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GROUP OF SPRINGHILL SOUTH KOREA - In today's economic climate, who will help you protect your company and your clients from the devastating impact of fraud? Fraud can creep into your business in a number of ways. You may find you need an objective expert to deter potential problems, investigate allegations or provide resolution. A Certified Fraud Examiner (CFE) offers anti-fraud knowledge and skills you need to: * Investigate allegations against one of your employees * Recommend strong anti-fraud internal controls * Conduct interviews related to sensitive issues * Provide assistance with financial dispute resolution * Resolve irregularities discovered during your company's audit * Provide expert testimony on financial and investigative matters A Unique Set of Skills Fraud Examiners have a unique set of skills that are not found in any other discipline; they combine knowledge of complex financial transactions with an understanding of law, criminology, investigation and how to resolve allegations of fraud. CFEs work in a variety of disciplines including accounting, auditing, fraud investigation and security, as well as in different industry segments including government, healthcare, financial services, manufacturing and retail distribution. CFEs are knowledgeable in four areas critical to the fight against fraud: * Fraudulent Financial Transactions * Criminology & Ethics * Legal Elements of Fraud * Fraud Investigation Reduce Fraud Risks and Costs Heightened fraud awareness, combined with new laws and regulations, has increased the already growing demand in the workforce for professionals who are highly skilled at deterring, detecting and investigating fraud. CFEs have the ability to: * Identify and reduce opportunities for fraud * Implement effective anti-fraud controls * Continuously improve anti-fraud measures based on new risks and technologies * Educate employees to deter fraud and report wr

In today's economic climate, who will help you protect your company and your clients from the devastating impact of fraud? Fraud can creep into your business in a number of ways. You may find you need an objective expert to deter potential problems, investigate allegations or provide resolution. A Certified Fraud Examiner (CFE) offers anti-fraud knowledge and skills you need to: * Investigate allegations against one of your employees * Recommend strong anti-fraud internal controls * Conduct interviews related to sensitive issues * Provide assistance with financial dispute resolution * Resolve irregularities discovered during your company's audit * Provide expert testimony on financial and investigative matters A Unique Set of Skills Fraud Examiners have a unique set of skills that are not found in any other discipline; they combine knowledge of complex financial transactions with an understanding of law, criminology, investigation and how to resolve allegations of fraud. CFEs work in a variety of disciplines including accounting, auditing, fraud investigation and security, as well as in different industry segments including government, healthcare, financial services, manufacturing and retail distribution. CFEs are knowledgeable in four areas critical to the fight against fraud: * Fraudulent Financial Transactions * Criminology & Ethics * Legal Elements of Fraud * Fraud Investigation Reduce Fraud Risks and Costs Heightened fraud awareness, combined with new laws and regulations, has increased the already growing demand in the workforce for professionals who are highly skilled at deterring, detecting and investigating fraud. CFEs have the ability to: * Identify and reduce opportunities for fraud * Implement effective anti-fraud controls * Continuously improve anti-fraud measures based on new risks and technologies * Educate employees to deter fraud and report wrongdoing * Resolve allegations or suspicions of f

In today's economic climate, who will help you protect your company and your clients from the devastating impact of fraud? Fraud can creep into your business in a number of ways. You may find you need an objective expert to deter potential problems, investigate allegations or provide resolution. A Certified Fraud Examiner (CFE) offers anti-fraud knowledge and skills you need to: * Investigate allegations against one of your employees * Recommend strong anti-fraud internal controls * Conduct interviews related to sensitive issues * Provide assistance with financial dispute resolution * Resolve irregularities discovered during your company's audit * Provide expert testimony on financial and investigative matters A Unique Set of Skills Fraud Examiners have a unique set of skills that are not found in any other discipline; they combine knowledge of complex financial transactions with an understanding of law, criminology, investigation and how to resolve allegations of fraud. CFEs work in a variety of disciplines including accounting, auditing, fraud investigation and security, as well as in different industry segments including government, healthcare, financial services, manufacturing and retail distribution. CFEs are knowledgeable in four areas critical to the fight against fraud: * Fraudulent Financial Transactions * Criminology & Ethics * Legal Elements of Fraud * Fraud Investigation Reduce Fraud Risks and Costs Heightened fraud awareness, combined with new laws and regulations, has increased the already growing demand in the workforce for professionals who are highly skilled at deterring, detecting and investigating fraud. CFEs have the ability to: * Identify and reduce opportunities for fraud * Implement effective anti-fraud controls * Continuously improve anti-fraud measures based on new risks and technologies * Educate employees to deter fraud and report wrongdoing * Resolve allegations or suspicions of f

In today's economic climate, who will help you protect your company and your clients from the devastating impact of fraud? Fraud can creep into your business in a number of ways. You may find you need an objective expert to deter potential problems, investigate allegations or provide resolution. A Certified Fraud Examiner (CFE) offers anti-fraud knowledge and skills you need to: * Investigate allegations against one of your employees * Recommend strong anti-fraud internal controls * Conduct interviews related to sensitive issues * Provide assistance with financial dispute resolution * Resolve irregularities discovered during your company's audit * Provide expert testimony on financial and investigative matters A Unique Set of Skills Fraud Examiners have a unique set of skills that are not found in any other discipline; they combine knowledge of complex financial transactions with an understanding of law, criminology, investigation and how to resolve allegations of fraud. CFEs work in a variety of disciplines including accounting, auditing, fraud investigation and security, as well as in different industry segments including government, healthcare, financial services, manufacturing and retail distribution. CFEs are knowledgeable in four areas critical to the fight against fraud: * Fraudulent Financial Transactions * Criminology & Ethics * Legal Elements of Fraud * Fraud Investigation Reduce Fraud Risks and Costs Heightened fraud awareness, combined with new laws and regulations, has increased the already growing demand in the workforce for professionals who are highly skilled at deterring, detecting and investigating fraud.

GROUP OF SPRINGHILL SOUTH KOREA - In today's economic climate, who will help you protect your company and your clients from the devastating impact of fraud? Fraud can creep into your business in a number of ways. You may find you need an objective expert to deter potential problems, investigate allegations or provide resolution. A Certified Fraud Examiner (CFE) offers anti-fraud knowledge and skills you need to: * Investigate allegations against one of your employees * Recommend strong anti-fraud internal controls * Conduct interviews related to sensitive issues * Provide assistance with financial dispute resolution * Resolve irregularities discovered during your company's audit * Provide expert testimony on financial and investigative matters A Unique Set of Skills Fraud Examiners have a unique set of skills that are not found in any other discipline; they combine knowledge of complex financial transactions with an understanding of law, criminology, investigation and how to resolve allegations of fraud. CFEs work in a variety of disciplines including accounting, auditing, fraud investigation and security, as well as in different industry segments including government, healthcare, financial services, manufacturing and retail distribution. CFEs are knowledgeable in four areas critical to the fight against fraud: * Fraudulent Financial Transactions * Criminology & Ethics * Legal Elements of Fraud * Fraud Investigation Reduce Fraud Risks and Costs Heightened fraud awareness, combined with new laws and regulations, has increased the already growing demand in the workforce for professionals who are highly skilled at deterring, detecting and investigating fraud. CFEs have the ability to: * Identify and reduce opportunities for fraud * Implement effective anti-fraud controls * Continuously improve anti-fraud measures based on new risks and technologies * Educate employees to deter fraud and report wrongdoing * Resolve allegations or suspic

In today's economic climate, who will help you protect your company and your clients from the devastating impact of fraud? Fraud can creep into your business in a number of ways. You may find you need an objective expert to deter potential problems, investigate allegations or provide resolution. A Certified Fraud Examiner (CFE) offers anti-fraud knowledge and skills you need to: * Investigate allegations against one of your employees * Recommend strong anti-fraud internal controls * Conduct interviews related to sensitive issues * Provide assistance with financial dispute resolution * Resolve irregularities discovered during your company's audit * Provide expert testimony on financial and investigative matters A Unique Set of Skills Fraud Examiners have a unique set of skills that are not found in any other discipline; they combine knowledge of complex financial transactions with an understanding of law, criminology, investigation and how to resolve allegations of fraud.

In today's economic climate, who will help you protect your company and your clients from the devastating impact of fraud? Fraud can creep into your business in a number of ways. You may find you need an objective expert to deter potential problems, investigate allegations or provide resolution. A Certified Fraud Examiner (CFE) offers anti-fraud knowledge and skills you need to: * Investigate allegations against one of your employees * Recommend strong anti-fraud internal controls * Conduct interviews related to sensitive issues * Provide assistance with financial dispute resolution * Resolve irregularities discovered during your company's audit * Provide expert testimony on financial and investigative matters A Unique Set of Skills Fraud Examiners have a unique set of skills that are not found in any other discipline; they combine knowledge of complex financial transactions with an understanding of law, criminology, investigation and how to resolve allegations of fraud.

Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

In today's economic climate, who will help you protect your company and your clients from the devastating impact of fraud? Fraud can creep into your business in a number of ways. You may find you need an objective expert to deter potential problems, investigate allegations or provide resolution. A Certified Fraud Examiner (CFE) offers anti-fraud knowledge and skills you need to: * Investigate allegations against one of your employees * Recommend strong anti-fraud internal controls * Conduct interviews related to sensitive issues * Provide assistance with financial dispute resolution * Resolve irregularities discovered during your company's audit * Provide expert testimony on financial and investigative matters A Unique Set of Skills

Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

NEWS FROM MULTIPLY - springhillcaregroup Springhill Care Group Join this Group! Report Abuse Welcome Nov 29, 2011 Springhill Group look to cater to the special requirements of each person citizen and any changing circumstances that occur throughout their time living in our care. This gives families the comfort that their loved one has the support and care. Tags: care group, florida group, gold, group, group florida, groupreview, health medicine, home care, korea, medicarefraud, of, seoulsouth, south, south korea, southkorea, southkoreagroup, springhill, springhill care, springhill caregroup, springhill florida, springhill group, springhillfraud, springhillgroup, springhillreview, warningto [ Show All Tags ]

Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

Joan H. Krause University of North Carolina (UNC) at Chapel Hill - School of Law August 8, 2012 Annals of Health Law, Vol. 21, No. 1, 2012 UNC Legal Studies Research Paper No. 2018589 Abstract: This essay considers how the 2010 Supreme Court decision in Skilling v. United States, which limited the situations in which mail and wire fraud cases may be premised on violations of the "intangible right to honest services," has the potential to alter the future of health care fraud litigation. While Skilling is widely perceived to have closed the door to several types of common mail and wire fraud prosecutions, this may not turn out to be the case in health care. In health care, the renewed focus on kickbacks as evidence of an honest services breach instead may dovetail nicely with both the Obama Administration's emphasis on criminal health care fraud enforcement and the jurisprudence of the Medicare & Medicaid Anti-Kickback Statute. This kind of leverage may prove very difficult for prosecutors to resist, and most certainly will require changes in the way the health law bar approaches common Anti-Kickback concerns.

In today's economic climate, who will help you protect your company and your clients from the devastating impact of fraud? Fraud can creep into your business in a number of ways. You may find you need an objective expert to deter potential problems, investigate allegations or provide resolution. A Certified Fraud Examiner (CFE) offers anti-fraud knowledge and skills you need to:

sophiamostel: Springhill Care Group : 2012 U.S. Healthcare: UCR or '$99,750 Ear Wax Fraud'? Aetna Wants Court to Stop Hospital's UCR Billing On Dec 7, 2011, Aetna filed a lawsuit against two PPO surgeons and one out-of-network (OON) hospital, in the District Court, Harris County, Texas. Aetna lawsuit seeks to recover damages and attorneys' fees and for court temporary injunction to stop the OON hospital's UCR billing and PPO surgeon's referrals, alleging breach of contract, conspiracy to overcharge, tortious interference, and common law fraud, including "a bill for $99,750 for the removal of ear wax". A new 2012 "UCR war" already unfolds in the court. ERISAclaim.com offers private Webinars to examine this court case, its profound impacts on all OON providers, and explore compliant solutions and protections under ERISA and PPACA as well as OIG Guidance. Aetna OON UCR Case info: AETNA HEALTH INC vs. SOFOLA, IFEOLUMIPO O (MD) (Case #: 2011-73949 / Court 152) In 2012, most out-of-network (OON) doctors, surgical centers and hospitals will "make it or break it", depending upon the outcome of this new Aetna lawsuit, as an emerging trend in managed litigations. "While the alleged $99,750 ear wax UCR fee may or may not be an isolated inadvertent error, the payor's new lawsuit to outlaw all OON UCR billing as fraud certainly represents a new 2012 trend and detrimental blow to all OON providers and 77% of insured Americans in private industry," says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance. "Failure to recognize the impact of the payor UCR legal actions under $99,750 ear wax anti-fraud strategies and to quickly act with compliant solutions, the OON market will most likely fail by the end of 2012," warned Dr. Zhou. According to the court documents, "Plaintiffs Aetna Health Inc. and Aetna Life Insurance Company (collectively, "Aetna") bring this action under the laws of thi

billiepalance: Springhill Group Florida:: Living and Care Options Springhill Group living and care options are available depending on what the residents need and prefer. Independent Living The independent accommodations are occupied for those who wish to maintain a significant standard of flexibility, but also value the friendly relationship, the security, recreational facilities, and care that is provided by to them. The homes are designed to allow residents simple and easy household management encircled by warm and friendly neighbours Assisted Living Assisted Living is desirable to people who need a little extra care with their everyday living. You will also find here theflexibility and security of owning your personal space, to have your valuable possessions and things around you. Resthome Level Care Resthome level care in a Ryman Village, offers residents the very best in clinical care, while receiving the benefits of living in our warm and welcoming community. sophiamostel: Springhill Care Group : 2012 U.S. Healthcare: UCR or '$99,750 Ear Wax Fraud'? Aetna Wants Court to Stop Hospital's UCR Billing On Dec 7, 2011, Aetna filed a lawsuit against two PPO surgeons and one out-of-network (OON) hospital, in the District Court, Harris County, Texas. Aetna lawsuit seeks to recover damages and attorneys' fees and for court temporary injunction to stop the OON hospital's UCR billing and PPO surgeon's referrals, alleging breach of contract, conspiracy to overcharge, tortious interference, and common law fraud, including "a bill for $99,750 for the removal of ear wax". A new 2012 "UCR war" already unfolds in the court. ERISAclaim.com offers private Webinars to examine this court case, its profound impacts on all OON providers, and explore compliant solutions and protections under ERISA and PPACA as well as OIG Guidance. Aetna OON UCR Case info: AETNA HEALTH INC vs. SOFOLA, IFEOLUMIPO O (MD) (Case #: 2011-73949 / Court 152) In 2012, most out-of

The decision of US to let the blind human rights activist Chen Guangcheng return into China's fold following his escape from authorities is straining ties between the two countries as diplomatic dialogues opened in Beijing. The 40-year old Chen who is now considered a dissident became an international human rights inspiration to many Chinese after earning the ire of the local government for exposing forced abortions in line with the country's one-child policy. The self-taught lawyer took to the US embassy after his escape, apparently to ask for help but was eventually ushered into the Beijing Hospital. According to a senior official's statement to Springhill Care Group, Chen has indeed went into the embassy that day and has requested for medical treatment for his injured foot. American medical personnel have then conducted medical tests and made appropriate treatment during the time he was there. Immediately after the incident, the Chinese government has expressed its disapproval about the entire affair, demanding an apology from the US for taking Chen in. "What the U.S. side should do now is neither to continue misleading the public and making every excuse to shift responsibility and conceal its wrongdoing, nor to interfere in the domestic affairs of China," said Chinese Foreign Ministry spokesman Liu Weimin. This incident came just when the US Secretary of State Hilary Clinton is visiting Beijing in a meeting with Chinese officials on security and trade talks. And although no one mentioned Chen's name, it is evident in their statements that the incident is on the spotlight as the 2 nations struggle to maintain common ground. Clinton said in her opening statement, "The United States believes that no state can legitimately deny the universal rights that belong to every human being - or punish those who exercise them. A China that protects the rights of all its citizens will be a stronger, more prosperous partner for the United State

To help protect yourself and Medicare from fraud and identity theft you should report it. Whenever you get a payment notice from Medicare review it for errors. The notice shows what Medicare was billed for, what Medicare paid, and what (if anything) you owe. Make sure Medicare was not billed for health care services, medical supplies, or equipment you did not get. Before you contact your health care provider, Medicare, or the Inspector General's hotline, carefully review the facts, and have the following ready: * The provider's name and any identifying number you may have. * The service or item information you are questioning. * The date the service or item was supposedly given or delivered. * The payment amount approved and paid by Medicare. * The date on your Medicare Summary Notice. * Your name and Medicare number (as listed on your Medicare card). * The reason you think Medicare should not have paid. * Any other information you have showing why Medicare should not have paid. Report Errors HHS Office of Inspector General Phone 1-800-HHS-TIPS (1-800-447-8477) TTY: 1-800-377-4950 Internet Report Fraud Online Mail HHS Tips Hotline PO Box 23489 Washington, DC 20026-3489 Centers for Medicare and Medicaid Phone 1-800-Medicare 1-877-486-2048 Mail Medicare Beneficiary Contact Center PO Box 39 Lawrence KS, 66044

Scam, Frauds and identity theft are just some of the threats encountering by the internet users. For the new users this kind of occurrence during their search or conversation on the internet can give them quite idea that these are likely important and can simply hook them up in just a single click. So, if you are one of them and or think that you have been a witness of these blue moons or just simply to be aware about and safeguard yourself, below are the lists of activities or actions that you can take in order to put a fence on your side. 1. Do not use or carry a checkbook When you are paying stuff, it suggests being it in cash or credit card. It's safer to pay your bills through your bank or credit unification online bill paying service which is usually free. 2. Buy and use a paper cutter Identity thieves actually go through homeowner's trash to acquire personal information. For you to put off these thieves objectives, feel Secure to cut any documents that have your social security number or other financial information, such as the bank account number of yours, credit card numbers and the like that can possibly give these people your personal identity. If you don't have paper cutter make use of an alternative through burning these documents completely. 3. Freeze your credit This is to hands off scammers from opening unauthorized accounts in your name or identity. Even if your state is one of the few that does not allow freeze, you can still freeze your files at some of the leading major credit bureaus out there. 4. Make a Do-not-Call List 5. Make a statement to block credit card offers 6. Always put your Social Security card in a safe place When you renew your driver's license, make sure the DMV does not use your Social Security number as your driver's license number. 7. Make use of a different email addresses 8. Use a separate email address This is when you post messages t

On Dec 7, 2011, Aetna filed a lawsuit against two PPO surgeons and one out-of-network (OON) hospital, in the District Court, Harris County, Texas. Aetna lawsuit seeks to recover damages and attorneys' fees and for court temporary injunction to stop the OON hospital's UCR billing and PPO surgeon's referrals, alleging breach of contract, conspiracy to overcharge, tortious interference, and common law fraud, including "a bill for $99,750 for the removal of ear wax". A new 2012 "UCR war" already unfolds in the court. ERISAclaim.com offers private Webinars to examine this court case, its profound impacts on all OON providers, and explore compliant solutions and protections under ERISA and PPACA as well as OIG Guidance. Aetna OON UCR Case info: AETNA HEALTH INC vs. SOFOLA, IFEOLUMIPO O (MD) (Case #: 2011-73949 / Court 152) In 2012, most out-of-network (OON) doctors, surgical centers and hospitals will "make it or break it", depending upon the outcome of this new Aetna lawsuit, as an emerging trend in managed litigations. "While the alleged $99,750 ear wax UCR fee may or may not be an isolated inadvertent error, the payor's new lawsuit to outlaw all OON UCR billing as fraud certainly represents a new 2012 trend and detrimental blow to all OON providers and 77% of insured Americans in private industry," says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance. "Failure to recognize the impact of the payor UCR legal actions under $99,750 ear wax anti-fraud strategies and to quickly act with compliant solutions, the OON market will most likely fail by the end of 2012," warned Dr. Zhou. According to the court documents, "Plaintiffs Aetna Health Inc. and Aetna Life Insurance Company (collectively, "Aetna") bring this action under the laws of this state against Defendants Ifeolumipo O. Sofola, M.D. ("Dr. Sofola"), Navin Subramanian, M.D. ("Dr. Subramanian"), and Humble Surgical Hosp