense Against A Providers State PPO Claims, When Aetna Denied All Provider Services For All Patients, Canceled PPO Contract, With A SIU Demand For $ 59,000 Overpayment Refund.
On Nov. 22, 2011, the federal District Court in Southern District Of Texas ruled, in Christie v. Aetna (Case 4:10-cv-01766), for Aetna in its ERISA removal defense against a providers remand for state PPO claims, when Aetna denied all provider services for all patients, canceled the providers PPO contract, and made a SIU demand for $ 59,000 overpayment refund. Relied upon Supreme Court decisions, the Court concluded that Under the test set forth in Davila, at least one of Christies claims is preempted by ERISA. Complete preemption permits removal to federal court. ERISAclaim.com offers Webinars to examine this court decision and its profound impact in 2012 for all PPO doctors and hospitals faced with similar or identical issues for ERISA compliance.
As vast majority of PPO doctors and hospitals in USA have direct contracts with payers, this Court decision is a wakeup call for provider PPO dreams. Court agreed with Aetna and Aetna is correct this time: PPO is not even triggered unless ERISA is resolved or moot, says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
Medical necessity, proper documentation, SIU audit and overpayment recoupment are the most frequent payment disputes in managed care claim denials. Federal law ERISA compliance must be the No. 1 priority in 2012 for all providers in reimbursement practice, advised Dr. Zhou.
According to the court documents, the provider plaintiff had been a PPO provider for more than 10 years since 1997 with Aetna and was paid by Aetna without issues. In 2007, Aetna SIU audited the plaintiff and made a $ 59,000 overpayment refund demand, and then stopped paying for all Provider Services for all patients which it had routinely and consistently paid in the past. Thereafter, Aetna terminated the Provider Agreement with Christie altogether. The provider sued Aetna for more than $ 119,000 in unpaid claims in the state court. The plaintiff brought this lawsuit in state court against Aetna, alleging breach of contract, quantum meruit, and promissory estoppel based on Aetnas alleged failure to perform in accordance with the terms of the parties Provider Agreement. The case was removed to this Court on the grounds that Christies contract claims raised federal claims in character because they were preempted by the Employee Retirement Income Security Act of 1974 (hereinafter ERISA).
Aetna argued that a PPO contract is not even triggered unless ERISA is resolved or moot. The Court document showed: Aetna filed a Sur-Reply in which it notes that by its terms, the Provider Agreement is not triggered unless Aetna is billed for Covered Services, which the Agreement defines as [t]hose Medically Necessary Services which a member is entitled to receive under the terms and conditions of a Plan. (Doc. No. 35, Sur-Reply to Reply to Response to Mot. Remand 2.) To qualify as adequate, Aetna states, Christie had to show that J.V.s claim was covered by J.V.s ERISA plan. (Id. 7.) In other words, when Aetna refers to lack of documentation, it means that Christie failed to make a showing that J.V.s claim was covered.
After the Court reviewed the facts, and relied upon Supreme Court decision, the Court agreed with Aetna that federal ERISA law governs, even only with just one of the provider ERISA claims. The Court determined:
To prevent remand, Aetna need only show that one of Christies claims is preempted. Giles, 172 F.3d at 337; Cotner, 2008 WL 59174, at *3. Aetna has made that showing. Regardless of Aetnas reasons for terminating the Provider Agreement, this case is properly in federal court.
The ERISAclaim.coms 2012 Webinars start at $ 5,000 per 2-hour session and will cover the following topics:
1.
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(PRWEB) January 03, 2012
The Corporate Whistle Blower Center is launching an incredibly ambitious initiative in 2012 aimed at exposing massive Medicare fraud on the part of corporations in healthcare, along with any type of massive fraud involving contractors overcharging, or fleecing the federal government in almost every category, from defense contractors, to environmental super fund clean up contractors, to federal highway projects, to low income housing schemes, Internet universities, that are little more than diploma mills, that rip off our Veterans, and their GI Bill, to banks, or mortgage servicing companies defrauding the federal government on FHA, or VA mortgages. The Corporate Whistle Blower Center says, “We know there are thousands, if not tens of thousands of US citizens, who possess the full set of party pictures on their employer defrauding the federal government, and aside from being the patriotic thing to do, stepping forward can make an individual rich, provided the wrongdoing is in the millions of dollars, and the documentation is very easy to see, and prove.” http://CorporateWhistleBlowerCenter.Com
The Corporate Whistle Blower Center says, “Just in one example we know many hospitals intentionally admit ER walk ins; not because they need to be admitted to a hospital, but because its a super easy way to cash in on bigger Medicare payments, as in thousands of extra dollars per patient. Just this problem alone costs Medicare billions of dollars per year. How about federal contractors fleecing the US taxpayers in Iraq, or Afghanistan? Again we know this problem is in the billions of dollars per year. What we are saying is if it is in the millions of dollars, and you can prove your employer, or a contractor is defrauding the federal government, we will help you put it together, we will help you package it, and we will find the absolute best national caliber whistleblower attorneys to advance the claim. No other group in the United States offers a service like this.” http://CorporateWhistleBlowerCenter.Com
Simple rules for a whistleblower from the Corporate Whistle Blower Center:
Do not go to the government first, if you are a major whistleblower. The Corporate Whistle Blower Center says, “Major whistleblowers frequently go to the federal government thinking they will help. Its a huge mistake. Frequently government officials could care less, or they are incompetent.”
Do not go to the news media with your whistleblower information. Public revelation of a whistleblower’s information could destroy any prospect for a reward.
Do not try to force a government contractor, or corporation to come clean to the government about their wrongdoing. The Corporate Whistle Blower Center says, “Fraud is so rampant among federal contractors, that any suggestion of exposure might result in an instant job termination, or harassment of the whistleblower. We say, come to us first, tell us what type of information you have, and if we think its sufficient, we will help find the right law firms, to assist in advancing your information.”
Any type of insider, or employee, who possesses significant proof of their employer, or a government contractor fleecing the federal government is encouraged to contact to Corporate Whistle Blower Center anytime at 866-714-6466, or they can contact the group via their web site at http://CorporateWhistleBlowerCenter.Com
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Hanover Park, IL (PRWEB) January 01, 2012
ERISAclaim.com Offers Webinars To Examine A New Federal Court Ruling For Aetna In Its ERISA Defense Against A Providers State PPO Claims, When Aetna Denied All Provider Services For All Patients, Canceled PPO Contract, With A SIU Demand For $ 59,000 Overpayment Refund.
On Nov. 22, 2011, the federal District Court in Southern District Of Texas ruled, in Christie v. Aetna (Case 4:10-cv-01766), for Aetna in its ERISA removal defense against a providers remand for state PPO claims, when Aetna denied all provider services for all patients, canceled the providers PPO contract, and made a SIU demand for $ 59,000 overpayment refund. Relied upon Supreme Court decisions, the Court concluded that Under the test set forth in Davila, at least one of Christies claims is preempted by ERISA. Complete preemption permits removal to federal court. ERISAclaim.com offers Webinars to examine this court decision and its profound impact in 2012 for all PPO doctors and hospitals faced with similar or identical issues for ERISA compliance.
As vast majority of PPO doctors and hospitals in USA have direct contracts with payers, this Court decision is a wakeup call for provider PPO dreams. Court agreed with Aetna and Aetna is correct this time: PPO is not even triggered unless ERISA is resolved or moot, says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
Medical necessity, proper documentation, SIU audit and overpayment recoupment are the most frequent payment disputes in managed care claim denials. Federal law ERISA compliance must be the No. 1 priority in 2012 for all providers in reimbursement practice, advised Dr. Zhou.
According to the court documents, the provider plaintiff had been a PPO provider for more than 10 years since 1997 with Aetna and was paid by Aetna without issues. In 2007, Aetna SIU audited the plaintiff and made a $ 59,000 overpayment refund demand, and then stopped paying for all Provider Services for all patients which it had routinely and consistently paid in the past. Thereafter, Aetna terminated the Provider Agreement with Christie altogether. The provider sued Aetna for more than $ 119,000 in unpaid claims in the state court. The plaintiff brought this lawsuit in state court against Aetna, alleging breach of contract, quantum meruit, and promissory estoppel based on Aetnas alleged failure to perform in accordance with the terms of the parties Provider Agreement. The case was removed to this Court on the grounds that Christies contract claims raised federal claims in character because they were preempted by the Employee Retirement Income Security Act of 1974 (hereinafter ERISA).
Aetna argued that a PPO contract is not even triggered unless ERISA is resolved or moot. The Court document showed: Aetna filed a Sur-Reply in which it notes that by its terms, the Provider Agreement is not triggered unless Aetna is billed for Covered Services, which the Agreement defines as [t]hose Medically Necessary Services which a member is entitled to receive under the terms and conditions of a Plan. (Doc. No. 35, Sur-Reply to Reply to Response to Mot. Remand 2.) To qualify as adequate, Aetna states, Christie had to show that J.V.s claim was covered by J.V.s ERISA plan. (Id. 7.) In other words, when Aetna refers to lack of documentation, it means that Christie failed to make a showing that J.V.s claim was covered.
After the Court reviewed the facts, and relied upon Supreme Court decision, the Court agreed with Aetna that federal ERISA law governs, even only with just one of the provider ERISA claims. The Court determined:
To prevent remand, Aetna need only show that one of Christies claims is preempted. Giles, 172 F.3d at 337; Cotner, 2008 WL 59174, at *3. Aetna has made that showing. Regardless of Aetnas reasons for terminating the Provider Agreement, this case is properly in federal court.
The ERISAclaim.coms 2012 Webinars start at $ 5,000 per 2-hour session and will cover the following topics:
1.
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All Bill Titles. <li><em>Official:</em> To amend the Federal Food, Drug, and Cosmetic Act to improve the priority review voucher incentive program relating to tropical and rare pediatric diseases.<em> as introduced.</em></l
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All Bill Titles. <li><em>Official:</em> To amend the Federal Food, Drug, and Cosmetic Act to improve the priority review voucher incentive program relating to tropical and rare pediatric diseases.<em> as introduced.</em></l
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All Bill Titles. <li><em>Official:</em> To amend the Federal Food, Drug, and Cosmetic Act to improve the priority review voucher incentive program relating to tropical and rare pediatric diseases.<em> as introduced.</em></l
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All Bill Titles. <li><em>Official:</em> To amend the Federal Food, Drug, and Cosmetic Act to improve the priority review voucher incentive program relating to tropical and rare pediatric diseases.<em> as introduced.</em></l
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