VIOLATIONS OF CIVIL RIGHTS PAGE 45: RESPONSE TO HUMANA PART D MEDICARE

                                                                                                                      DOYLE E. ADAMS

HUMANA
Critical Care/ Urgent Inquiry Dept
004/36270
101 East Main Street
Louisville, KY 40202
      TO WHOM IT MAY CONCERN
           Thanks for the continued payment of Doyle's prescription drugs even though Medicare is not legally the primary payer. We are in a process now, under HR 1063 to get all monies recovered to Medicare and have the real primary payers pay.
The Recovery ad Coordination center has continued deleting the employer group health plans off the common working file even though they are to now be enforcing the law and not obstructing it. no due process notice  with appeal rights is sent bi weekly either to let us know this is going on and severe retaliations have occurred when we had to find out as medical care  has been  obstructed over it when ones medical provider can't find out whom is the primary payer to contact for an approval for  surgery or a treatment, etc.  Federal Blue Cross Blue Shield  is Doyle's primary as the subscriber Linda J Adams is active duty and it posts that way from the US Department of labor and is legally accurate. And the Appellate judge at Medicare said so in the ruling M09-1406 and no change has occurred since then on status.
We do not know if you received the extensive filings that explains all that has occurred within  the partners of Medicare  which are the same entities over all  four health plans involved with the three of us on her FEHB plan.
 All control of what is occurring on the  health plans of Linda is with Affiliated Computer Services-Xerox, CEO Lynn Blodgett went to heads of multiple agencies and said she had gotten a workers  comp settlement and retired which DID NOT OCCUR.   Even the Judges orders she obtained from their appellate Judges for him to reconstruct her file for her records  and post, process and pay has been withheld from them so every govt official is having to take his verbal words which is A LIE.  The judges said clearly all were to ask Linda for the facts as no one else seems to know anything but rumor and gossip run amok. At the appellate level is where we are still able to reconstruct the files for review and they ARE NOT SENT TO ACS TO DIGITIZE AND DISAPPEAR WHICH IS ON GOING AT MEDICARE, AS SOME OF OURS HAVE DISAPPEARED OVER THE LAST FEW YEARS ON OTHER CASES.   SSA, AND OTHER AGENCIES WHICH GIVES THEM TO THEM  IS ALLOWING THEM TO CONTROL THE OUTCOME IF THE DISAPPEARANCES ARE NOT DISCOVERED BEFORE THE JUDGES RULE.
Linda has an established  non controverted  Federal Workers compensation case with permanent medical benefits already, but  can not retire until ACS-Xerox allows her claims examiner to see the file to rule on a schedule award and permanent disability. Neither  can the law suit she was required to file to reimburse the taxpayer be settled out in Hudson County NJ until the federal govt decides what the damages are and that can't be done until these violations of her civil rights ends.  She was injured 1/10/89 and there are some items as far back as 1989 that have yet to be processed due to a repeated felony rifling and destructions of records that always led through the appeals process and back to benefits paid  until the next crimes committed against  her file.
  This last time, the govt contractor ACS-Xerox ignores the Judges  and ignores even the separate order she got.
 There is a second but separate law suit in Philly on as few claims that has not been settled either. Its one on a broken ankle, etc. and not related to the 1/10/89 claim. Unknown to us at the time was that  CNA  is the liability insurer for both and some skullduggery occurred . that may have led to the second injury case we were unaware of until later on.  Neither have ever been settled. Linda does have some permanent residual loss  on her right ankle, but compared to the toxic cloud enveloping her at work on 1/10/89 it is minor in comparison.  A determination needs to be made whether each of these law suits are related or not. We had assumed they were not. but CNA seems to have some knowledge we don't have as to why Linda got locked out of access to her car and ended  up falling.
  Our letters to CEO Blodgett  go unanswered to set up some sort of system to do the reconstruction and work through a tremendous back log so she can retire and then Medicare would be Doyle's primary payer and hers, and  the dependent on her Federal Blues also.
       We notice that the letter you sent that only contained a print out of all the claims paid for Doyle since 11/1/11 came from Louisville.Ky.  instead of Nashville, Tn. headquarters.
And there was no mention of the request to forward this to the Recovery/Coordination contractor,
Are you going to do this? HR 1063 says you could be fined for not doing so.
We do thank you for the concise print out as we do need it to file for co pay refunds with our other health plan which is primary.
Since 2006, Linda and Doyle  has been filing payers and sending letters, and calling trying to find out what the promised coordination  plan was between the FEHB plans and Part D Medicare. The Blues booklet (contract) only said there was one. But none ever seemed to be known by any at OPM or elsewhere..
Even when Doyle signed up for Part D, no sales person had any info as to what the coverage would be. If this was a state regulated insurance plan, it seem all the sales people would have been in trouble with keeping their state licenses for not being able to state what would or would not be covered. But, OPM which is under their contractors seemed to not be concerned?
We recently learned that Affiliated Computer Services-Xerox has been paying all the Part D claims since 2006 ad NOT EVER SENT ANY TO THE RECOVERY UNIT OR ANYONE.   The management in charge of that facility had no knowledge of such. to be done.
 Linda's current plan, got their management to call her and later got her on a conference call with them and her, also,
 A lot of money is owed back by primary payers to the taxpayer on this for those who may have just incurred an injury such as in a car accident and later would get money to repay, or as in or case where the illegal dumping on to Medicare by those that decided to get our of paying primary occurred for what ever reason. ITS CALLED THEFT AND THE US ATTORNEY CALLED IT THE BIGGEST RICCO CASE IN THE HISTORY OF THE USA WHEN WE CHECKED WITH THEM BEFORE WE STARTED OUR INVESTIGATION SHOULD THERE BE ONE WE SHOULD NOT INTERFER WITH. 
TO date no investigation has occurred as Congress needs to give some money for it to occur is what we have been told  by the party assigned in the US justice dept as well as the HHS OIG investigator assigned a few years ago and all said nothing can be done when it involves a govt contractor of HHS. They suggested  we file the civil rights cases as that would allow them to get inside as there are no internal audits done either that  would have caught the  fact that ACS management was never instructed to send anything to recovery on any one. They now know this as we confirmed in a conference call with Linda's Part D plan and them.
    But nothing has happened with our claims yet.  We would know, as we would get a copy of the recovery letter sent to the primary payer.  Their new phone and fax numbers listed on line are still not operational. And the old ones are now disconnected since they merged in to one unit on 4/1/14.  On orders of CEO BLODGGETT LINDA WAS INFORMED BY THE RECOVERY UNIT, THAT ALL THE GOOD EFFORTS AND LETTERS SENT OUT BY THEIR DETROIT FACILITY  HAD BEEN DESTROYED AND NOTHNG EVER RECOVERED. ALL THOSE FILES HAVE TO BE RECONSTRUCTED AND THAT LED TO OUR REQUEST TO YOU TO ASSIST IN THIS LEGALLY REQURIED EFFORT. MAYBE YOU HAVE SENT THEM IN THE PAST, AND THEY WERE DESTROYED ALSO? But ACS management that pays the claims for all the plans? did not do so and may have ignored I any instruction  you may have given them in the matter. They can just now say, "YOU NEVER TOLD THEM."

In 1/08, the first Civil rights complaint was filed with the Dallas regional office and led to none ever being allowed to be docketed in or answered, The gross retaliation was the regional manager Ralph Rouse calling Linda and laying her out cold for even filing and other actions he has done, since. HHS OCR has no provisions for f going on for a Hearing as their is at the EEOC.
And HIPPAA does not help as govt contractors and govt officials are not under the HIPPAA law.
Its time Congress addresses a very broken system where ever avenue to resolve issues  has not even a process to follow under the due process provisions of the US Constitution.

Linda gets special help on a grandfathered in cost of living raises provision., but Doyle does not and that has been appealed as it seems as if the contractors don't have much understanding of the programs they have control of now.
 In our case, all of our health plans have come under the ultimate control of ACS-Xerox and their CEO Lynn Blodgett  who personally told multiple agencies misinformation that Linda had gotten a workers comp settlement and retired. A lie. And the official .secured records that the Administrative law judge for Medicare got to determine Linda's request for recovery  on oxygen claims Medicare was forced to pay on case showed the same as the posting to the Common Working File owned by Emblem health International which is the recovery / coordination unit govt contractor 
THAT IS NOT THE INFO YOU GET AT ALL. AS SOON AFTER THE CORRECT AND OFFICIAL INFO POSTS, THEY ILLEGALLY GO IN AND DELETE THE FEDERAL BLUE CROSS BLUE SHIELD OFF OF EACH OF OUR COMMON WORKING FILES. And its done for others, too as part of secret deals within the insurance industry. OIG FOR HHS CAN DO NOTHING AS THEY ARE NOT ALLOWED TO SPEND ANY MONEY INVESTIGATING AND THE INITIAL INVESTIGATIONS ARE NOW BEING DONE BY A FINANCIALLY INTERCONNECTED COMPANY.....
 Medicare is being robbed by some of its own partners and this needs to stop and only Congress seems to have the  power to do it and wish they would so we would not have to  make right what they have done to us. To you also, if you are not one with a 'secret deal.'
We will be able to use this to file for all the co pays due under the coordination plan that has just started being upheld recently where we pay $0.
    We had always been misinformed that we paid the lower of the copays between the two comparable plans and that was not true. what was occurring is Medicare paid and others got out of paying anything, How could no one know anything for 8 years as we with federal health insurance, whether primary or secondary where unable to decide what we were to pay or even whether it would be beneficial to sign up for Part D,.
Obviously it is for most. When we have no co pay to pay just as occurs on Part A and Part B Medicare when one has the federal health insurance and that is well known to all or should be unless the billing person is accessing that illegally altered COMMON WORKING FILE.  Anytime but the short time every other Tuesday AM after it posts and before they run the illegal deletion program,
NO MYSTERY WHY THE NEW HEALTH EXCHANGES KEEP CRASHING WITH ALL THE CLASHING INFO ON PERSONS to any with the basic understandings of systems.

So, please let us know whether you have sent the print out on to the Medicare recovery unit to get the monies recovered back to the taxpayer for the Medicare Part D fund which is your responsibility to do under HR 1063 as we have always made this clear as to whom is to pay first on all filings. And no one has ever sent us any due process with appeal rights notice on all of these alterations which is unconstitutional as well as  violations of civil rights for those of us in protected classes as we all are.
        What you may not understand is as the judge ruled on M09-1406 is that the patient is overpaid to Medicare when Medicare pays and no coding for recovery occurs.  HR 1063 relieves the patient of having to file a false claims suit as the govt , for the first time since 1994, is now back enforcing its own laws even though the contractor in charge is also the one making the illegal alterations and someone at HHS needs to stop this so the law is upheld.
The only recourse is bankruptcy court for the patients or to get a letter of waiver from the govt to get out from under the over payments we can not stop form occurring. We can't arrest anyone, or cancel a govt contract or padlock the door of in illegal operation that is on ongoing. If the govt itself can't when the taxpayers money is being stolen.
SSA agreed to do these kinds of waivers in 2005 for Medicare as it was already getting bad with the other parts of Medicare getting illegally dumped on due to no enforcement of the conditional pay law since 1994.
But our forms SSA 632 which is 'against equity ad good conscience" has yet to be processed. This is one where no personal financial info is given. as we have well proved we can't stop what is occurring when the govt , itself has been unable to do so. And they need to do so and Congress needs to allow some money to be spent to enforce it against those entities allowed to do this, even if it includes their own partners of Medicare allowed to do this for almost two decades. now.

All three of us have forms  to represent each other as non attorneys  on file so we can all share in any information under the HIPPAA law.
Thanks for paying the claims and it appears you will be asked to pay as a conditional primary for some time until the law is fully implemented. The safety net under Medicare is a life saver for many. But it has been abused by too many for way too long.
It was never intended to be an ongoing ( 'financial bail out for the liability and health insurance industry at all.)
                                                                                              Doyle E Adams
                                                           
                                                                                              Linda Joy Adams