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Past Speaking Engagements
HFMA Metro Members Click Here for Presentation Materials
Disgorgement for Denial of ERISA Benefits – Awards Above Plan Benefit Amounts
We have been carefully reviewing and analyzing recent case law and have found a very interesting case dealing with remedies under ERISA for denial of benefits. In this case, the Plaintiff, a plan beneficiary, was denied his disability benefits under his employer’s insurance plan for five years. The District Court found that the insurance company wrongfully denied disability benefits and awarded the beneficiary around $3.8 million dollars based upon remedies set forth in ERISA §502 (a)(1)(B) and §502 (a)(3). This case is a good example of how the Courts are cracking down on health plans attempting to avoid legitimate medical claims.
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Health Plan Recoupment Defense
As you know, there have been a lot of out of network providers facing recoupments, refund demands and so called “special investigations“ (“SIU”) from insurance payers and health plans. This is a serious problem that we are looking to address on behalf of our out of network clients. This article attempts to dig a little deeper into this issue and evaluate recent, relevant cases in the area of recoupments.
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Using ERISA to Get Your Claims Paid
The Employee Retirement Income Security Act (ERISA) has been viewed as both a blessing and a curse in the medical insurance industry. While there are many drawbacks and ambiguities associated with this statute, providers can and should use it to their benefit. If your patient plan is self-insured (about 60 percent are), ERISA and its corresponding federal regulations contain many hidden gems that can help get your claims paid.
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The Patriot Group
The Patriot Group and their affiliated law firm, The Force Law Firm PC, report the recovery of $1.1 Million Dollars in six (6) months for out-of-network private Dallas Ft Worth area Hospital. The accounts recovered involve two year old, written off hospital debt that was paid, but at low reimbursement rates. For more information, contact company President, Thomas J. Force, Esq., at tforce@patriotcompli.com or at 631 665-1880 ext 7.
ERISA Victory for the Force Law Firm on behalf of a New York Plastics Surgeon
On June 6, the U.S. District Court for the Northern District of New York declined to dismiss key elements of an action for reimbursement of medical costs. After "liberally construing" the proposed amended complaint, the court found plaintiffs stated three cognizable cliams under the Employee Retirement Income Security Act (ERISA).
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How to Obtain Increased Reimbursement on Your Out-of-Network Claims
Many physicians and other healthcare practitioners need to go "in-network" with managed care organizations because these network agreements drive patients into their office. These practitioners typically enter into managed care participation provider agreements with the health insurers for the privilege of becoming an "in-network" provider.
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Out-of-Network Reimbursement: Don’t Expect Insurers to Do the Right Thing
In early 2008, New York Attorney General and Gov. Andrew Cuomo conducted an investigation into what they viewed as under-reimbursed claims by most insurers in the state.
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Leveling the Playing Field - 9 Tips to Receive Payment for Medical Claims Fairly and Quickly
Most physicians and health care administrators believe that health care and particularly the "revenue cycle" is controlled entirely by the managed care companies. They believe this because these companies are multi-million dollar conglomerates with seemingly endless streams of revenue.
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The Patriot Group is not just a billing company. The Company is owned and operated by an experienced healthcare attorney who formerly was a Senior Executive and General Counsel of an New York Health Insurer. The Company has several high level contacts at all of the major insurers.
br /!--/Row-- br / The Company are true advocates for your practice and patients. The Company's fees are contingency and based upon the amount recovered meaning that no fee is paid unless funds are recovered for your practice.
Let us help you improve the efficiency and cash flow of your practice by ensuring that all of your claims are paid promptly and at fair reimbursement rates.
The Patriot Group's staff is a very seasoned mix of senior billing executives, attorneys and collection professionals. The Company's revenue recovery techniques are truly innovative and proven effective.
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