Contacts - Centers for Medicare & Medicaid Services we are getting phone messages from you that you have some of our claims, or appeals, re openings or collection from primary payer reports or appellate judges requests? AND YOU DO NOT HAVE ANY AUTHORITY TO PROCESS ANY OF THOSE. S SO WHOEVER TRIED TO GET OUT OF THEIR LEGALLY OBLIGATED DUTIES PLEASE SEND THE REQUESTS BACK TO THE PARTY WE SENT THEM TO AND ASK THEM TO ANSWER AND PROCESS THE REQUESTS.
The phone call that came in yesterday, while we were using the phone line was for Doyle and he has requests pending at all levels. And they do need attention.
WE DID NOT CALL 1-800 MEDICARE AS OUR PHONE LINES FROM OUR HOUSE HAVE BEEN BLOCKED FROM DOING SO SINCE 4/09 WHEN I AND THE DEPUTY SECRETARY OF HHS FOUND OUT THAT NOT ONE OF THE 500 FRAUD REPORTS WITH THE BEST EVIDENCE OF THEFT BY PARTNERS OF MEDICARE AND THE THOUSANDS OF REPORTS YOU CALL CENTER EMPLOYEES COMPLETED OVER A TWO YEAR PERIOD HAD NEVER BEEN SENT TO WASHINGTON , DC AND DOCKETED IN THERE AS REQUIRED AS THEY WERE CRIMINAL COMPLAINTS AGAINST PARTNERS OF MEDICARE . And as such they do not go to another partner of Medicare to 'cover up' and obstruct must must go to DC per your contract. Shortly thereafter, when a phone call did get transferred by another CMS employee to your line, we learned that in violation of your CMS contract with Vangent your owners, now bought and owned by General Dynamics of Dallas, TX you are forbidden to see fraud and report it on anyone.
And since the fraud line is now only an ethics line and in 4/14 we caught them covering up the deletion of the Employer group health plans from records that showed it for us and others as a primary payer, they are not much of an ethics line either which is what the subsidiary of Goldman- Sachs is supposed to be for much of govt now and in national around the world and many corporations which have hired them to handle employee complaints such as civil rights allegations, etc.
Within an hour of our criminal complaint being filed after a billing person saw the US Dept of labor posting on a dependent on my Employer group health plan post in the wee hours of a Tuesday AM and then by 7:05 Am it was deleted to trick all billing persons into billing Medicare and not sending the paid claim on to Recovery/Coordination unit (they do the illegal deletion)to collect the monies back to Medicare form the primary; they had contacted them and a manager had added the Federal Blue Cross Blue Shield back in on my COMMON WORKING FILE AS AN OK MEDIGAP POLICY SECONDARY TO MEDICARE WHICH IT IS NOT AND RETIRED ME WHICH IS FORBIDDEN BY FEDERAL WORKERS COMPENSATION LAW AND NO DUE PROCESS NOTICE WITH APPEAL RIGHTS HAS BEEN RECEIVED SINCE THEN or ever each time they do this for years bi weekly since 409 and before that it occurred every time a partner of Medicare was going to pay a claim and illegally have Medicare pay as some insurer's deal over rode the law, and in defiance of Medicare judge's ruling on the matter also. . And ever since the process repeats bi weekly to facilitate the theft of Medicare and the resulting overpayment to the patient. The Death Panel ISSUE IS THAT OXYGEN IS Federal WORKERS COMPENSATION BILL AND ITS ON A SECURITY LOCK IN THE POSTING SO THEY MUST BE BILLED FIRST AND DO TO THIS IS COULD BE A YEAR BEFORE ANY PAYMENT IS RECEIVED FOR A SUPPLIER AS THEY HAVE TO BILL FIRST THE REAL PRIMARY AND THEN Fed BLUES THE OTHER PRIMARY BEFORE Medicare CAN PAY. HR 1063 IS ABLE TO MAKE CEO BLODGETT OF ACS-XEROX INPUT THE CLAIMS AND THEY ALL SAY IF THEY DO THEY WOULD BE PAID AND THEY HAVE CLAIMS PENDING NOT INPUT SINCE THEY TOOK OVER FEDERAL WORKERS COMP IN 2002 AND ARE TAKING OVER THE STATE ONES IN THE SAME MANNER
You are reading about first one state and another going to save money in their worker comp program. That means Medicare will be paying the bills and the patients is being overpaid and HR 1963 being implemented is the only thing that will stop the coming death panels for injured workers in this nation.
We are also aware you at 1-600 Medicare do not have any appeal results posted and ESPECIALLY NOT HEARING DECISIONS OR APPELLATE JUDGES RULINGS OR YOU WOULD KNOW THAT ON M09-1406 THE OFFICIAL POSTING FROM THE US DEPT OF LABOR IS ACCURATE AND IS NOT TO BE ALTERED. We should not have to remand any one that if the primary payers do not pay their bills, then the claims Medicare paid under the very good and life saving safety net for such a purpose called a conditional payment is to go to whomever is designated to collect the monies back for the primary payer.
This law has not been enforced since 1994, until after M09-1406 well illustrated the inherent problems for everyone and the monies owed back to the taxpayer not being collected, but even the partners of Medicare participating in the thefts. HR-1063 was passed and signed by President Obama on 1/11/13 and was given to the facilitator of the theft Emblem Health International formerly Group Health to over see and process the collection letters to the primaries and to assess fines and penalties against those providers and suppliers who billed Medicare and did not code that it was a conditional payment.
Since the Recovery/Coordination unit is the facilitator of the theft as well as the one to recover the stolen monies, how could this be? When CMS has had the documented evidence and even the summaries of this Daily recap, etc, sent to them over the last few years. We have had the email and fax number of several CMS and HHS employees and they have been notified and it does not take much to verify all of this.. The documentation alone should have been a forewarning not to set this up in such a manner i.e put the FOX IN THE HEN HOUSE. They cab trick ones good doctor into billing Medicare as the primary is not on the system having been deleted and them under HR 1063 Emblem Health can seize ones doctor's lab .etc ; bank account for over payments.
HOW COULD CMS DO THIS? Because there have been no criminal prosecutions or even investigations done of govt HHS contractors for over a decade or more and they have a clean record as even the worse offender does if their are no longer any police.
There is a provision for the patient to self report and the postings I did make under that provision a few years ago have been deleted also. So no billing person has any idea what is going on and the gossip and rumor and defamation toward me goes full blown. WITHOUT THE APPELLATE DECISION POSTED, no one is privy to the truth of the facts of what is going on. And CEO Blodgett's verbal order they said made them destroy all the hard work that their Detroit office had done to identify bills to recover for worker's comp and sent out recovery letters that CEO Blodgett never answered and Affiliated Computer Services never posted so any one at the US Dept of Labor never saw to formally answer for if they did I and my attorney would get a copy. ITS CALLED THE LAW THAT IS THERE DUE TO THE 4TH AMENDMENT OF THE US CONSTITUTION until he said destroy the records, and the law and constitution along with the records paper and digital? That's what I was told and the posted phone and fax numbers to the new unit are not in service yet since 4/1/14. so how is this extensive reconstruction to be done, as I do not have the money to put back what has been destroyed. WHY DON'T THEY DO THEIR JOB AND RECONSTRUCT AND GO GET THE MONEY BACK SO WE ARE NOT OVERPAID AND THE LEGAL PRIMARY PAYER IS MADE TO PAY, ETC.
EVEN WORSE IS PUTTING THE MEDICAL PROVIDERS' PRACTICES AT RISK OF FINES AND PENALTIES AFTER THEM PAYING THOUSANDS OF DOLLARS TO ACCESS THE COMMON WORKING FILE AND THEN BE GIVEN CRIMINALLY ALTERED INFORMATION TO TRICK THEM INTO ILLEGAL BILLING.
Yet this continues. And the phone and fax numbers posted for the RECOVERY/COORDINATION UNIT HAVE NOT BECOME OPERATIONAL YET, EXCEPT FOR THE ONE THAT ACCEPTS THE CHECKS OF REPAYMENT.
All Congress seems to want to do is file law suits that will not correct any real problems. The real problems is lack of accountability of the partners of HHS and govt contractors taking over this nation and our constitutional rights including obstructing our very right to live.
States are now adopting the Federal workers comp plan to turn total control over to Affiliated Computer services a Xerox front company and state after state is now boasting how much money they will save in costs in the state workers comp programs. ( THAT'S WHAT OCCURS WHEN MEDICARE GETS TO PAY ALL THE BILLS OF INJURED WORKERS ON APPROVED MEDICAL CONDITIONS) And then the estates of the injured worker get to be attached by the govt for debts owed to it. WE ARE BEING TAKEN FOR FOOLS BY THOSE IN POWER WHO SEEM TO CARE LESS ABOUT SAFE WORKING CONDITIONS WHICH WORKERS COMPENSATION LAWS IS A METHOD OF CHECKS AND BALANCES AGAINST UNSAFE CONDITIONS.
Unfortunately, its only after a workers is injured or dies, is notice taken of unsafe conditions so more claims do not have to be paid in the future. IS ALL THE SAVED MONIES GOING TO BE USED TO HAVE MORE OVER SIGHT OF THE OSHA LAWS AND INCREASED INSPECTIONS TO MAKE SURE ALL WORK PLACES ARE COMPLYING WITH RULES PUT IN PLACE OFTEN DUE TO INJURIES AND DEATHS IN THE FIRST PLACE AND TO PREVENT FUTURE ONES?
I DOUBT IT.
We do not have 'no fault health insurance' in this nation , yet. Nor do we have Medicare for all, yet. BUT THE PARTNERS OF MEDICARE HAVE MADE IT THE ILLEGAL LAW THROUGH THEIR 'DEALS' WITH HEALTH AND LIABILITY INSURERS.'
And per their requests will continue to alter the COMMON WORKING FILE USING MADE UP INFORMATION to have Medicare pay the bills as primary and in our case in blatant defiance of Medicare's own appellate judge? Who affirmed the lower one who had gotten the real internal documents for the US Dept of labor. THE REAL ONES NOT THE ILLEGAL OFFLINE ALTERED FACTS.
WHAT IS BEHIND THE LAW SUIT THAT SOME WISH TO FILE AGAINST PRESIDENT OBAMA WHO HAS HELD OFF ON THE EMPLOYER MANDATE AND WHAT IS BEHIND HIS DELAY?
The employer mandate under the new health care law was that all employers except the very small ones, would be required to provide health insurance to their employees and dependents.
Since 1994, there has been no enforcement of the conditional pay laws under Medicare which sets the over all standard for health care in this nation. In 1999, Group Health , Inc. of New York, now Emblem health International got a CMS contract to set up the Medicare coordination unit and a another to do recovery of monies owed back to Medicare as well as the national health Insurance data base which is not under HIPPA so errors can not be correct4ed and has caused deaths and injuries as medical personnel use it for medical history and treatment, especially in a busy emergency room. There is no way to get co mingled records of patients as me has in it corrected and its healthy cost me my life twice as how I got into finding out about it and in 2007, it was highly secret that it existed and was being used and now will be used for all kinds of things from medical research to whether one can buy a gun, etc. IT NEEDS TO BE UNDER THE HIPPAA LAW SO THE PATIENT CAN GET A COPY AND CORRECTIONS MADE. .
None of these are under the HIPPAA law as govt contractors and govt officials are not covered under that.
The national health insurance data base, is filled with errors and in my case others medical records co mingled into it, yet no one has done anything to correct errors and work with ones doctor to save lives and prevent horrific harm to patients as that is where most medical care and treatment is directed from now especially in an Emergency room. The movie THE NET that came out in the late 90's shows the deadly results of systems info being illegally altered or even just a typo error by someone can cost a life. TORT REFORM FOR MALPRACTICE CLAIMS NEEDS TO START WITH CORRECTING THAT MESS FIRST SO SOME BUSY DOCTOR DOES NOT GET THE WRONG INFO.
What is in your medical records at your doctor or hospital may have no resemblance to what gets on that data base after health insurers and govt health plan contractors finish processing and inputting claims information. And that is going to be used and is being used for medical research? That mean every one of us needs it to be accurate to help find cures and treatments for injuries and diseases we may not have any idea we might have some day and need a cure or treatment to save our life and health.
SO WITH ALL THESE ILLEGAL DEALS IN PLACE AN EMPLOYER COULD BUY A POLICY FOR THEIR EMPLOYEES AND DEPENDENTS AND AMONG THOSE MIGHT BE A CERTAIN PERCENTAGE THAT ALREADY HAVE A MEDICARE CARD. That might be a senior employee or the worker might have a disabled dependent on their record with a Medicare card.
HOW ITS BEEN WORKING FOR MANY YEARS, IS THAT ALL AN UNETHICAL INSURER HAS TO DO IS CALL THE RECOVERY/COORDINATION UNIT AND HAVE THEM ALTER THE COMMON WORKING FILE TO SHOW THAT THE EMPLOYER GROUP HEALTH PLAN IS EITHER DELETED OFF THE SYSTEM OR ITS FLIPPED TO A SECONDARY PAYER.
Thus the higher bills of the senior or a disabled dependent will not have to be paid by the employer group health plan. That can be a very big expensive item to not have to pay for many diseases and injury cases.
SO IT APPEARS NO SIDE IN CONGRESS OR IN THE WHITE HOUSE IS WILLING TO STOP THE ILLEGAL DUMPING ONTO MEDICARE AND THE 'SMOKE AND MIRRORS ' OF WHAT IS THE REAL WORLD BEHIND THE SCENES GOES ON.
In the real world, greed exists. And its why we have laws and regulations and cops and Federal law enforcement and used to have Office of Inspector generals to stop fraud like this.
Some very simple fixes to any and all federally regulated health care plans and the new health care law needs to occur. ITS ACCOUNTABILITY OF THE GOVT CONTRACTORS. It does not matter what form of health care plan is passed, the end result is going to be the same with those running it not accountable to any law or even ethics.
My faith book, THE BIBLE, tells of an end time when 'lawlessness runs rampant.' In my faith, Yahusha, whom we Christians call Christ Jesus, created us to have free will to choose to do good or evil. And together we create govts and laws to live by and over sight to make sure a few among us are stopped form harming the others through bad actions we call crimes.
That is the first item to be fixed. Currently there are no real internal audits, or the govt would have known that for 8 years, Affiliated computer services had sent NO CLAIMS PAID UNDER PART D MEDICARE PRESCRIPTION DRUGS TO RECOVERY they paid for all the plans. It only took a few moments speaking to management in charge to find out they were never told it needed to be done. ACS in charge of that process. (I AM LATE EDITING THIS AND POSTING AS I THE MAIL TODAY WAS A LETTER FROM A CONTRACTOR INVESTIGATING AND AFTER ALL THESE YEARS SOMEONE IS ASKING FOR SOME RECORDS AND WILL IT RESULT IN CESSATION OF THE ILLEGAL ACTIVITY? NOT COUNTING ON IT.... DID MAKE SOME CALLS AND FAXED SOME RECORDS UNTIL THE MACHINE ON THE OTHER END MUST HAVE RUN OUT OF PAPER. I HAD OTHER FILINGS TO DO TODAY. AND IN MANY WAYS DO NOT HAVE MUCH HOPE ANYTHING WILL BE DONE. BUT THE DISCOVERY OF A SCAM CALLED PART D MEDICARE SEEMS TO HAVE BEEN PASSED JUST TO BE A MAJOR ILLEGAL BAIL OUT FOR THE HEALTH INSURANCE INDUSTRY) Congress, you really have to read what you vote on and have some Hearings so experts can make suggestions as its been 8 years to make the discovery of a single claims processor for the nation is what I was told by their management, yet they said they had no knowledge of anything called conditional payments and nothing ever sent to be recovered from a current or possible future primary payer. And ACS got this contract, too. The original law was passed without any recovery provision in the law and was added in a couple of years later. I was not on the Internet then and kept trying to get paid claims to recovery to no avail. No one at the call centers seemed to know much either. That is the way contract call centers areas they do not have access to much technical information and doesn't that why people call as something does not make common sense?
Most working at CMS or their 'partners' or in the medical billing field have little knowledge of the conditional payment law and how powerful it can be to stop all kinds of illegal and shady game playing with claims and people's lives.
So much of what needs to be gong to recovery has not been going on I some parts of the country for 20 years as more and more budget cuts to payments under Medicare occur much due to blatant theft and even a payment system in it that does not do much good to foster efficient or good modern medical care. When a health system is tied to profit motives, its much harder to adapt and change when new kinds of treatments or cures are found and investments and even stock market listings are affected in our health care system just to update to what modern science has discovered to use. And fortunes can be lost, if some vitamin or natural food is discovered to be what is needed and not some expensive pill.
The new thing being 'touted' is Vitamin D. Blues will pay for 500 units a day, and my doctor had me on 1000 units Then upped at my last doctor visit to 2000 units which few take that much. It has been a very positive effect. The only term I , as a non doctor; can use to describe it is SYNERGISTIC. Not a cure but it gives me some strength I have not had for over a year now.
All kinds of studies are going on and is any one studying that maybe its not working for some is due to it not being a high enough dosage.
Glucasamine Chondroitin had the opposite effect. If I take the recommended dosage o the bottles, its as if my joints 'freeze up' but I take the lowest dose I can find and it works fine, If I stop taking it I get problems. its all about the dosage ad what is needed and these supplements I get as organic are cheap compared to some prescription one can buy that are to do similar things with the side effects and adverse reactions from added ingredients and a chemically engineered substitute. The studies are mixed. But my doctor had said try it for 60 days, if it is gong to work you will know in that time. The knee that was headed for a joint replacement rarely even bothers me any more and the positive effect was great. YET INSURANCE WOULD NOT PAY FOR AFTER X RAYS TO PROVE IT WORKED. . NO profit in a $5 or less bottle per month doing what a very expensive drug or knew joint replacement might have cost and might not have worked as well. IN MY CASE, IT COULD NOT HAVE BEEN TOLERATED DUE TO ALL THE CHEMICALS USED IN THE KNEE REPLACEMENT.
SO BACK TO CONDITIONAL PAYMENTS AND FEW EVEN KNOW WHAT THEY ARE IN THE MEDICAL FIELD TODAY.
MOST UNDERSTAND THAT IF ONE IS JUST INJURED THAT SOME DAY MEDICARE OR YOUR HEALTH INSURANCE IS TO BE PAID BACK FROM ANY SETTLEMENT MONEY AND THAT IS DONE I THE PROCESS, BUT ITS NOT BEEN HAPPENING FOR PART D,\/
And that includes even such incidents as Grandma gets in a car accident and has some prescriptions filled from that and little controversy exists over who is the primary payer to be on that..... one of the car insurance companies after their attorneys do some 'haggling.'
THE NEED FOR THE LAW, IS WHAT IS OCCURRING WITH OUR RECORDS AND ITS A FELONY THEFT OF MEDICARE. WHETHER ANY INDIVIDUAL CAN BE PROSECUTED IS WHY LAW ENFORCEMENT NEEDS TO BE INVESTIGATING WHAT IS GOING ON AND HAS NOT DONE SO FOR 20 YEARS. IN APRIL THE CONTRACTOR TO TAKE AND ASSESS FRAUD ENGAGED IN IT and in the cover up goofed..
Also getting that national health Insrucne data base under HIPPAA which even the patient has no access to yet, would be the first step to any real TORT REFORM FOR MALPRACTICE CLAIMS AGAINST DOCTORS AND HOSPITALS TO STOP MISTAKES FROM BEING MADE IF ITS FOLLOWED. Congress has known about this for 8 years and the harms and deaths caused.
What seems to simple to the rest of us, seems so difficult for those we have elected to be in charge and it does not seem to be one party or the other having difficulty understanding some very simple principles.
We have our phone line tied up with out going requests, and those at General Dynamics, if you have information to give us just leave a message. Any confidential info would only be in the many legally filed claims and appeals and recovery action requests and I have seen nothing that says you are now the entity that processes those. So send those requests back to the one who sent them to you and tell them to do their job and answer the appeal and advise them that the Common Working file is only accurate a short time every other Tuesday AM and then all who are paying good money for altered garbage that could back fire on their providers and suppliers need to be asking for a refund of monies shelled out as well as petitioning ones govt through ones elected officials to get control an over sight of an out of control on ongoing theft of the Medicare trust fund that harms everyone in the end whether as tax payer, heir of one overpaid and may not even know or understand it, or taxpayer whose hard earned monies are taken to be stolen and not used for those intended to benefit from it, or skewing medical research in case one might need some medical cure or treatment found for a future medical need for ones self or ones loved ones.
COMMON SENSE HAS BEEN ALTERED JUST AS THE COMMON WORKING FILE IS AND THE RESULT HARMS US ALL.
Doyle and I will 'continue climbing the mountain of back log of paper on all of this' as we do our best to abide by the laws and rules and pray all those on the receiving end will do so , also.
As Doyle told one person who did get through on a phone call from one of the Medicare partners with some appeals, etc.: " If you do not understand what we have filed, CALL THE ATTORNEY FOR YOUR COMPANY." NO one in these companies should be retaliated against when legal terms they have not been trained on are included in the filings. Use the mail, for specific requests related to the legal matters in the filings, as lives are at stake over what has occurred here as medical care gets obstructed and if this can not get resolved at your level, then your decision will need to be appealed and the written record needs to exist.
ITS BEEN 20 YEARS SINCE THE MEDICARE LAWS HAVE BEEN ENFORCED ON CONDITIONAL PAYMENTS AND MANY DON'T EVEN UNDERSTAND THE CONTEXT OF HR 1063. ITS TIME TO DUST OFF THE ORIGINAL AND START REALLY IMPLEMENTING THIS LAW AND AS PRESIDENT OBAMA SAID WHEN HE SIGNED IT OVER A YEAR AGO, IT MAY NOT BE ENOUGH. I had not realized my contacts, and others? led to the law being written and it does not state that it is an amendment to the original one of 1981. That is confusing as that needs to be gotten out and training done and follow it as it still is the law. Suspending the enforcement of it led to the collapse of our health care system as the rules and ethics got 'suspended' too.
But its there and the Office of Inspector general for HHS is part of the process of that, as they need to decide if what is going on in each alteration, etc. needs to be investigated as a crime and referred to the US Attorney for prosecutions. How can an intentional process set in place not be? Its still part of the constitutional rights of each individual in this nation for a legal process to be followed with all due process rights. I just wish the patients could be given the same rights when our files are altered and our health insurance cancelled off the records given to our doctors etc.... The letter would have to say: based on information received from your employer group health plan, from CEO Lynn Blodgett via their OPM govt contractor who gets it from his company, we have decided to delete it so Medicare can pay the bills as CEO Blodgett has decided you should not have Federal workers compensation even though you have permanent medical benefits and an established case per even the appellate judges who ordered CEO Blodgett to post, process pay etc and ask you for the facts of the case, etc. in 2/09 and he has decided that they are to be ignored as well as the Medicare appellate judge, too. as you should be retired now as he does not want you to live or have a livelihood and here are your appeal rights from this letter... AND WHOM TO APPEAL TO GIVING COMPANY NAME AND ADDRESS.
If you think this sounds ridiculous, it is and that is how ridiculous what has been going on inside the govt for 20 years since SEC OF HHS DONNA SHALALA SUSPENDED THE ENFORCEMENT OF THE CONDITIONAL PAYMENT LAW BACK IN 1994 AND I AND OTHERS AT WORK GOT HER MEMO IN OUR MAILBOXES ONE MORNING AND I REMEMBER SAYING TO OTHERS/" What planet are you living on lady?" as I commented on her memo to all HHS employees. As I knew full well the horrific abuses that had occurred before the first conditional payment law was passed and how effective it became to stop all the skulduggery that has transpired since 1994. NO MYSTERY TO ME THAT THIS NATION SPENDS THE MOST ON HEALTH CARE AND GETS THIRD RATE NATION CARE. Lawlessness has over come our health care system and the patients and doctors have ended up on the bottom of the heap, helpless to do anything as the govt has decided to do nothing to stop the horrendous abuses that have over come us and any half way ethical health insurer can not financially survive or even bid to get a govt contract with the illegal actions that are on ongoing.
SO WHATEVER HEALTH PLAN IS PASSED, THE RESULT MIGHT SAVE SOME LIVES WHO DO GET NEEDED CARE, BUT AT THE HIGH COST OF LAWLESSNESS OVER ALL WE, AS THE TAXPAYERS CAN NOT AFFORD. Lawlessness is the real DEATH PANEL.
I am exhausted and I know this is not my best writing.
Linda Joy Adams 7/31/14
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