HANOVER PARK, Ill., Jan. 25, 2016 /PRNewswire/ -- On January 20, 2016, Supreme Court ruled that an ERISA plan cannot sue to recover medical expenses paid on the participant's behalf after the settlement funds have dissipated, because "…a plaintiff ordinarily cannot enforce any type of equitable lien if the defendant once possessed a separate, identifiable fund to which the lien attached, but then dissipated it all…. This rule applied to equitable liens by agreement as well as other types of equitable liens." Op. at 9
Supreme Court case info: Robert Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, case #: 14-723, January 20, 2016
Supreme Court link for a PDF copy: http://www.supremecourt.gov/opinions/15pdf/14-723_1bn2.pdf
On January 21, 2016, ERISAclaim.com announced 2016 hospital ERISA appeal & litigation department support services to demystify why this high court decision also protects hospitals and doctors from any health plan's overpayment recoupment and to recover all overpayment recoupment unlawfully withheld or embezzled by all payers under any incorrect ERISA equitable lien arguments, because "this rule applied to equitable liens by agreement as well as other types of equitable liens." Op. at 9
"More than billions of dollars in revenue losses, or even bankruptcies, for hospitals and doctors nationwide in the past 10 years are directly resulted from all types of overpayment offset and recoupment by payers under ERISA equitable lien arguments, inside or outside of court rooms, this Supreme Court decision is extremely timely and most important for every health care provider's financial survival," says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on ERISA appeals and compliance, and an ERISA "Special Collection Agent", as recently ordered by a Federal Bankruptcy Court for a bankrupt hospital system in Texas.
"At minimum, all overpayment offset or recoupment across the plans and/or the patients are not permissible under ERISA equitable lien law in accordance with the Supreme Court decision on January 20, 2016, because the alleged overpayment equitable lien is attached to the other people's fund or property where there is no ERISA equitable lien existed or otherwise clearly not permitted," says Dr. Zhou.
"For all pending overpayment court cases in absence of any fraud claims, this Supreme Court decision could be a rainmaker for all healthcare providers, both in-network and out-of-network, " predicted by Dr. Zhou.
ERISAclaim.com's 2016 hospital ERISA appeal & litigation department support services will brainstorm on this Supreme Court order on January 20, 2016 and assist hospital executives and legal departments in assessing and immediately compliance with the Supreme Court decision, in advocating for ERISA rights of the plan participants and beneficiaries in the hospital's financial survival ordeals, or otherwise in preventing hospitals and doctors from being bankrupt as a result of the totally out-of-control revenue losses from the endless and relentless overpayment recoupment or offsets under ERISA in absence of any fraud claims.
These new ERISA compliance services include, but not limited to, executive brainstorming, education, ERISA & PPACA appeal practice, ERISA litigation strategy & support, overpayment prevention through corporate compliance in fraud & abuse prevention.
In a personal injury subrogation overpayment lawsuit, after the District Court and 11th Circuit Court ruled for the health plan, on January 2016, the Supreme Court ruled for the plan participant. In an 8-1 ruling penned by Justice Clarence Thomas, the majority said that the National Elevator Industry Health Benefit Plan couldn't sue plan beneficiary Robert Montanile under ERISA §502(a)(3) for overpayment reimbursement of about $122,000 from a $500,000 auto accident settlement because the settlement fund had already been dissipated, the plan fiduciary may not sue to get at the participant's additional assets.
According to the Court Documents, the Supreme Court ruled:
- "Plan fiduciaries are limited by §502(a)(3) to filing suits "to obtain ... equitable relief."
- "[A]s here, an equitable lien by agreement, only against specifically identified funds that remained in the defendant's possession or against traceable items that the defendant purchased with the funds."
- "If a defendant dissipated the entire fund on nontraceable items, the lien was eliminated and the plaintiff could not attach the defendant's general assets instead."
- "The Board's arguments in favor of the enforcement of an equitable lien against Montanile's general assets are unsuccessful. Sereboff does not contain an exception to the general asset-tracing requirement for equitable liens by agreement."
- "In sum, at equity, a plaintiff ordinarily could not enforce any type of equitable lien if the defendant once possessed a separate, identifiable fund to which the lien attached, but then dissipated it all. The plaintiff could not attach the defendant's general assets instead because those assets were not part of the specific thing to which the lien attached."
- "This rule applied to equitable liens by agreement as well as other types of equitable liens."
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.
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