UHC Administered ERISA Plan Sued for Embezzlement in Overpayment Offset - ERISAclaim.com Demystifies
May 11, 2016 (PRLEAP.COM) Health NewsMay 11, 2016 - On May 10, 2016, a UnitedHealthcare (UHC) administered self-insured ERISA plan, Gap Inc, and its Plan Administrators, Cynthia Radovich, and Lesley Dale, were sued in the Federal District Court for the Southern District of Texas for the alleged ERISA plan assets "self-dealing and embezzlement" through its co-fiduciary, UHC, over the alleged cross plan overpayment offset. ERISAclaim.com timely announced today a new ERISA Compliance Forum to brainstorm, assess or demystify the potential impact of this unprecedented and multifaceted ERISA lawsuit for all interested parties.
As a part of this new ERISA Compliance Forum, on May 17, 2016, at PBGH "Legislative Updates Forum", Dr. Jin Zhou, president of ERISAclaim.com, will speak to PBGH members from self-insured plans, "the only employer-led, non-profit coalition", on "ERISA Benefits Compliance and Cost Containment: Potentials in plan asset auditing and recovery", and the inevitable impact to all self-insured plans from this type of ERISA actions by healthcare providers nationwide with the billion dollar market under the sky-rocketing overpayment recoupment and offset wars.
The Court Case Info: Redoak Hospital, LLC v. Gap Inc., Gap Inc. Health and Life Insurance Plan, Cynthia Radovich, and Lesley Dale, in the United States District Court for the Southern District of Texas, Houston Division, Case 4:16-cv-01303, Filed on 05/10/16.
"This is absolutely an unprecedented and multifaceted ERISA lawsuit with unpredictable impacts for all ERISA self-insured plans, all employer sponsored plan employees, and all healthcare providers, for resulting uncertainties for every healthcare claim," says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on ERISA compliance and appeals, a "Godfather of ERISA" for healthcare providers, as regarded by some in the healthcare industry.
"Cross plan offset practice will ultimately make or break ERISA healthcare system for USA, now it's up to our court system to make this judgement, but we shall watch it very closely," explains Dr. Zhou.
After the Plaintiff filed for DOL EBSA Complaint over the dispute of the alleged overpayment offset by the Defendants Plan, Gap, Inc, by the plan's co-fiduciary, UHC, it filed this ERISA lawsuit, alleging:
"This dispute arises out of Defendants' ongoing and systematic ERISA violations consisting of an elaborate scheme to abstract, withhold, embezzle and convert self-insured Plan Assets that were approved and allegedly paid to Plaintiff for Plaintiff's claim, to purportedly, but impermissibly, satisfy a falsely alleged ―overpayment‖ for another stranger claim, especially when the stranger is a plan beneficiary of a fully-insured plan that is insured by the Plan's co-fiduciary, United Healthcare (hereinafter, ―United‖). Defendants knew or should have known that the Plan's overpayment recovery provisions cannot be triggered until there is an allegation of overpayment by the Plan to the Plan Beneficiary subject to this action, and that converting the Plan Assets by a fiduciary or co-fiduciary of the Plan, in this case United, to the use of another and his own use, to ultimately pay to United's own account is absolutely prohibited under ERISA statutes. Regardless, Defendants and United recklessly conspired, orchestrated and authorized to this kind of self-dealing and embezzlement even while being under active investigation by the Department of Labor and after repeated detailed alerts and notices from Plaintiff regarding the aforementioned." according to the Court Documents.
In the Compliant, the Plaintiff makes the following "COUNTS AGAINST DEFENDANTS:
The Plaintiff, as a statutory defined Claimant with a valid and unchallenged Assignment of Benefits, is entitled to ERISA rights ―to bring a civil action under section 502(a) of the Act following an adverse benefit determination on review‖ after Plaintiff has legally and administratively exhausted any and all appeal remedies.14 Therefore the Plaintiff is entitled to pursue Benefit claims: (i) to recover benefits due for already approved claims but abstracted and converted by the Defendants' co-fiduciary, United; (ii) breach of fiduciary duty claims under 29 U.S.C. § 1132(a)(2) in violation of 18 U.S.C. § 664, 29 U.S.C. § §1104, §1105, §1106(b)(1)(d); injunctive relief to enjoin the Defendants from engaging in prohibited transaction 29 U.S.C. § 1132(a)(3); and (iii) injunctive relief to permanently remove the Defendants Cynthia Radovich and Lesley Dale from serving as fiduciaries to the Plan permanently under 29 U.S.C. § 1132(a)(3)." according to the Court Documents.
On May 17, 2016 at PBGH "Legislative Updates Forum", Dr. Jin Zhou will also brainstorm and assess the impacts of other court pending ERISA class actions cases over the industry's prevalent overpayment offset wars:
Peterson, D.C. et al v. UnitedHealth Group Inc. et al, U.S. District Court, U.S. District of Minnesota (DMN)
CIVIL DOCKET FOR CASE #: 0:14-cv-02101-PJS-BRT,
Riverview Health Institute v. UnitedHealth Group Inc. et al, U.S. District Court, U.S. District of Minnesota (DMN), CIVIL DOCKET FOR CASE #: 0:15-cv-03064-PJS-BRT
To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
Located in a Chicago suburb in Illinois, for over 16 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.
ERISA Compliance, Plan Assets Auditing and Recovery
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