VIOLATIONS OF CIVIL RIGHTS: PAGE 47: REQUEST TO CGS, CELERIAN GROUP

Linda Joy Adams: violations of civil rights page 25: Cigna govt services Redetermination and pending cliams and reopen all

                                        I  am aware that the current regulations do not permit you to reimburse the patient for getting a liquid oxygen tank filled by  the manufacturer with out going through a supplier. A waiver of that is also requested and an answer.

Currently there is no supplier available to me in our area.   We recently Faxed you extensive information explaining the life threatening situation I am in as I need to replace a liquid oxygen tank that is barely being held together with glue and gorilla tape and is currently getting weaker. Its a miracle that our patch job lasted almost a year. The current rules will nota  permit me to go to a supplier and just have them order a liquid oxygen tanks and they bill the insurances or Medicare. and our finances are very limited. Its been a hardship to have to pay for the oxygen tank refills with only a small amount reimbursed by Federal blues.  Our son has had to help pay.

Even though Federal Workers  Comp is the primary payer, the govt contractor , for some reason , will not allow my file to be posted even though I have permanent medical benefits. All claims have been filed with them since they took over in late 2001, but they will not input them as their manager said " THEY WOULD BE PAID and they have strict orders to Let her die and not input is the exact quote from one than one party on this.
When All About Mobility who took over as my supplier  in 2006,  they sent  the  claims in to you to be processed, they rejected because it said primary payer. Its a security for the US Dept. of Labor system to stop what is occurring and to make worker's comp pay the claims under a 1988 law to prevent deaths when a patients with an established case has a life ending medical need and the act of then inputting a decision for life time need locked in the system.  There was no need almost twenty years ago for any formal decisions letter as I already had my other bills being paid by them. as some have  for such. But now, no one has access to any file as it was shredded by ACS, etc. which is all explained in the faxes we recently sent you. 

       Other kinds of medical bills do get paid  without this kind of rejection as its not in that kind of category  under a law, that many currently seem not to be  aware of and shows the lack of training now going on thorough out govt  when its assumed the computer systems will handle it and when they do, its not understood why and assume the wrong answer.

What we learned  since directly from  the IT at US Dept of Labor, is that I have permanent medical benefits locked in with a security lock on the US Dept  of labor system under the 1988 law that was passed to stop life threatening skullduggery  and abuses of power against  injured federal workers with established cases and oxygen seems to be a major item that gives the permanent benefits automatically when the claims are  paid  for lifetime and the system locks it in.IT is proud of the system effectiveness from being altered as the rest of the Common Working File it posts to can  manipulated and is not to be altered when official  postings are  made to it to prevent what has been going a 'duping of bills; onto Medicare by many other insurers and health plans with no coding as a conditional payment and no recovery actions done.

At least you did that on the oxygen claims you paid and the initial letter did go out. But there  has been no enforcement of that part of the conditional payment law since 1994 and even though HR 1063 now says its to be done, its still not.  The govt contractor is not set up to do it. And is making things worse by constantly going in and deleting the also primary employer group health plans on many  bi weekly without any notification to the patient to even know its being done so Medicare can pay the bills, And  ignores my protests and repeated questionaires sent and so often were the call center persons correcting it, and then changed back that they have blocked the phone lines  to our home so I can't call then anymore and their people add it back in.,  All because Blues thinks Medicare should pay  first as they get their info from the OPM interconnected contractor  who is also tin charge of workers comp and soon all of the states workers comp too, and expect to see more of what is going on with me on many others as Medicare is expected to pay all the bills and no one have to repay them?

I had also  gone in on the MSPRC self reporting system and listed what is pending as secondary and tertiary issues and put in the IC9 codes of the accepted conditions, but they took it all down and none up yet to redo it. And although they have the written info and the still pending third party law suit that Workers comp required  me to file to reimburse the tax payer , which in itself would make it a conditional listing.  Now, some one  has gone in and put down some kind of generic 'breathing problems' and  a muscle skeletal injury which has no relationship except  and where that came from is a real mystery. No one ever sent me a notice when it was altered either to get it corrected. Now I can't get in to do so as not even the new phone and fax lines are working yet,

This means all the other medical bills surrounding  the need for the oxygen and  accepted medical conditions are primary also,  BUT  THE CONTRACTOR WILL NOT INPUT THEM AND SET UP AN ONLINE SYSTEM YET. The diabetic supplies you have had to pay primary  are also under a pending secondary claims that will never be answered until the file is posted by the contractor so my claims examiner can decide. VA has medically approved such  for Vets with similar injuries to mine some time ago. Basically all my medical bills are either for accepted conditions or claims have been filed over the years to add them in and nothing can be done to make this govt contractor  do it not even three appellate judges orders who also ordered I be asked for the facts of the case as no one else seems to have a clue.

     This sets up a delayed process for a supplier to get paid. As they have to file with Federal workers comp and wait, and they are still waiting. But then, the official status as determined by US Dept, of labor still is active duty and will until the contractor is made to post my file and allow the  permanent disability request be processed which has been pending since before they took over total control

( most state workers comp are going the same way and hiring the same contractor  and its bad  for many) And Medicare is being asked to pay what is already approved.

Since I'm active duty, Federal Blue Cross Blue shield is also a primary. They had to be billed next and they are under the govt contractor who gets their info from the same entity that is not posting my file even though since then I have been able to get the appellate Judges panel to order the file be posted and reconstructed from my records and all pending matters  processed and paid, etc. which is being defied by the contractor and my claims examiner  in Dallas has no control over much of ayything anymore with this turning over the program to a govt contractor which has been given complete autonomy to do as they please?.

        So Federal Blues, made Medicare pay the claims primary. which you did to All about Mobility.

My prior supplier Lincare and Rhema said they were not allowed to submit the claims to ACS, the govt contractor, which made no sense.  All About Mobility got an ID number and sent them in to fulfil the needed requirement to file with the primaries. I am officially still under the US Dept of Labor jurisdiction and a transfer done and may never be is I do not choose to do a complete buy out and that   will not be until there is a process gone through for permanent disability which also entails  a schedule award payment  made for permanent loss of body parts, which at this point what else there is can not even be  known until the complete file is reconstructed and  worked. as it should have been done timely as things were filed over the last almost  26 years and only partially done due to repeated felony  destructions and then appeals as reinstatements, And the judges were always obeyed until the govt contractor is allowed to disobey them. HR 1063 us a very powerful law to stop all of this as the original conditional payment law was when enforced.   I BEG FOR YOU COORPERATION IN THIS AS THE BILLS WILL OCNTINUE TO BE DUMPED ONTO MEDICARE IF NOT DONE FOR MYSELF AND MANY OTHERS.

You , as Cigna Government services correctly followed the law and regs and then sent the paid claims to the Medicare recovery unit and they sent a recovery letter   ( they thought) to  the US Dept of  Labor, but it went to the address listed for all mail which is to ACS in London KY. No govt official has ever gotten it to date. My supplying a copy is not official and the US Govt seems unable to even enforce its own appellate judges orders either.

 In fact the govt officials are not allowed to have paper  as they can't provide security on them is the excuse. So if  they get such by hand, mail or fax, they immediately have to mail it to ACS AND IN ESSENCE ACS IS NOW THE DECIDER OF FACT BASED ON WHAT THEY DO WITH THE SUBMISISONS, EVEN TO OVERTURNING  15 APPELLATE JUDGES ORDERS IN MY CASE.

I AMDEALING ACS DOBNG THIS IN OTHER AGENCIES AS WELL  WHO HAVE TURNED CONTROL OF THER PROGRANS OVER TO THEM, WITH NO OVERSITE AND NO ENFORMCEMNT OF LAWS IF THEY ERR.  So why are we the taxpayers even paying the salaries of the judges and others? Because by law  they are to be in charge , but due to no over site or enforcement of the laws against the govt contractors,  they are not in charge. SEE HOW POWERFUL THE CONDITIONAL PAY LAW TO PRESERVE THE INTEGIRTY AND COST EFFECTIVENESS OF THE ENTIRE HEALTH CARE SYSTEM. NOT JUST MEDCIARE IS PRESERVED BUT  LIFE AND CIVIL AND CONSTITUIONAL RIGHTS OF ALL.  HR 1063 DOES NOT EXCLUDE GOVT OFFICISL NOR GOVT CONTRACGTORS FROME FINES AND PENALTIES.  SO WE NEED IT  IMPLEMENTED ASAP.  When President Obama signed it he said ore was needed. The original law was passed before there were these separate govt contractors in charge of so much and the OIG for HHS was an integral part of it and even that has been contracted out now for the first level and is an interconnected entity of them.

They are saying that its alright to alter official govt records to make Medicare pay the bills, and to destroy govt files, and all the things that have gone on the US Attorneys and the law, etc. still says are felonies. So what we do  here, may be helpful in illustrating what is needed to be done. To me, its simple obey the  judges and the law and if they don't do it enforce the laws against the govt contractor disobeying them and either give the jobs back to a civil service entity or hire a new contractor that will not decide to take the law into their own hands for what ever reason,,, it appears not for very lawful ones?

        After you paid. then Blues paid as secondary. But only after I sent them your summary notice as that's how confusing? the whole process was made to be for even experienced billing personnel,. They had had me approved for life also  for liquid oxygen from before when I ended up in an ER without oxygen as Lincare has come to my house and taken away my tanks and left me and eventually went to the hospital and got the low sat rate. This occurred back in 2000.  And they paid Lincare about 90%,But when Illinois Blues took over, they took the money all back and asked them to bill Medicare first and then  refused to give the medical necessity file to Medicare which was and is the law when there is a switch and that included the approval for life and  test results.  Palmetto GBA was the DME Medicare. Lincare would not even send a medical necessity form to the doctor and I got one and got it filled out and the doctor kept a copy in his file.  when I later got Part B Medicare coverage.

   It was said that OPM ( the contractor?)  had ordered the tests records be  disappeared out of the hospital, but  the billing person had already sent the claims to FEDERAL BLUES  (Arkansas then(AND THE MANAGER IN TULSA GOT LINCARE PAID and continued until Illinois Blues took over in 2002 and dumped all bills onto Medicare, due to the misinformation  from  the same govt contractor? 

 At that time I had had another  partial file disappearance in the Dallas regional office of to make it look as if I had not returned to work in 1990 and did. with eventual EEOC Sanctions against Donna Shalala for torture  as the written agreement  to return to work given to Workers comp was  that removal of chemical barriers and a non exertional job would be provided was ignored and litigation started through union grievances and EEO to be accommodated, etc. and retaliations were horrific.

     I had been returned to work  in 1989 and sent home on orders of federal workers comp as could not now , post injury,  tolerate the  modern office environment after 20 years of working in several and some with a lot of formaldeyhyde , etc  with no problems, including the one in which I was injured where the owner did make some construction changes and put in more vents as required by the building codes before we ever entered on duty in 7/88 at the 9Th floor 2 Journal Square Jersey City NJ  owned by Hartz Montain Industries and known as the ADP building there as they were the main tenant.

 My being sent home form there in 1989, post injury  was said to be a precedent  case of some kind , too.    Retaliations  got worse each time one of my injured co workers died and other matters, I was not always aware of on cases elsewhere. I was the precedent case  for my office as before we all got to the hospitals  on 1/10/89 we had been black listed for life unknown to us at the time. and ALL but me got turned away. the wrong employer got put down  on my chart as I was too badly injured to give info myself and others were in my purse getting info. and the diagnosis made of toxic fumes before that got corrected and then I was sent home to die with no treatment rather than being admitted and near  death, as was being done at the time a doctor came over and filled  out the NJ state health dept report of a toxic exposure in the state and they learned I was HHS- SSA and none of us were to get medical care  and certainly not a diagnosis by tests  of any kind. I understand few of us ever got any workers comp and not as easily as I did with the initial work up.  Its in  the other faxes of how I was  rushed by ambulance to another hospital admitted over night and more tests run and 5 doctors in a heated argument for not being allowed to keep  e for proper medical care and sent home with a shot a anabolic steroid with my chest burning like a hot iron in it , under the same peer review, etc.? and finally went into infection and bleeding the third time after my husband called a pulmonolgist first..  How well I might have recovered to, if proper medical care had not been provided at the time, we will never know. but  DEATH PANELS ARE NOT NEW WHEN GOVT  IS CORRUPTED OR THEIR HIRED ENTITIES AS IT WAS SAID THE PEER REVIEW GAVE THE ORDER. BUT THEY HAD NO INFO TO GO BY? 

   I was a healthy person with a strong heart and making my case more strong was that  in the prior region I had just transferred from, we used to get complete physicals done every few years that included EKG's breathing and lung volume tests, etc. and I  had no  problems as I had after  a short time exposure when a toxic cloud enveloped me due to the build up and us in our area not even told until too late. The fire dept. had already fined the owner, unknown to us and  had threatened to condemn the new building  if construction  changes were not made and the owner had turned off the gas detectors in a building that could not have legally passed city, state or federal inspections for us to be in it.

 I was in the last group over come and we got the entire chemical mix of the build up. and OSHA person said that the  carbon tetrachloride etc. in the copy machine chemicals in our area got added into it on top of all that was in it already. I should never have been injured at all if the laws had been obeyed even before we entered on duty in  the building in 7/88. CORRUPTION CAUSES HEALTH CARE COST TO RISE.AND INJURIES AND COVER UPS AND WHY IS IT ALLOWED TO GO ON?

And  I was told. when  the first group of vets returned from the first Gulf War, my case was some kind of precedent for those with toxic and chemical injuries , too. My case was not wanted to exist by many, and the felony destructions began in a repeated pattern and OIG would  do nothing as I pleaded and filed and documented what was going on. 

    So for almost 26 years the threat  of death has taken form in many corrupt ways and methods.  By the time the appellate judges got the file in 2000, the local office had taken every bit of any medical et.c and and anything to show I had an attorney of record as he had sent in much of it  under his letter head at the time even though we had taken over much of the 'leg work'. ALL   was removed from the file and the answer was not favorable. We reconstructed the file via fax to them as  when the judges found out they reopened the case and sent it in 2004 and everything should have gone forward as in previous felonies done against the file. & US attorney's say what has occurred is a felony and its a felony when the felony is not reported and the reported has to be done by the custodian of the record and I am to nake them do it, But the trying get then to has only net with retalitoaitonhs,  EXCPDET IN THE PHIILLY FEDERAL WEROKERS COP OFFICE WHERE THEY DID BEEF UP SECURIUTY AND WERE ABLE TO FINALLY GET ME BACK HOME IN 1994 AFTER ALNSOT DYING TWICE O THE JOB,AND BEIHNG ADNITTED TO INTENSIVE CARE AND FINALLY THE DOTOR SAID I WAOUDL OT SURVIVE IF I WENT BACK IN.  By HTIS TIE I HAD BEEN ALOWED TO TRANSFER TO THE CAMDEN NJ OFFICE, BUT EVEN THOUGH IT WAS NOT AS TOXIC TO ME IT WAS STILL UNSAFE FOR ME.  ITS WHAT OCCURS WHEN ONE MUOCUS MEMBRANE IS DHANMGED ON THEIR BODY.  I white paper done by Rebecca Bascom MD in the early 90's and whom I have seen as a patient;  says that its a main cause of chemical sensitivity  and in the lungs its bad.

Its why to say everyone is a COPD PATIENT AS IS THE COMMON TREND DOES NOT REALLY DESCRIBE ME AS THEY SEEM TO HAVE LOTS OF MUCOUS ALL THE TIME. I GET FLUID FROM EXERTION OR MINUTE LEVELS OF CERTAIN CHEMICALS ALL TOO COMMON IN  MANY PRODUCTS.  That is measured in parts for billion for the estimated 10 million of us some more recent studies say is in the USA, now from various kinds of toxic exposures. Most do not get the total mix , we did.

But its estimated 2 million did in New York City on 9/11/01from the toxic fires that ended with the EPA director, illegally altering the air studies to say the air was safe and those that live there do not have cars to get out and didn't as in other kinds of disasters around the country where people load up cars and leave until safe to return.,  .

The upper respiratory is badly damaged , too  for me and causes recurrent sinus infections, that can spread rapidly if not treated. My doctors have  me have antibiotics on hand and started then yesterday, again and am a little better today after a day of total rest. Which is why the mountain of paper work never seems to lessened much in the struggle for survival to get the medical care to be here . the others on my Federal Blues are not getting what is to be done for them either. Any filing date one thinks is a little delayed, I am doing my best and its not easy to have to avoid the copy machines and printers, etc. as one can create a modern environment in ones home and have to use perfume free products, etc.  for cleaning, etc. and a lot of foods have to be avoided due to  some preservatives and now some of them are not even labeled any more to know. This injury involves the whole body and why there are so any secondary and tertiary claims still unprocessed as discoveries were made as doctors diagnosed etc.  and why my certified letter to set up a logical and systematic way to work through the back log on the workers comp  case to comply with the15 judges and two hearing officers remands is to  take care of current needs, and then start with 1989 and finish up the few things left from there and work chronologically through as what has occurred is a piece meal mess of what got done before another  rifling of the file occurred each time and we got restarted in getting paid and processed. Unless that is done in such a manner , it is nearly impossible for any one to know what is gong on with my case and all to easy for some contractor to say "nothing  to do as COO Lynn Blodgett told the former manager in Dallas, Christina Starke  and she believed? him, and many more  horrors followed from her acceptance of his verbal word and she  never even knew of the 2/09 last remand from the appellate judges to believe me and not him as ACS was withholding them from her.

 Since 1/10/89 there has been repeated felony disappearances of records; paper and even systems hacked into in multiple agencies that  have any part of this. and the policy is no law enforcement investigates  at all for any one.

      Back on 6/8/2004, this obstruction should have ended when

THE APPELLATE JUDGES SENT THE FILE AND ORDERS BACK WITH A RECONSTRUCTED FILE.   BUT BY THIS TIME, ACS HAD TAKEN OVER AND 35,000 PAGES DISAPPEARED OUT OF THE LONDON, KY FACILITY HEVER  TO BE SEEN AGAIN. But the Tallahasee office did start making some payments and when Lincare contacted the about submitting their claims, they got told I had a million dollars given me and all of a sudden things went crooked again and they abandoned me and I got Rhema and Rhema was not allwed to bill as they were told  Lincare had my worker's comp contract and would not release it and they abandoned me  and it took CMS in Dallas to get All About Mobility certified for liquid oxygen and did in two days and I was on the last hour in the little green tank when they got here. So thanks to those who saved my life then.

But  then the process of then getting paid led to that workers comp claims having to be answered first, , AND WE DID NOT KNOW ALL THIS WE KNOW NOW AND EVEYONE EITHER DIDN;T KNOW EITHER WHAT NEDED TO BE DONE OR WAS NOT SAYING, AND THOSE IN CHARGE SEEM TO KNOW AND WAS CARRYING OUT "let her die" as if that is OK to do.



 Sec of Labor 's staff made it possible to reconstruct the file using the 1-800 number to ACS's Tallahasse office and they boxed up the reconstructed file again and sent them to London, Ky. and again they disappeared..... under orders of a person now convicted  in the Jack Abramoff bribery scandal, and its was abut this time all these millions per head of seriously injured federal workers with older established cases seem to have all that money go missing and no one knows where and I did not get any.  And it was those of us with life sustaining medical needs like oxygen.. So those oxygen claims now  about to be coming in, caused all the payments starting to be made for my medical care and travel expenses came to a grinding halt by high orders.

 For all I know  millions for our medical care  was used to pay bribes as Media reports say ACS was implicated some how.

WHAT HAS ADDED TO MY SITUATION IS MANY HAVE SAID I AM SOME SORT OF NATIONAL PRECEDENT CASE ON TOXIC AND CHEMICAL INJURIES AND THERE ARE ENTITIES THAT DO NOT LIKE THERE BE ANY SUCH CASE AT ALL.  



And my heart never fully recovered to the former level each time a test is run to get the saturation rate down to 88%. My former cardiologist diagnosed this as an ischemic heart attack. And I do have a form of heart failure which is part of the progression from  the original injury  which the oxygen slows the progresison of. Severe pulmonary hypertension is the reason ore recently put down for oxygen need. But all of the above has been , etc.

The 2005 guidelines which you recently republished online, does reflect some of theses other kinds of medical conditions which the medical field understand the need for oxygen for those conditions. And since the beginning of Medicare the guidelines had said  a saturation rate OR medical records to make the medical case . In fact the saturation rate used to be higher and when it was lowered to 88% it out any doctor in a malpractice situation to induce it.

  So,  one has to be in distress and get to the doctor or hospital and get the test run or it could not be down by a doctor with out risk of a malpractice case as permanent damage is/ can be done. In 1/2004, I first saw a pulmonary doctor at University of Texas (now under ACS management) , and ran the tests I went for broke and the angina pain was horrific. In Texas, no doctor has to be in the room and by the time the tech noticed the EKG and stopped the cardiopulmonary stress machine  it was down to 70% but came back  up to 85%. It took two years to get the full report and EKG and I understood why due to concerns by the hospital administration. It took two weeks for my heart to stop hurting and it never quite came back. But as one can know, one dies if they don't do this. As the current rules require it in order to get the oxygen.

 Now we got the test run in 7/13 and I found out someone was running around saying it was not done and the doctor just copied done the prior one.   It was done/ and the tech got the numbers. She almost didn't start the echo stress as I was already out of sinus rhythm but I added a statement to the waiver and we got it done even if the malpractice insurers were unhappy. Its what patients and doctors are put through to day in order to get the medical needs provided. and then I still got medically abandoned and you had sent out press releases  earlier in 2013 saying already this did not have to be repeated if Medicare already had  approved  one for life and the 2005 guidelines had disappeared and none of the suppliers had any knowledge of them and were  still sending out a respiratory tech to ones  hoe to induce a possibly life threatening   induce a heart attack  and other organ failures makes no medical sense, just as lowering the saturation rate from 91 to 88 did either when the underlying medical diagnosis really is the determining factor for the need for oxygen, and would  I not be alive if not for my husband  finding out from a welder some things to do to patch a tank. I was only getting about a 1/2 a liter of oxygen out of. Now its getting weaker again from the patch done. So how much more?  FOR THEM TO PUT A SIMPLE OXIMETER ON ONES FINGER WHEN DOING A CARDIAC STRESS TEST OF ANY KIND MEANS IF THE PATIENTS QUALIFIES FOR OXYGEN  IT WILL NOT BE DIAGNOSED AND THE TREATMENT NOT GIVEN, SO HOW MANY GET SICKER AND DIE SOONEER DIE TO ALL THAT IS GOING ON. THERE IS TO BE  TRAIAING SESSION FOR ALL ON OXYGEN AND PRAY EVERY SUPPLIER GETS ON THE LINE AND ALL THE REAL RULES GET OUT AS THE PRESS RESELASES DON'T SEE TO BE GETTING THROUGH.

MY CARDOLOGIST DID  RUN THE  TEST AND DID PUT THE OXYMETER ON MY FINGER DURING IT AND AFTERWARDS  AS THE SAT RATE WENT ON DOWN AT REST WITHOUT OXYGEN AND THE PULMONOLOGIST THAT WORKS WITH HIM AT THE SAME HOSPTAL HAS NOW BECOME MY DOCTOR AND FOLLOWED THROUGH, BUT FOR SOME REASON I AM STILL MEDICALLY ABANDONED, I HAVE AWAYS GOTTEN ALONG WELL WITH ANY OF THE DELIVERY PEOPLE AND THE ONLY ISSUES HAS EVER BEEN THIS CORRUPTED MESS THAT ALL OF US ARE CAUGHT IN UNTIL HR 1063 IS ENFORCED ON THIS CASE OR SOMEONE HAS A CHANGE OF HEART AND I PRAY FOR THAT TO OCCUR, EVERY DAY

    

                                POST 1/08  CIGNA SUMMARY OF EVENTS

So, My husband and I prepared a filing with you for the claims since 1/08 timely  and you sent a denial summary notice saying you need a supplier. We appealed that and then filed for a hearing to try and make the case  over turn the regulation  that Medicare would only pay if there was a supplier.

When the hearing was set,  the clerks at the Miami Medicare hearing office has set up a different case on some other issues.

To this day, we have not yet had a hearing rescheduled. and have filed to get one. In fact several other issues are pending   for years since our first case which did lead to HR 1063 getting passed by congress and signed in to law on 1/11/13

               Back when the recovery letter to  ACS-Xerox went unanswered, and no repayment made, we proceeded to file for Medicare appeals for reinstatement of enforcement of the conditional payment law which had  been suspended back in 1994 by former Sec of HHS Donna Shalala.

saying the insurance industry would obey the rules and  also  then set up the Common working file where employers and agencies would post directly to it. And no one at CMS was to alter those posting which the current contractor  ignores and does bi weekly deleting the federal blues off the system and before 4/09 would flip the Blues to a secondary payer after the biweekly posting All done with no notice sent to us and no appeal rights, to protest,

               We eventually took the paid oxygen claims and along the way at each step we also appealed  the claims from Lincare and Rhema which we filed on a form 1490 and have yet to receive a response and need to . even if its only for a summary notice with appeal rights that They need to send in the claims on form s 1500, etc. Our filings should protect their filing date even if its years passed. It will make the enforcement request stronger for HR 1063.

            The initial hearing conducted by Judge Carter resulted in an affirmation of your approval for life of the liquid oxygen , but a denial that he could enforce the recovery of the monies and reinstate the conditional payment  law enforcement procedures.  In essence ,the could not overturn an executive order. But the process needed to be followed,. He also got the internal documents from the US Dept. of labor and ruled that Federal worker comp  and fed Blues were my two primary payers and that Medicare  was secondary, He also ruled that oxygen was federal works compensations's legal obligation.

The govt contractor, in total control is in defiance to this day and worse than that is the CEO has verbally told multiple agencies including US Dept of Labor that a big lie saying that I had gotten a workers comp entitlement and retired and there was no more workers comp, What he said and was repeated in letters and verbally to us, doesn't even make legal sense as to how  the Federal program even works. In fact, ACS was saying I and others had each gotten a million dollars to pay for our own medical care and that never happened either.

   Our repeated requests to find out  led  us to an investigator at OIG at OPM who said they suspected an embezzlement ring . But they have never been allowed to investigate and when the Current director Patrick McFarland testified in a congressional hearing a year ago, he reiterated that OIG is unable to investigate a govt contractor as no monies are allowed to be spent. This was a hearing on the falsification of back ground checks by this contractor's interconnected entity that led to a security clearance give to the man who shot and killed people at the Naval Ship yard.

 I thank him for ' blowing the whistle' as those on the Committee did not  generally seem pleased he volunteered that  info, I have been in contact with him and he gets my daily recap blog and pray all those who want to make things right and lawful will be allowed to do their job so I would not be here writing this trying to save my life over the rule of law and federal judges , etc being defied,,and monies apparently gone missing for our health care whomever it to get it to see the bills are paid . .

                           REQUEST FROM FEDERAL BLUE CROSS BLUE SHIELD  -HCS HOLDINGS INC OF ILLINOIS. OK, NM AND TEXAS

                    See the attached request that they now wish a decision by you first before they pay the part they  have been on the oxygen I get now bypassing a supplier,

 There is a provision in our policy that they can pay if you don't and have been paying about 60% although its been applied to the deductible this year and other copays don't apply to the deductible which does not seem correct and we are needing to follow up on that. and find out, so I have not filed since 1/14 claims, hoping other bills would meet it to get some actual money back, I have filed with federal workers comp and with you. Of course workers comp will not allow any to be acknowledged. There have been some years in the past that we did not have a supplier and got tanks filled at a gas company and they paid for the fill, and tanks and mileage. There never has been any rule they would not pay if one did not have a supplier, so when you pay me or a supplier, the paid claims would need to go recovery and end this horrific abuses of the patients and health care system.

 Doyle did need some equipment DME Medicare  did not cover and they did pay for it but the claims did have to get sent to you first and say not a covered item so I would expect unless you can get  wavier for those n my situation or me, you will send a denial on the claims without a supplier and we need the claims for Lincare and Rhema paid. for the past years and they are way back.

When you took over in our area , you had said that everything sent to Palmetto GBA and not yet processed had been destroyed before you got the records.

      So if a reconstruction is needed please do advise  so we can do this, but why don't these two companies file the claims is beyond me and makes no sense why they would not do so to get paid. even if  you wanted some more info or something. They never even tried to complete the needed filing. As I said above I  had to get the medical necessity form from Palmetto GBA as we were not on the Internet at the time.  SOME OTHER KIND OF SLULDUGGERY HAS GONE ON AND WE ARE TOLD TO BLAME ACS.  The bigger problem I get blamed and  I get retaliated against for what those not following  the laws and rules have done or not done by too many and others may not say it , but are definitely unhappy at the position this patients has put them in over what has gone on that never should have or is. We can end this dumping onto Medicare by all these other entities that think its OK TO  "JUST LET MEDICARE PAY" which has been said too often. What many do not understand and the judge put this in his decisions is that the patient is over paid if Medicare pays and its not coded for recovery.  Now with HR 1063 the govt is to do the recovery and not get stopped.

there is no way to get a waiver  of overpayment as the 2005 agreement between CMS and HHS for Social Security  to do the Medicare  repayment ones  has not been implemented and ours go unanswered. This is where its "against equity and good conscience" and no personal financial info is given as the patient has no way to make a govt contractor behave if the govt can't.

   HR 1063 also relieved the patients from finding a non existent attorney to file a false  claims on behalf of the govt and get the money back, also. There are few false claims attorneys and none willing to take an amount less than 10 million or so. as its costly for them, but not so much for the govt with ready access to all the info and files needed.

 My past experience  with the conditional payment law and having signed enforcement orders against companies dumping onto Medicare  when it was enforced is that a phone call from the US Attorney a resulted in quick results and  no one had to go to court, unless OIG found some criminal liabilities  against those involved.  The govt has power to protect the people and the taxpayers money if it has the hands freed to do so by laws passed and now they do. So its time to do it,

when I started on this process to save my own life, I called the general counsel's office at CMS as I had assumed they would still be  directly involved in getting the monies repaid, and no one there had any idea about the law or what their job used to be under it as its been 20 years this has been a free for all looting of the Medicare trust fund by some.

AS YOU CAN SEE THOSE NOW IN CHARGE AMONG ALL THE GOVT CONTRACTORS IN VIRTUAL CONTROL  ARE NOT FOLLOWING  WHAT MEDICARE APPELLATE JUGE SAID AT ALL ON M09-1406 WITH NO CHANGE IN STATUS SINCE.

After the hearing judge's  decision  affirmed the life time approval for liquid oxygen, but could not enforce the recovery law. We appealed that to the appellate judge and on M09-1406 also affirmed the life time need for liquid oxygen, but could not set aside  the  1994 suspension of the enforcement of the conditional payment law. We were told to file a false claim , but we need the other claims you have pending to go up the line and be joined to that from LIncare , Rhema and All About Mobility to ask for en enforcement of HR 1063. since now has occurred so far under the law.

  So far you have not done this and we are requesting it now for HR 1063 enforcement,

HR 1063 was passed after Congressional Chairman was given HR 1063 and although it passed in the House, it took until 12/12 to pass the US Senate and then signed into law. But  full implementation has yet to occur and it seem many have little idea what the conditional payment law  is since few on the job  now were  before 1994 and knew how effective it was to stop a lot of these shenanigans that do go on and shouldn't when lives and health are at stake.

              PLEASE DO PROCESS THE MORE RECENT OXYGEN CLAIMS WE SENT YOU ATTACHED TO THE FORM 1490 AND IF THE CURRENT REGS STILL SAY YOU CANNOT PAY WITH NO SUPPLIER AND IF YOU CAN NOT GRANT A WAIVER FOR ME OF THAT PROVISION, IF THERE IS NO SUPPLIER WOULD YOU PLEASE MAKE IT CRYSTAL CLEAR TO FEDERAL BLUE CROSS BLUE SHIELD SO THAT THEY KNOW THAT THE  DENIAL IS ONLY BECAUSE THERE IS NO SUPPLIER AND SO FAR THAT IS THE ONLY WAY MEDICARE WILL PAY,  We did attach updated medical forms which are not really needed, but the current prescriptions are with them, too.\ And the past filings and current ones do show and should fulfill the requirement to show there a has been no interrupting of my being a liquid oxygen patient since you last paid for ALL About Mobility in 2008.

     My Congressman thinks competitive bid  law is bad. There does seem to need to be a thorough updating of the whole process as  the need for a respiratory technician being on duty makes no sense as that should fall under home heath care which I do not anticipate needing   for some time.

All it did was force the smaller suppliers out of the business who were just exchanging filled tanks and costing less to take care of patients as they could hire a part time delivery person, I would call the one for All AboUt Mobility when the tank got low on his cell phone  and he came as he only had 6 patients.

All of them got turned over to Rhema, but I got medically abandoned as I lived in OK.

 And the way things are coded on the system may be  misleading as to what all the appeals were about  if anything, we have an appellate judge upholding the life time approval for liquid oxygen .

HR 1063 is the law that provides a patient such as I from what is going on, but until we can get it enforced for me, and others like, me; I am requesting that Medicare help under the conditional payment provision.

Part of the process to get enforcement of HR 1063 is your requested cooperation to get all the claims processed that are pending and either paid, or a clear denial showing the need for a supplier. If there is  no  waiver of the law and regulating on that that could be made. I have the press release that says we can not pick up a filled tank at a supplier and that makes no since either. I request that  a waiver  be granted as HHS has made such wavers under the Affordable Care Act for major companies on laws , so why not an individual patient invoking the Teri Shiavo law by saying I CHOOSE TO LIVE.  n  be able to stay alive and ask for it.

 Thanks for your cooperation. We are sending a copy of this letter to the attorney for Rhema Rotech who is the only supplier in our area but has chosen not to service me for reasons we do not understand, but surmise its over the mass confusion over how and when they might be paid as I only called them once just before I would not have been alive last year and then we found out how to patch the tank. I did beg for my life and that seems to be unacceptable to  many to choose life.?

Claims for LIncare and for Rhema were filed by me with ACS-Xerox , the US Dept of labor contractor for federal Workers comp  timely over the years  but to date  they have not been allowed to input any oxygen claims as they all say "they would be paid and the gig would be up and they would have to pay all of my claims" , and other claims they do process they do not pay referring to this missing  million dollars? , I and no one else has ever seen or heard of until ACS Call center started saying that to medical providers and suppliers back soon after they took over.  They have stopped that, but  no one knows anything as to what is going on with out access to the file and HR 1063 would dove tail with the orders I got from the appellate Judges at US Dept of Labor in 2/.09 to post my files and get things done, like input the oxygen claims,

and Lincare and Rhema, both need to send in their 1500, etc as I only filed the  delivery copy with the standard form 957 which they have never acknowledged receiving any oxygen claims, but we have certified mail recipets, etc. and numerous follow up requests and all ignored as they are following the orders from CEO Lynn Blodgett.  not to do so,.?

          





When my suppler All About Mobility and other small suppliers of liquid oxygen were forced out do to the horrific expense of hiring a respiratory tech,

I was left medically abandoned in 1/08 when the regulation that required all the liquid oxygen suppliers to hire one and most smaller suppliers only had a few patients and just exchanged filled tanks out of a sideline business of liquid oxygen;. THEY COULD DO IT CHEAPER THAN THE BIG COMPANIES BUT GOT EXCLUDED FROM COMPETING.

You have me approved for life for liquid oxygen due to inflaming reaction to the concentrators as well as it not being a therapeutic dose.

      This was done when you were CIGNA  GOVERNMENT SERVICES  and then  bought by South Carolina Blue Cross Blues Shield and became first CGS ND NOW  AS THE CELERIAN GROUP

        As you do know once you are approved for life , Medicare does not require further testing and recently you republished  the 2005 guidelines which I medically meet in multiple ways due to my pulmonary hypertension. etc. as well as without oxygen my saturation rate  slowly goes done to 0.

To get the 88% or lower oxygen saturation level requires an induced heart attack and over the years each time I have been required to do this to get home oxygen to live, I never fully recovered to the level I was before. I pray it does not have to be done again in order to e able to live in order to get life saving home liquid oxygen

Many of the suppliers seem to not understand this last year, when the tank I had failed and before we learned how to patch it up to get by.

 I was retested. I appeared at my regular cardiac visit in respiratory distress without oxygen and he put me on an echo stress with an oximeter and then had me lie down as the saturation rate went on down to 88%.

According to my  current pulmonologist, the saturation test is not always being done correctly. One exercises and with pulmonary hypertension the sat rate  goes down, then one rests without oxygen was it goes on down more and when it gets to the required 88% then one is given oxygen

 to verify the condition as the saturation rate comes back up to a normal one  which for me is about 98%. when on oxygen 24/7.

Apparently much of the current guidelines are not very clear to many  and why there is still a misunderstanding that after one gets home oxygen they usually are not going to live more than about three years and the payment rates are set to reflect that at Medicare which is not correct anymore for me with a toxic inhalation injury  with bronchial spasms where the mucous  membrane, etc was burned off, etc. with the resultant  occupational asthma. and chemically induced pneumonitis.

I have been a home oxygen patient for almost 20 years and am living proof that one can live a long time and slow down a progressive disease , even when badly injured as I was. IF ONE CAN HAVE THE HOME OXYGEN SO THAT THE BODY GETS WHAT IT NEEDS TO NOT PROGRESS THE DESEASE SO FAST.

This is only a summation of what my good doctors have told me since injured on 1/10/89.

I fact, I have been told in recent years, that the medical understanding now is one like me would be an oxygen patient from day one of the injury as there is little  that can be done once the permanent damage to the lungs occurs as did with me. The only hope is at some future date, something like stem cell therapy be available. So far, its been said not for one like me and certainly not yet covered under Medicare.

Linda Joy Adams 7/16/14