In the world of ERISA, compliance is not a goal, it is the law – and harsh penalties await the offender! ERISA stands for Employee Retirement Income Security Act of 1974. ERISA is the federal law governing and regulating any appeal dispute and reimbursement from health insurance obtained through employment in private sectors. ERISA governs or controls more than 90% of non-Medicare claims; yet ERISA has been almost completely misunderstood by health care providers and reimbursement professionals for decades.
ERISA is governed by federal agencies such as the IRS and Department of Labor, which oversee and enforce these plans. ARM stays in the loop by paying close attention to plan sponsors’ compliance and non-compliance. Forcing insurance companies to comply with ERISA allows ARM’s clients to be true patient advocates. In 2009 and 2010, an estimated 70 percent of retirement plans audited by the Department of Labor were fined, with penalties averaging about $450,000 per plan.