CMS: FOIA REQUST C09FOI)281(KS) AMENDED

Yes: I do need the information, nor only for pending appeals but to stop on going civil rights abuses that is reflected in the files requested. Since this involved federal workers compensation and EEO any fees are being requested as waived. What I've requested are the actual claims processing files from the intermediaries as well as a copy of the National health insurance data base. Secondary evidence from other sources who have had direct knowledge of what is contained in my records is that is it filled with illegally altered information from that submitted from my medical providers and involves multiple thefts of my id and claims by one of the major contractors, Trailblazers, who has used 17 claim numbers to turn each claim into 17 pays with only one incorrect pay to the provider who can only be paid if the claim is labeled as a conditional payment and forwarded onto Medicare Secondary Recovery  which has only had claims paid for my home oxygen referred by Cigna Govt Services when all should have been.  claims processing Records for all 17 Medicare numbers which are housed on the internal offline computer systems at the intermediaries is requested. Trying to send summary notices will not get the requested info as system  'hides' this from patient and provider.There are 17 checks for each claim as part of the request. I want to know who signed them! As all my providers state its not them! Cigna Govt Services used 3 claim numbers, but only one pay each. Wisconsin Physicians used 3 with only one pay. Palmetto GBA has claims and appeals unprocessed since 8/00 and all these claims are under appeal. Cigna Govt Services claims records were never transferred in 2007 when they took over in my area but were destroyed. This FOIA request was filed before the 17 numbers and $4 million  theft was discovered a few weeks later. You have other FOIA's pending on that as an amendment.  The National health insurance data base was discovered as filled with altered info after I was denied treatment at a Hospital Emergency room with serious medical problems including a 'super bug ' infection that had 'pressed on optic nerve, shattering  the lens in an eye which was weakened from being on inhaled steroids since 1989. and untreated hypoglycemia that had developed as a resulted as part of the progressive disease accepted by Federal workers compensation. which had led to a fall and rotator cuff injuries. All ignored as the 'altered' data base was used for medical history. A congressional study on wrongful death malpractice suits indicates just how 'flawed' the data base is as a result of manipulation of claims to get Medicare to pay the bills and not label as conditional payments. Some CMS insiders estimate there is upwards of a trillion dollars owed back to Medicare over this.The data base also includes claims from Federal Blue cross/Blue shield and OWCP. I'm not after EOB's; The actual filings are needed to compare to what ended up on the national data base that has almost cost me my life twice. ( another doctor used it to prescribe a medication that caused terrible adverse reactions) Many of my providers state that claims were clearly marked for owcp medical subrogation and/ or conditional pays at Medicare and that was removed, also.
One would think that the OIG s would investigate but: Congress passed laws that gave all govt business associates and contractors full immunity from criminal investigations. And the office of Civil rights has refused to even docket in 25 complaints filed covering all of this including the assertion of retaliation for pending EEOC complaints against HHS who was my employer prior to transferring to OWCP in '94.
Attached is a list of the 17 Medicare numbers as well as OWCP and Fed Blues claims numbers. Fed. Blues was ordered by a prior Director of Office of Personnel management to 'ignore' owcp and 'dump the bills onto Medicare.  The national health insurance data base is maintained for the insurance industry by Group Health ( now an international company) as a CMS 'business associate.  There are also requests pending for a copy of the contracts between CMS and Medicare Coordination of benefits, Medicare Secondary Payer recovery Unit, and also needed is the contracts with trailblazers, Vangent ( 1800 medicare who is in violation of not forwarding 500 fraud reports to CMS directly as part of their contract on my records.) Those @ 500 fraud reports are also being requested that Mel Curtis the president and CEO refuses to send me as i  asked for them under HIPPAA not realizing that CMS's business associates and contractors were not covered under HIPPAA, yet.  Its time for all of us to get this information together to assist the hew Director of stopping on-going abuses against medicare. Vangent has the 'best' evidence of the 17 payments made on each claim under the 17 numbers. I'm also asking for any internal memos, documents, or recap of contacts to determine why and how the Medicare computer files as to insurance info  and status keeps getting altered after the bi-weekly posting form the US dept of Labor. The contract/agreement between CMS, Medicare Coordination of benefits and Us Department of Labor is requested.     THIS REQUEST IS A "MICROCOSIM " of almost everything 'wrong' at MEDICARE. that is causing so much physical and financial harm  to me and indications are to many others including the taxpayers whose monies are not getting used for medical care for those it was intended for. There is a 1696 on file to discuss any and all matters with my non-attorney spouse, Doyle E. Adams

                                                                              Linda Joy Adams