Self-Insured Health Plans Expected to Reap Windfall From TPA’s Overpayment Recoupment Practice

Self-Insured Health Plans Expected to Reap Windfall From TPA’s Overpayment Recoupment Practice

Avym Announces 2012 Free Webinars And Plan Assets Recovery Programs To Assist Self-Insured Health Plans Recover Hundreds Of Millions Of Dollars In Plan Assets From Successful TPA’s Overpayment Recovery.  More Than 60% Of TPA Recovered Money Originated From Self-Insured Plans And Should Be Returned To Self-Insured Health Plans Under New DOL Contributory Plans Criminal Project.

Avym announces 2012 free webinars and plan assets recovery programs designed to assist self-insured health plans potentially recover hundreds of millions of dollars in plan assets from successful TPA overpayment recovery efforts.  According to industry estimates, TPA successful overpayment recovery reaches into the billions of dollars nationwide over the past 5 to 7 years.

More than 60% of national TPA recovered money initially originated from self-insured plans and should be returned to those same self-insured health plans.  Every plan fiduciary has statutory duties to safeguard plan assets: to audit all alleged overpayments by TPA’s and to recover every dollar in plan assets when there were known successful overpayment recoveries by the TPA’s.  Avym offers this unique and powerful Plan Assets Recovery Program for the purpose of compliance assistance under new DOL Contributory Plans Criminal Project.

02/23/2011: DOL EBSA News Release:

Morrow, Ohio-based third-party plan administrator pleads guilty to embezzlement of $1 million from retirement plan clients [02/23/2011]

“The third-party administrator to 56 employee benefit plans — most covered by the Employee Retirement Income Security Act — located throughout Ohio and several other states pleaded guilty to one count of embezzlement of $1 million in assets from 12 retirement plans.”  

This defendant’s theft of employee benefit assets jeopardized the retirement security of workers covered by these plans. This crime is particularly egregious in light of the duty of plan officials and service providers to protect plan assets from abuse,” said Phyllis C. Borzi, assistant secretary of the Labor Department’s Employee Benefits Security Administration.”

During the last 7 years, there have been industry wide reports of successful healthcare anti-fraud and overpayment recovery in the billions of dollars.  On November 16, 2010, U.S. Labor Department announced nationwide enforcement actions to protect millions of dollars in worker retirement and health benefits.

DOL EBSA: Contributory Plans Criminal Project Fact Sheet States:

“Millions of American workers share in the costs of employee benefits by contributing to employer sponsored retirement and health benefit plans. In 2010, the Department of Labor’s Employee Benefits Security Administration (EBSA) initiated the Contributory Plans Criminal Project (CPCP) to combat criminal abuse of contributory benefit plans.”

It is simple and clear -when a contributory benefit plan initially overpays millions of dollars due to TPA’s errors, and several years later, the same TPA recovers said overpayment in its anti-fraud operation, such recovered money should be returned to the self-insured health plans, and must not be converted or embezzled into the TPA assets.

Avym Webinars are designed to assist self-insured health plans comply with ERISA fiduciary laws by safeguarding contributory plan assets, and to assist with DOL EBSA Contributory Plans Criminal Project:

“EBSA works closely with other federal, state, and local agencies to enforce laws safeguarding contributory plan assets. Criminal prosecution of individuals who abuse their authority or control over contributory plans can result in severe criminal penalties, including imprisonment. Those convicted of embezzling or misappropriating moneys intended to fund pension plans or pay health benefits typically are barred from providing services or acting in any capacity for a period of 13 years.”

Avym Webinars are free to all self-insured ERISA plans.  Webinars are designed to review industry facts and applicable federal laws, and explain how and why a self-insured ERISA health plan should be refunded by its TPAs for recouped overpayment money.  These free webinars are scheduled for 30 minutes each session.  To schedule a free webinar, or for more information contact us at:

Located in Los Angeles, CA, AVYM is a leading provider of services focusing entirely on the resolution of denied or disputed medical insurance claims by participating in the nation’s first ERISA PPACA Claims Appeals Certification program.  AVYM also 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.



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Overpayment Denials,

[…] accordance with recent developments, Avym Announces 2012 Free Webinars And Plan Assets Recovery Programs To Assist Self-Insured Health Plans Recover Hundreds Of Millions Of Dollars In Plan Assets From […]

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