Trailblazers, Medicare intermediary for Doyle, Linda and Doyle for M appeals:
PO. Box: 650714; PO Box;660155; PO Bx: 660156 Dallas, TX. 75266
These are redetermination requests and to treat as anything else is a violation of our civil rights. This is also a request to reopen all claims back to 8/1/00 to pay as conditional and get them over to Medicare secondary payer recovery so they can list them for recovery from Federal workers compensation on Linda and Federal Blues for Doyle and Martha. based on the Dept Appeals Board decision of 9/29/2010 case: M09-1406 that makes OWCP primary for Linda and upheld that Fed Blues is also a primary. not one claim has ever been sent to MSPRC and that is considered A ricco theft of medicare. All but one appeal has ever been answered and no hearing have yet been held on any of the issues. Q2 administrators after getting a hearing remand admitted that you had paid these claims 17 times on 17 claim number ( 15 you created) starting 8/08 and retro on all Linda's claims back to 1/1/06. My letters and phone call to your reg. CEO never stopped this. Linda's FEHB dependents status is determined by her OWCP status. And medicare is secondary for them. you have not forwarded one of their claims for recovery from Federal Blues ( Ill Blues of TX and OK) in violation of judges, contracts and the law. No final determination has been made by DAB as yet on your claims, but if you had coded these as conditional payments, no appeals would have been necessary except for the specific claims where the test run or the specific surgery or procedure was miscoded such as the cardiopulmonary stress test on Linda in '05 and the sinus surgery and hospitalization on Linda to save her life and part was inoperable due to so much damage from her work injuries. This got coded like a simple office procedure to down play the severity of her injures which has become an all too common practice. the office manager for the doctor got lied to by every contractor and then ' blamed' Linda for not being able to straighten out the whole health care violations that have been on-going for over a decade. Linda lost a good doctor and this is part of what real ' death panels' are: obstruction of life sustianing medical care. More recently Doyle received a summary notice for our daughter and the ricco situation has ' dumped' an office visit with her family doctor onto the State medicaid which the state of ill had to get stopped in the tune of $25 million. A medicaid fraud report has been filed and this needs to be paid as secondary and Fed Blues as primary. There is also a situation where even though MH is not a participating provider with Fed blues, they need to be paid under the equity provision and then medicare. There have been no medical service dates there were no medically necessary and all should be paid conditionally if Medicare ends up having to pay primary to stop the ' death panel decisions.' On Mymedciare .gov, Linda could not find any claims in the last 15 months yet Part B cliams should have been sent in conditionally on all dates of service to protect the filing dates so when SSA ' finds' the missing part B premiums. Where all govt contractors ( partners) giving out so much false info continuously all medical providers should not be held to any filing dates. Your collusion with Medicare coordination of benefits to alter the official records in violation of their contract with the US dept of labor and CMS is death panel violations of our civil rights and the physical and financial hardships have been overwhelming. If you want to turn each claim in 17 and pay your self and bill for all, then send us each letters of waiver that we are not liable for any overpayments nor our estates. This is not a hardship waiver , this is one against equity and good conscience because of the violations by you. You should never listen to any corrupt or misguided federal official at CMS who tries to stop you from doing your job legally. This has occurred and been docmumented in 9/2010 when a letter was sent from Stephanie Gammon Head of fee for services in Dallas to Ms de-Coq head of the call center for the medical providers with the obvious intent to obstruct the DAB decision that affirmed you had engaged in violations by not treating all claims as conditional when medicare had to use the safety net provision in Medicare when the primary payers were and are still in violations. Then an attempt was done to block any final appeals from DAB on any subsequent appeal decisions. SO far no final ones have been done over it. More civil rights violations. Cigna Govt services has been the only intermediary that has cooperated in any way with the civil rights of allowing appeals and on their own sending the paid oxygen claims on over to MSPRC who sent out a letter to ACS as they had done on their own with claims you had paid since 8/1/00 with recovery letters to ACS in '05 and '07 with no response and their parent company group health, which is the parent company for Medicare coordination of benefits whom you have successfully gotten to facilitate bypassing owcp and fed Blues for years; ordered them not to collect. Now they show only muscular skeletal injuries, which are secondary/tertiary claims on the original accepted diagnoses- as my job injuries. This has intentionally mislead medical providers along with the date of injury being listed as 3/1/97 instead of 1/10/89. Even my pulmonoologist asked questions trying to figure out what was going on. yesterday was the first time I was able to access any pertinent info of of my Medicare .gov but no claims for last 15 months are listed. Now I understand why he asked questions that seemed to not ' correlate' as he knows and seen documents on my original accepted conditions and pulomonolgists, cardiologists, ear,nose and throat; and any other doctor who treats is under owcp. Plus there is a myriad of seocndary and tertiary claims filed and ACS won't let have an initial review as they have not processed 11 years of oxygen invoices because they will be paid as before and bring the offline incorrect file online with the official US Dept of Labor file. Claiming some long - gone federal OPM director official ' made them do it' in violaiton of any legal govt contract to uphold the laws of our soverign nation.
THIS IS A REDETERMINATION ON ALL CLAIMS BACK TO 8/1/00 on Linda and 11/1/08 on our daughter and 11/1/08 on Doyle as well as all processed ones be reopened based on the two ALJ decisions of 08 and 09 and the affirming DAB dicision of 9/29/10 ( only final one so far) which clarified that owcp gets Linda's claims first. ALSO a WIAVER of liabiity against us of any overpayments for your actions and our futile attempts to get your compliance with laws and judges decisions. This is filed timely. Due to hardship other documents will be faxed separately. This filing goes to three different PO BOXES: - more finanical hardship.
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7 comments:
Everything is now pending with High Mark, now owned by Novatis and even though we sent them a packet of info on this, nothing has happened to correct problems, even though HR 1063 could make them subject to the $1000 day fines and have paid claims on fmaly already in violation of that and did not mark them conditional pays to recover form Federal Blues of ILL, NM, TX. Linda Joy Adams
and OK is also owned by HCS Blues of IL. Theft of Medicare is on going and not ended in spite of formal notification by us. Linda Joy Adams
UPDATE; Novatis hired former chief employees of Trailblazers. They now own Highmark. No change atalt all Thefts are still going on with claims not coded for recovery as a conditional payment.
HR 1063 signed into law a year ago to stop all of this and not yet implemented while billions ae being given out to govct contractor for new program, the old program is still being robbed by the same parties?
The High official in Dallas CMS office who had okayed all of this wrong doing retirember t summer and no one has made corretive change.. If she had 'only followed orders'for years, then I wish she would start talking now.
Every one who has medicare might want to check out if they have had id and your ability to stop it. . One Can't find out using MyMedicare .goveas its programed to hide theft in most cases if a phoney claims number was created using a different suffix on the ssn. If Medicare is not your pirmary, but emsims are paid as if it were and not sent for recovery from the primary payer then that is also theft as most of our claims are now You can download Form -632 and file with Social Security and make sure all com numbers are on t, etc. You do not have to give personal financial info. This is a kind of waiver of liability for over payment which is called " against equity and good conscience" where the patinet has no way of stopping the overpayment. I was trained to put that phrase on the forms I filled out for others. I never had anything this bad to do it for .
In 2005, SSA signed an agreemnt with CMS to take and process these wivers for Medciare but it has not been imlemented and yourcertifed mail reciept with the infoon the green card what is inside may be the only proof your heirs have if the govt comes agaist your estate.
YES the appellate judges at Medicare on M09-1406 that the patient is liable when monies are stolen withoutyour ability to stop it. een the govt has not been able to either . If the govt can;t stop it os can one patient; If you get any untoward response orm SSA, contact your Congress Person. You hae the rigth toask to not be heod liable for the govts own wrong doings.
Its up to you what you wish to do. We filed ours.
Linda Joy Adams 12/3/14 (spellcheck is not working and had a lot or problmes gttin ghtis wrtten as much as was able to)
Follow ups filed with Novartis over and over and no answers to appeals nor has the claims for all of us been sent to recovery per the judges rulings and the law. nor has any of our SSA 632's been answered to waive the overpayments created aisnt the patien do to these paymets made without being sent to recovery which that puts the onerous on the govt now to collect its debts from the pirmairy payers and we and the medical prividers and suppiers are not liable as ther eis no way we can colelc the money for Medicare when the govt cannot collet its own debts form the parnters which hae been given immunity form any acocuntablility or liability, unconstitutional situation cerqated that must be ended if there is to be any medciare trust fund left . Linda Joy Adams
Sorry for typos this posted before finished spell check and cannot go back in an edit a comment. at least have not figured out how to do it yet. Linda Joy Adams 5/13/15
Novatis* seems to not be paying multiples. but Lynn Blodgett is still their 'boss' and illegal dumping onto Medicare goes on and appeals ignored and pleadings . and judges orders not even posted for any to see to know what the official rulings have been Medicare being stolen still and records before 2002 have 'disappeared all over the govt and from systems access now plus only the last 3 years visible even if matters are still legally pending THIS IS AN ARCHAIC SYSTEM THAT THE TAXPAYERS PAID TO HAVE MUCH BETTER. nothing has changed and what changes have occurred are for the worse. Linda Joy Adams
* Novatis inherited the contract from Trailblazers whose parent company S C Blues owns celerian group and isn't processing oxygen claims legally filed for over 2 years now under Lynn Blodgett's orders and Fed Blues will not process until they say they will not as no supplier and cannot get the 60% back from Blues as was able to get as FECA under Lynn Blodgett has not input a single oxygen claim since 2002 over throw. and ordered 'let her die and told all I had million dollars for my medical care and I never got the check, he has it? he is still in defiance of 38 federal judges including the last three at US Dept of Labor in 09 who affirmed my approval as the real system shows it at DOL and an oxygen claim input would access it and THE GIG WOULD BE UP AND THEY WOULD HAVE TO PA ALL OF MY BILLS ' is his manager's quote. its what you were given the money to do by the taxpayer! and you have items as far back as 89 on some things yet to be processed that are legally pending and timely fled and followed up on. ACS still refused to allow the real DOL to see any of their judges order as he is the dictator of the USA as my cases well prove. and one of many these things are being done on. Linda Joy Adams
update; This goes to Novatis which hired many who worked for Trailblazers. NO RESPONSE TO APPEALS AND FOLLOW UPS OF A COUPLE OF MONTHS AGO OR YEARS AGO AND EVERY CLAIM PAID BY MEDICARE ON ALL OF US IS LEGALLY ALIVE AND PENDING A SOME LEVEL THERE IS NO PRETENSE OF EVEN ANSWERING AN APPEAL ANYMORE. The US Constitutional is on its final deathbed if Congress does not act and allow the real government to do its job. No government to help, congress can not help until they get rid of their unconstitutional gag order rule with regard to government contractors not being able to be mentioned let alone contacted or have one testify . This denial of basic rights and the on going theft of those stealing the public treasury by those we entrusted to take care of our governmental business for us, means we all need to be praying for divine intervention in the lives of those who are to permit the real government to act. WHO IS THEIR MASTER? COUP OF 2002 REALLY HAPPENED CONGRESS! check it out! Linda Joy Adams 8/18/16
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