Blue Cross and Blue Shield's Federal Employee Plan - Provider Directory
Blue Cross and Blue Shield of Oklahoma/Health Care Service Inc.
P.O Box 3283
Tulsa, Oklahoma 74102-3283
Attn: Manager:
with copy to
Riggs -Abney Law Firm general counsel for Blue Cross/ Blue Shield of OK
whom has also represented me with regard to obtaining liquid oxygen from Lincare and Rhema- Rotech, suppliers of liquid oxygen from 2002 through 2014. and in other matters as a Prepaid Legal and Legal Shield Member.
502 W 6Th St
Tulsa, OK 72119
copy being sent to
Blue Cross Blue Shield of Texas\ Health Care Service. Inc.
P.O. Box 660044
Dallas, TX. 75266-0044
Copy being sent to:
Health Care Service Inc.
(Parent Company )Blue Cross Blue Shield of Illinois, ,New Mexico, Texas and Montana. etc.
P.O. Box 7344
Chicago, Illinois 60680-7344
Copies also being sent to Lincare in Denison, TX and their Corporate headquarters in Florida
and to Steve Berson, legal counsel for Rhema- Rotech from which we are still trying to negotiate services as the only supplier of liquid oxygen in my area now, due to a disruption of service from Lincare whose policy is not to take 'new' patients in Oklahoma.
Also being notified is CEO LYNN BLODGETT OF AFFILIATED COMPUTER SERVICES A XEROX COMPANY , which is the US Department of Labor contractor given control in@ 2002 of FEDERAL WORKERS COMPENSATION CASE 02-0600326 DATE OF INJURY 1/10/89; AN ESTABLISHED NON CONTROVERTED CASE WITH PERMANENT MEDICAL BENEFITS DUE TO FEDERAL WORKER'S COMPENSATION LAWS OF 1988 WHEN THEY PUT ME ON HOME LIQUID OXYGEN FOR LIFE.
Additional copies of this are being sent to Alan Porwich, Esq.,
Emblem Health International, the parent company of Medicare's Recovery/Coordination unit to implement HR 1063 actions against ACS
, Securities and Exchange pending complaints,
Director of Centers for Medicare and Medicaid'
HHS office of Civil Rights Dallas regional office:Ralph Rouse, manager to associate with multiple civil rights complaints filed since 1/08 and never answered or docketed in on these matters and others involving HHS programs including a filing for retaliation for prior EEOC matters which included EEOC sanctions against the Sec of HHS as employer and other EEOC and Whistle blower complaints which have never been settled that were apart from any filed against my now current independent employer agency Social Security Administration from which I was transferred to the jurisdiction of Federal Workers Compensation US Department of Labor on 10/10/1994.. after the third attempt since 1/10/89 to try and work and nearly died due to none of the reasonable accommodations agreed to by HHS were provided including a non exertional job ( sedentary) and " removal of chemical barriers" due to occupational asthma and chemically induced pneumonitis which was diagnosed prior to my return to work the second time in 7/1990 after being sent home from the first attempt to work in 1989 resulted in reactions to the modern office environment chemicals which had never bothered me for over 20 years working in various offices for Social Security since 6/68 and before that in other office work.
George Ciechanowski MD original workers compensation pulmonologist and who first prescribed home oxygen for workers comp to pay for and did.
Many have stated this set the second of some form of precedent cases that acceptance of my job injuries of a traumatic onset case of Toxic Fumes with Bronchial Spasms from a toxic cloud which had enveloped me at work on 1/10/89 at the Social Security Teleservice Center 9TH Floor, 2 Journal Square, Jersey City, NJ where our office had moved to in 7/88 owned by Hartz Mountain Industries. usually referred to as the ADP Building.
The workers compensation claims was not controverted and while on Jury Duty my case was accepted and Federal workers compensation advised me not to return to work as the attending pulmonologist and federal worker's compensation doctor George Ciechanowski MD had advised against it due to reactions to the modern office environment. It was he, as workers compensation doctor,first prescribed home oxygen almost 20 years ago.
Also being sent a copy is Acting manager Gloria Taylor, US Department of Labor, office of Workers compensation, Dallas, Tx/ It was her predecessor and others who stated they had no official access to my file, or judges orders and as such had no control over complying with the US Department's Claims Authorizations Boards appellate judges or even to understand the context of any orders without the complete file. Numerous reconsiderations are now pending unanswered on multiple items which they are unaware of due to ACS refusal to comply and post my file, process and pay, etc. Some of those multiple ites include secondary and tertiary CA1's and CA2's to add in later discovered medical conditions arising from the initial injury. Also in file are some 'new' items that were timely filed and refilled that go back to 1989 and multiple judges have referred to these in their multiple remand orders.
The file has been shredded, disappeared even after a reconstruction was done each time for the judges to even have a file to review. This has been a continuous pattern which US Attorneys state is a felony each time and a felony when the custodian of the record did not report. Rarely has any done so or taken any due diligence to secure my file and the reason given for Affiliated Computer Services to be contracted out to is they were to provide the security that was non existent in the US Govt offices. Instead what has resulted is even worse and more life threatening as now those in charge are not able to follow the judges orders which did occur in the past and for awhile items and wage loss were paid, etc. including for home oxygen until another 'disappearance of records.
The last time was in the Dallas regional office and they decided I had never returned to work in 1990 and that no disease claims of Occupational Asthma and chemically induced pneumonitis had been accepted is how they represented the file after it had been 'rifled' again. They did have it as I got a copy of the cover letter in detail from my claims examiner in Philly had sent along. And then the change of address ended up becoming the retirement date Federal Blues of Ill started using for several years after they took over in OK and TX. as the OPM contractor found something to tell them looking for a non existent date. They are still looking and using one thing after another as if it were.
This constant pattern of disruption of processing has led to utter chaos as to what has or has not been paid and to add to the confusion is that the Dallas office did not itemize items when paying for medical bills and travel vouchers so the on line bills shown as paid are incomplete and some are not even on there to be seen.
The were ordered by a hearing officer on the case to change this so that itemized payment vouchers with full appeal rights would be sent on all items paid as other regional offices did on my case that had worked it.
Now ACS does not issue any notices with appeal rights and on the claims I have timely filed they keep referring to some other party should pay and when asked verbally and in writing, no one knows what it means. The only source was ACS's call center was saying their screen reflected that I had been given a million dollars to pay for my medical care myself and I HAVE NOT RECEIVED SUCH and immediately sent a ceritied letter to the US Dept of labor, which had to go to ACS in London Ky as they control all the flow of information even from the appeallate judges and no answer to that to this date and they have never bothered to change that information with Lincare or Rhema-Rotech and any other medical prividers or suppliers it was said to. It resulted in my being medically abandoned by Lincare in 2006, and then Rhema due to this. I was able to find a small supplier All About Mobility and we finally figured out as no one told us, that Federal workers compensaition had to be billed first for the oxygen and they did so and waited and waited and finally they had me call only to hae the ACs manager tell us that they had strict orders not to input the oxygen claims because "THEY WOULD BE PAID AND THE GIG WOULD BE UP AND THEY WOULD HAVE TO PAY ALL OF MY MEDCIAL BILLS" To this day ACS has not processed/input one oxygen claim as they followed orders which the manager stated very matter of 'factly' "LET HER DIE". and she was not the first of several to have stated that was the orders with regard to me since 1998.
The first was the manager of Texas Blue Cross Blue Shield when they were Arkansas blues and he had called to tell me don't worry that they would pay my bills and they did pay Health Connections which is now owned by Lincare for my liquid oxygen as at the time, I was unaware that my medical benefits were permanent due to the liquid oxygen as the local office for workers comp in Dallas apparently has never been online with the official US Dept. of Labor system which does show that.
When the injured worker moves, the files get transferred to the new region and that has caused major problems, also over the years as it then becomes too easy to 'rifle and disappear?' I did get a copy of a pretty good summary that was sent from my claims examiner in Philadelphia regional office when they transferred the file and that apparently was ? ignored or disappeared? that pretty clearly reflected what they had done and established. I had filed for a schedule award with them and that is the first step to a permanent disability and being able to be legally retired. The originating office is New York regional office and although each case stands on its own merit, they had cases from others in our office and as such had a general understanding of what had occurred and the magnitude of it.
ACS has over a decade of oxygen claims not processed now. And that obstructs any timely payment from Medicare or federal blues for services and any medical provider or supplier can not survive in business long at that rate. All About Mobility went out of the liquid oxygen business in 1/08 due to a Medicare regulation that forced all smaller suppliers out and I got medically abandoned. Since then, in order to live, my family has taken tanks to the manufacturer directly to be paid. Medicare will not pay if there is no supplier, such as Lincare or Rhema, but Federal blues does and has as they have a provision to pay for items not covered by Medicare, etc. Doyle got some equipment paid for by Blues not covered by Medicare, but Medicare is secondary for him and any dependents on my Fed Blues do to my status.
Ironically, Doyle's last employer was bought by ACS and he filed a complaint over the hostile work environment there he had to observe that distracted from his work after they took over of on- going sexual harassment of others on the job he wanted to not have to see go on. We have noted that in the HHS civil rights complaints. Federal workers compensation, has also paid for going direct to the manufacturer as on occasion we have done so over the almost 20 years.
It was federal workers compensation who at one point tried to put me on the concentrator, but switched to liquid due to immediate and life threatening severe inflaming reactions, The newer concentrators are no better and our pending civil rights complaint against FDA included in the ones pending is their refusal to address the issues of the low levels of ozone getting back into the lungs. In 2002, they were going to ban all ionizing machines and air purifiers and then the safe levels of ozone got raised to 4 parts per million from 1 ppm and that's all most sell now. FOR ONE LIKE ME AMONG AN ESTIMATED 10 MILLION IN THE USA, WE CANNOT TOLERATE PARTS PER MILLION BUT SPEAK OF PARTS PER BILLION.
Actually, one molecule can cause an adverse reaction, but to get to that level is impossible, but one can only try and avoid such as well as the chemicals that cause reactions, the main one for me being formaldehyde. One of my former doctors, Rebecca Bascom, MD at the University of Maryland, was in charge of some medical research at the National Institutes of health on chemical injuries to the respiratory system and wrote a published white paper on how damage to the mucous membrane results in this acute sensitivity which is not an allergic reaction. My doctors stated early on that the mucous membrane was burned off my entire body, but the acute immediate need was the lungs as one must be able to breathe in order to live. Cortisone steroids are treatment for the inflammation, and I have had all the known side effects including Diabetes 2 now and do to the obstructions to getting medical supplies paid for; not only am I being denied access to a liquid oxygen supplier but can not get my diabetic supplies paid for anymore due to the constant manipulation of the Common Working File official postings from the US Dept of Labor bi -weekly. I can not pay myself and then wait a decade or more for reimbursement. At one time I did pay first for oxygen, but by the time the credit card bill was due, I was reimbursed if I got the claims in right away.
The Recovery /Coordination unit continues to go in and delete my other primary Federal Blue Cross Blue Shield off of it soon after posting bi weekly and no supplier or pharmacy can get the split billing done that way. Their is a secondary medical CA-1 and CA-2 pendng to add this in at ACS since diagnosed in 2009, but its never been seen to do so. I must had had it for some time, but in our training class the instructor said its taking about 7 years before a is often made. Often when one gets a regular blood panel done, one is asked to fast for a cholesterol level and for one like, me who tends to go hyperglycemic, the level drops when fasting and can be missed until much longer. VA has accepted such on vets with injuries similar to mine several years ago.
Federal Blue Cross /Blue Shield of Illinois ( HCS, Inc.) took over in my area also, and they proceeded to tell Medicare Coordination of Benefits ( Group Health Inc.- now Emblem Health Int that I was retired and to alter the official posting to the Common Working File which they own as a Govt Contractor) and then took back from Lincare all the monies they had paid out to them for my home oxygen. They had never billed Medicare as they paid at 90% and the 20 % that Medicare would have paid was less. we now know that Federal Blues does not get their information for any official records or official sources, but through a govt contractor which gets their information from CEO Lynn Blodgett of ACS-Xerox who is being consistent in what he is saying to multiple agencies and entities, but he is not speaking the facts at all and no one is able or willing? to question his verbal assertions when in his possession was the last appeallate judges orders from 2/09 to ask me for the facts of the case and to reconstruct form my records and to post, process and pay, etc. And he is saying "there is nothing to do on my case that I had gotten a workers compensation settlement and retired. If he is looking at a million dollars on my computer screen at ACS, it did not occur and you need to proceed to ask some questions and find out why and where the money is before defying the judges who have access to the official system that posts to the Common working file, plus we are able to reconstruct files for the judges, and then ACS not post and ......
I do give him the out that he is innocent of stealing it himself until proven he did so. If that is what occurred. But all I know it ended me having Lincare and put me in a life and death struggle and Lincare wanting me to pay them out of the million dollars I have never had nor ever informed of until Lincare's office manager repeated it to me.
AND THE JUDGES ALSO GOT CORRECTED THE INFO THAT GOT RIFLED THAT CASUED THE PROBLEMS IN DALLAS. THAT I DID RETURN TO WORK IN 1990 AND THAT I HAD THE OCCUPATIONAL ASTHMA DISEASE CLAIMS, ETC. ACCEPTED ALSO. AND THAT IT WAS AN ESTABLISHED CASE AND NOT CONTROVERTED.
Our son, found out from Linda Tripp in 1996, when Monica Lewinsky went and got her to answer questions he was trying to get answered as to why the White Houses of Presidents Clinton and Bush 41 were involved with what occurred in our office which we had just learned of their involvement at the time. President Bush had made it a matter of National Security and had also ordered a full investigation of the matter but it never occurred to this day. .? Although there was a contact over a decade ago that Homeland Security then had 11 dead from our office related to the toxic cloud and that our personnel director's suicide was being reopened by them as a homicide as a fingerprint of a known terrorist was found in his apartment and when sharing of info began it got identified.
On her way home, a tape recorder was bought and the rest is history. She was surprised any one from our office was having difficulty getting benefits Our son is the "cute guy trying to help his mother" on the tapes. Ken Starr spoke to every one else, but for some reason, not to him. He was told that Pres. Bush 41 had made this a matter of National Security and that all of us were to be given the 'benefit of the doubt in being awarded Federal workers Compensation claims. Without the file, no one seems to understand the importance of their statement and orders at all and since my file is some kind of precedent is it a matter of some kind of 'national security' precedent , also?
At this point , I am just trying to stay alive and with a defective oxygen tank and no supplier to sell me one and bill insurance, and it springing another leak we had to glue and gorilla tape it; my life could well end as ordered due to the medical abandonment that has been created when three health plans have me approved for life as the squabble goes on as to which is to pay and who pays first or the total. All Medicare requires it be reported as a conditional payment and since the medical benefits are current and open, they are bound to do the recovery and can enforce that recovery under HR 1063..
On page 138 of the 2014 Federal Blue Cross Blue Shield Contract with patients and HCS Holdings Inc. Federal Division it states clearly that any decision as to whom is the primary and secondary payers of bills is to be determined by Medicare for those who have Medicare coverage. The highest legal authority at Medicare is the appellate judges in Washington, DC.
Medicare finally paid primary on the oxygen claims to ALL About Mobility after the two real primaires refused, saying Medicare should be primary. When the claims processor tried to input them, it rejected for having a primary payer. There is a security lock on the posting to the Common Working File that lists oxygen as federal workers compensation's bill and since then, have learned more about the provision to have permanent medcial given before any reitrment or schedule award and regardless of work or wage loss, received. This is a fine point of a law that many billing persons may not be aware of and may be causing added confusion as to how or who is to pay or if even approved. its why patients must not be left out of the process as we have info to share that can help find the answers. just because I am an old, disabled woman does not mean I do not still know things from almost 50 years of working with Medicare program which SSA used to be in charge of. And the split has not been a good one in my opinion as there is a lot of interconnection still to this day that needs to always be coordinated. Just a lot of fine points in the law, many are never trained to know anymore.
The 1988 Federal Workers law that is often referred to as the emergency medical law; is a law that assures that all of this skullduggery and abuses of power and too often associated with trying to bluff ones way through ignorance of the law is endangering the very lives of injured federal employees the law is to save. Its for those with an established case and allows permanent medical benefits be done when there is a life sustaining need and oxygen is one of the main items. It automatically locks in the system once the oxygen is input and coded for life.
When federal workers compensation put me on liquid oxygen for life and coded it as such on the input, it locked in with a security lock that even the IT people at US Dept of Labor are very proud of that can not be hacked into and altered as they some and have done with the employer group health plan, which each of us can change yearly in the open enrollment period if we choose to do so and that does not have the same kind of security as what FEHB plan is chosen has to be able to be altered on the system. But the active duty status is going to remain until certain items are input that have yet to occur and won't until the full file is worked and the schedule award paid for permanent loss. ONLY THE US DEPT OF LABOR IS TO MAKE ANY CHANGES. And that is part of the contract between them at CMS 's govt contractor or Partner as they refer to themselves. But they are not Federal judges.
That posting records are the same as those at Office of Personnel Management that the General Counsel and former Acting Director accessed and a later Director accessed before she resigned in 2008. THEIR CONTRACTOR DOES NOT GIVE OUT THE SAME INFO AS THEY GET THEIR INFORMATION NOW FROM CEO LYNN BLODGETT AT ACS-XEROX. AS LINKED TO THAT INFO ON MY WEBSITE.
So for Emblem health to have an offline system to go in and delete ones employer group health plan off ones records is a violation of that contract. AND USURPTION OF THE US CONSTITUTION TO USURP THE AUTHORITY OF THE JUDICIAL BRANCH OF GOVT. AS THE AGENCY JUDGES ARE FIRST LINE FEDERAL JUDGES.And since there is no notice to me bi -weekly, that there is a deletion with appeal rights; It violates our constitutional rights and civil rights as all of us on my plan are in protected classes. No doctor or any one trying provide medical care is allowed to know what our health care coverage is and who pays first and may need to be contacted for approval for surgery or treatment or even be admitted to a hospital. and this resulted in long delays for care in 2007 for me and I got medically abandoned by an excellent doctor whose office manager and billing person did not make the call to federal workers comp first or to Federal Blues as she got lied to big time ? I got the brunt of it as if it were my fault what all is going on with manipulation of official govt records and defiance of judges. But the surgery did get done, but now I have no doctor for the upper respiratory part and that is not a good thing. All of the family members on the plan now also have Medicare cards and whom to get approval for treatment from for any medical providers has caused numerous medical abandonment and retaliations as if we can stop it and don't . \
I AM VERY THANKFUL FOR OUR DOCTORS ETC/ WHO HAVE CONTINUED THEIR BEST TO PROVIDE MEDICAL CARE FOR SELF AND FAMILY, ALSO AFFECTED, WITH SUCH ON GOING OBSTRUCTIONS. Just needing to get a doctor, etc. paid does not have the same security lock and is a masisve recovery that started being done several years ago by Medicare recovery unit in Detroit, but all those records were destroyed on the verbal orders of CEO Lynn Blodgett is what we were told when they moved to Oklahoma city and their new fax number does not work and the old one is disconnected now. They have now merged into the Recvery and Coordination unit and its them altering the Common Working File creating all the chaos.
My years of training and experience at HHS and with the Medicare program has always taught me that the highest legal authority at Medicare is the Agency judges. First the administrative law judge and then the appellate judge. No govt contractor is a federal judge.
Cigna Government Services paid the oxygen claims to All About Mobility and then sent them to the recovery unit to treat as conditional payments and to get the monies back from Federal workers compensation and a recovery letter went out and its never been answered and nothing repaid. At least not officially answered as I would have received a copy. What I was told by them is CEO Blodgett told them to destroy the records and did without questioning anything? Up unitl last year, when I spoke to them; they were unaware there that no one at the US Dept of Labor ever would have officially seen any of their requests for repayment as my file is not posted and the address was PO BOX 8300 London Ky which is the unit at ACS that must receive all paper filings and its here that the real decisions are made on all claims as if they do not post, no one knows anything and that is total control of the flow of information apart from the real system which does post to the Common Working File. all billing persons use to send in claims to Medicare. To cancel ones insurance off of it with out any notice or right to appeal is unconstitutional and a gross malfeasance of interfering with ones rights of life and health care.
Since 1994, when former Secretary of Health and Human Services Donna Shalala set up the system where emplyers and agencies provided the infomationas to employement status and insurcne and whoch is primary, etc, their a has been no enformcment of the conditional payment law under Medicare. She suspended it and many insurers went rght out and began an illegal 'dumping ' of bills onto the medciare system for any who had medicare as a secondary payer. In my experience opinion knowing how h=bad it had gotten before that law was nacted in 1980's and have actually siged enforcement orders aginst insracne companies doing far less that in gong on since 1994, THE COLLAPSE OF OUR HEALTH CARE SSYTEM HAS OCCURRED IN A GREAT PART DUE TO THIS as no ones health insurer could be 'made' to behave.
In our area, Arkansas Blues paid their bills. But in 2002 that all changed and there was no status change for me. It has been rather secretive that any such Common Working File system even existed nad many were very unhappy when we finally unearthed the facts about it ad how it worked, etc. I had gotten into terrible situaitons geitng medical care and almost being abandoned by Lincare if Riggs-Abmey had not intervened on my behalf not knowing that it was there other client that was involved in adding to the chaos and putting my life at risk and taking back money from Lincare that should have been taken back from Federal Workers compensation. The system is so secret that the FEHB plans do not have access to it when every medical provider and supplier does. Why would such an omission occur? It leads to a lot of life threatening situations and worse, as I've heard of..
So I first asked Cigna Govt Services in 2008 to enforce the conditional paymnt law and make ACS repay and process the claims. I had filed the Lincare and Rhema claims as ACS refused to let them file, but All About Mobility did... I could not overcome the refusal for them to file so we could proceed as it seemed obvious to me they would need to due to my years of experience with the programs even if I did not have access to all the info and rules, and manuals. I did not get online until 12/08 except for some billing and brief items and have had to do a lot of catching up on skills, and some I still have not mastered some the younger set has. .
In fact, Lincare refused to provide the medical necessity form to James Stocks. MD at the University of Texas, now under the management of ACS. Dr Stocks had a cardio pulmonary stress test run and had an oxygen saturation rate in 1/04 low enough to qualify me for oxygen under the strict rules the Medicare suppliers were using. Unknown to me, I thought the claims were getting sent in and they were waiting.
Riggs -Abney told us that Lincare did not wish to get locked into the lower Medicare rate and that is why they did not file and would not get the form to the doctor. But the new federal blues that had started paying the oxygen claims as primary refused to hand over the former medical necessity file where I was approved for life to Medicare as legally required if who is primary switches and would not give me a copy to this day and the records disappeared out of the hospital.
In 2000, Lincare had come to my home and drove off with all the oxygen tanks and left me without and I eventually got to the hospital and they got the magic 88% or lower saturation rate and then the hospital refused to give me the test results , and the ER doctor's prescription for home oxygen and would not even give me my discharge instructions which included the prescription for oxygen. when I signed I added above my signature what the sat rate was put down on the chart. , But,thankfully, the billing clerk had already faxed them to Tulsa Blues, which Arkansas Blues and Lincare did come back and they were paid. she had been the billing person for a former doctor of mine and there are many earthly angels who have aided in me in still being alive and I thank each of you. Later I was told that OPM had been directly involved in the whole action. Lincare sent people, I had never met in their van to do this. But was it the Director or their govt contractor? They said it was the Director at the time. Kay Coleman James. Only she would know but getting through to these high people is nearly impossible.
In 2006, I called Palmetto GBA and they sent me a new medical necessity form and I went to the doctor and got it filled out and he kept a copy in the file and by that time the new 2005 guidelines for Medicare were out and rarely followed since, but are now resent out that does not require the inducing of an ischemic heart attack to get the low oxygen saturation rate as certain medical conditons do qualify and I meet those in more than one way. I'd still have that doctor but ACS got involved and it became impossible. Most states have contracted with them for their medical schools and health facilities to manage them. They are I control of almost all of ones medical care and if one is like me among 90 blacklisted for life before we got to the hospitals in Jersey City back on 1/10/89 one is in deep trouble. and few understand the implications and the severe conflicts of interests a patients and doctor could be in to sever a relationship.
Even then neither Lincare nor Rema would send in the claims, so I filed with Federal blues and with Medicare and with ACS as Workers comp contractor and none of them have ever been input as " They would be paid and the gig would be up and we would have to pay all of your bills" and "Let her die" are the direct quotes. from ACS and the convicted official at US Dept of Labor in the Jack Abramoff bribery scandal from more than one who seem to have no unction to say it to us.
WE FINALLY GOT TO THE ADMINISTRAVE JDUGE LEVEL AND JUDGE CARTER with the threat of subpoena powers got the real internal dcuments form the real official records at the US dept of labor. We had filed asking that the suspension of the enforcement of the conditnal payment law be set asidie for the first time since 1994. He could not okay that. He affirmed the approval for life by Medciare for liwuid oxygen and ruled that the psoitng to the COmmon owring file showing acive duty status and Federal workers comp and federal Blue corss Blue shields wer my two primary payers and THAT THE OXYGEN CLAIMS WERE THE RESPINSIBILITY OF FEDERAL WORKERS COMPENSAITION. I was left to enforce the law and no govt authority behind me to do so at all. Even the OIG for US Dept of albor would not help and neither would HHS's OIG. It was at this time, $4 million was stolen from Medicre using my clims and Id and creitng 17 clisms form one on every clims paid by Trailblazers as they used an offline system to do so. No one in the US sjutice dept oudl do anything or at HHS as no money could be sepet to ciremnally invesitigate a govt contractor. And SSA and FTC OIG's said it was misues of SSN to defraud and HHS? in Dallas? blcked the cyber cirmes divico sof the FBI in Dallas from investigating. In fact they even asked me to file a complaint and that resulted in retalitons for Ms Evans ( probably not here real name) there which is listed in the ciivl rights complianst filed since 1/08 of which the first one reosulte din the regional manger Ralph Rouse calling me and laying me out cold and reducing me to tears for even filing. and further retaliaaitons followed and he has never allowed one civil rights ocmpalint to be assigned, read or answered. HIPPA complaints did get docketed in and answered but they do no good as HIPPA does no cover govt officials or govt contractors.
So Doyle Adams, as my no attorney legal representaitive and I appealed further and listed and included all the oxygen claims from LIncare and Rhema and All About Mobility and asked for recovery from ACS- as US dept of albor be done.
ON CASE M-09-1406 I received the same rulings as before. Affirmiing the life time approval for liquid oxygem by medicare but not setting aside the suspension fo the enforcement done in 1994 and stating I would need to go to US Federal court and sue unde the False Clims act. BUT AFFIRMING THE LOWER JUDGES DECISION BASED ON THE DUMENTATION AND SUBMITEED TO ALL OVER AND OVER AGAIN TO NO AVAIL AND NO CHANGE OF ALTERATIONS THAT MEDICARE IS SECONDARY TO FEDERAL BLUE CROSS BLUE SHIELD AND TO FEDERAL WORKERS COMPENSATION. THE SAME INFO OBTAINED FROM OPM along with advice I should not forget that Federal Workers compensation law overrides everything. I do not even know what a permement civil ervice bnenfits check might be as we have never gotten to the point to find out as that is part of the entire process not completed and then I would be able to choose between that and a buy out or just receive monthly wage loss checks from Federal workers compensation.
This is also obstructed any proceedings in Hudson County NJ court of the law suit filed by us agsint hartz mountain et al as its in a kind of abeyance waing on the the federal government to fighre of wht all the injures ae and the total damamge costs since is was filed under the orders of the Federal workers compensation law to reimburse the taxpayer. So CNA, the insurer and et al others listed may be thinking that as time goes by any esonable response may be in their favor and the taxpayer not be able to get monies restored. Too many parties have an incentive for my files to disappear not to have due didligence for securiuty of them and stop this pattern of illegal acitons against it so it can not be timely worked with all the due process rights one is to have. And not the least is putting my life in grave danger, especially now. I may make a typo or other misstatement but its a clear and undeniable fact this is a very personal life and death struggle and I CHOOSE TO LIVE AND I INVOKE THE TERI SCHIAVO LAW AND ASK FOR POSITIVE ACTIONS TO TAKE PLACE. Those who think its worng to beg fr the right to live, I don't and I am begging every legal way possible even when one retalitoation after another has occurred and gossip and rumors and misisnfroamtaion run amok.
Three things occurred.
Number 1 is unsucesslful attmpets to getCigna Govt Serivces, now Celerian Group and now owned by Trailblazers parent company South carolinsa Blue Cross/ Blue Shield to process all of the pending oxygen claims from all three suppliers as well as from me form the local gas company manufacturer. I am aware that medciare will not apy if there is no supplier and later did get a denial for that rason and there was a reconsidieration and now a hearing has been pending to try and get medciare to pay if no suppler is available. But ACS has control of their paper and I have not been able to get to a hearing on the issue. for nearly 6 years. JUSTICE IS SLOW BUT THERE I OBSTRUCTIONS SLWOING IT MORE THAN IT SHOULD BE. ACS? HAS DONE THIS WITH AN SSA HEARING FILE DIN 8/09 AND CAUSED SOME SUBSEQUINT ITMES TO BE THE ONLY THING SEEN BY THE JDUGE AND THAT GOT DISMISSED AS JUDGE HAD NO IDEA THEIR WAS A HEAING LEGALLY FILED BUT DISAPPEARED FROM THE OFFICE ON ENTITLEMENT FACTORS OF MEDICARE WHICH IS SSA JURISDICTION. About 1/3 of the publicized back log got worked thorugh in quick order and one of them was mine. Also the Hearing got dleted off the system and the head of IT for SSA says that can not occur and the system was hacked into to do that. LOTS OF HACKING DELEITONS GOING ON WITH OUR LIVES AND RIGHTS AND NO ONE IS NOTIFIED.
Now, The Appeals council sent the file back and most of it got posted by ACS, but no ne seems to know at SSA that they have a backlong of over a decde of items to process and I continue to overpay my part B Medciare prieurms as a result of new software that apparently has no field to enter there is a workers compensation case involved which alters what occurs with benefits rights, etc. Northrup Grumman and Lock Heed Martin has been reported are the new software programmers and all paper is ow scanned to ACS as locals have said. obviously securuty of files is not there when seltively not wanted to be? Since 6/68, I only knew of two paper files ever go missing in our offices and both were eventually found. So contracting out is not the anser to security, but overturning that naitnaide olicy not to invesitigete even a gross pattern of diesppearences of files paper or digital a felony. has to be must be changed as in my case, this intentionaland constant pattern is obviously an intent to commit a crime and cause threat to life and livelihood. ITS A CRIME TO ALTER OR DESTROY OFFICIAL GOVERNEMENT RECORDS. Why are those doing it think it is OK? Because someone verbally says its OK?
RESPONSE TO LETTERS FROM TEXAS BLUE CROSS BLUE SHIELD FEDERAL DIVISION DATED 7/8/2014 AND COPIES ATTACHED.
ALSO ATTACHED IS PAGE 138 OF THE FEDERAL CONTRACT COVERAGE.
Page 138 clearly states that if one has multiple insurances and health plans and one of them is Medicare. Medicare will determine which plan is primary and secondary, etc. M09-1406 IS THE APPELLATE JUDGE AT MEDICARE AND THAT IS THE HIGHEST LEGAL AUTHORITY AT MEDICARE. I AGREE WITH IT.
But another twist and turn took place. M09-1406 EXPOSED A GRAVE WEAKNESS IN THE MEDCIARE PROCESS AND HR 1063 WAS PASSED BY THE HOUSE AND WENT ONTO THE US SENATE AND WAS PASSED IN 12/12. PRESIDENT OBAMA SIGNED IT INTO LAW 1/11/13. It resusrrects, with added fines and penalties, the original conditional payment enformcment actions. AND NO GOVERNEMET OFFICIAL NOR GOVERNMENT CONTRACTOR IS IMMUNE.
This constant alteration of the official positng to the Common working file has put every medial supplier and provider at risk as they pay big money , or their billing services do, to access it through a CLEARING HOUSE' and if they follow what its altered to soon after psoitng they could be geitng fined and penalzlied for the acitons of those who have now been b givien authority over enforcing the law. THE SITUATION, IN MANY WAYS IS NOW WORSE. And since the respsinsiility for enfremcment is taken form the patient and given back to the government, I am in a legal quandary as to how to proceed as all my files need to be reconstructed at Emblem health's sibsidieiary Recovery/ cocoridnation unit and they are taking it up on themselves to continue altienrg the file to make medie primary. My contacts to the HHS OIG phone line , which is another interlocked company and is no linger a fraud reports back more of an ethics one, resulted with in a couple of ours the recovery unit adding my Blues back in as if it were a secondary to medciare medigap type policy.
SO I AM PROCEEDING AS THE APPELALATE JUDGE ORDERED AND A LEGAL OPINION GIVNE IN DETIAL FOR PHILIPS AND COHEN FLASE CLAIMS LAW FIRM IN WIASHNGTON DC THAT I HAD 6 YEARS FROM DATE OF DISCOVERY TO FILE. I went public as a reault of their lengthy opinion, but they do not take case unless they are in much larger amounts.
NO ONE AT CENTERS FOR MEDIARE AND MEDICAID SEVICES SEEMS TO HAVE ANY IDEA HOW HR 1063 IS TO BE IMPLEMENTED YET. Most seem not to understand that the original law was passed to cover situations just like mine. And I suspect that the time extension for the employer mandate and not even covering dependents under the Affordable Care Act has occurred due to HR 1063 being made law as any whose dependent has a medicare card, they would be penalized for doing exactly what is occurring on my Common WOrking file and an illegal dumping on to Medicare. So Speaker Boehner, please reconsider any law suit and address some major flaws in the processes and what laws need to be passed to supplement HR 1063 under that law. First is to stop the govt contractors such as Emblem health and ACS, etc, from running amok thinking they have the authority of a judge. or the laws of this nation that are good laws if obeyed that protect those most vulnerable among us who have suffered job injuries and are caught is system that demands they proceeds wth claimsand even law suits up against billionare companies in order to just get a 41 liter tank ofliwuid oxygen filled every 10 days or so. A small cost in comparison to other kinds of medcial treatments and services and equipament that is covered under all insurances.
Another issue is that shouldn;t these letters have come from Tulsa , my resident Blues office? But, I have gone ahead and forwarded these letters and the Expanation of benefts to Afifliated Compter Serices -Xerox as US Dept pf Labor contractor and ask that all the oxygen clims pending fr over a decde be input and processed. and paid. And that either LIncare or Rhema be contacted to get the rest of the info needed since I only had the paid recipets and invoice information and attached those to the claims forms which I have complted and submitted timely over the years. along with a trvel voucher.
I am requesting you also go back to when Federal blues first paid or oxygen and request a refend form them also. And the Secretary of Labor problaby should be sent a copy directly as so far the govt contractors think the jduges are not to be obeyed and there has been no change in status sicne and there can't be any reteriment just because a govt contractor wants there to be.
Even SSA has dleted me off the employment roles based on this verbal misinformation and I have ben aunable to obtain a copy of my personnel file for several years as it appreantly was sent to e digitized and went? If I were truly retired, it would be in St LOuis, but my attempts to locate it there have bene unsuccessful. If any one there got it and saw an open workers compensasiton case it would be returned but who is scanning and digitizieng them now?
When judges and the laws are not followed all kinds of chaos results and lives and livelhoods get endangered. Its why we have due process rights also, so if an official deidiosn doesn not seem right, one has the appeal right to go forward. But appeals have to be done by one with official suthoity and with all the factsand files avaialbele also. So far OPM has allowed the same govt contractor misinformeing you as they get misinformed to do tose and they do not have access as the general consel did to even my signed agreement with SSA , my emplyeng agency.
Federal worekrs cmp law, just will not let one 'walk away' and not pursue those claims is one wishes any health plan to pay. And any OPM benenfits paid are only a temporary estimated amount when one is pursing a federal workers compensdsaiton clsim and they hae not done the peermemet didisilibty diedison and schejduale award yet. We are not een there on mine, as we don't even know how many boafy parts there are involved since he judges over there have been ignored completely since ACS took over.
The reference numbers on the 7/8/14 letters from Texas Blues asking Medicare to pay for my oxygen first when the Tulsa OK office has known the will not pay when there is nosupplier, but Blues will and has and they have called and verified this with the manufacturer that they are not a aupplier many times and wish they would stop bothering them with the questions. What we need to is for medciare is to either make a suppier who is now allowed to have a monopliy n an area take all covered patients, or go back to the free market system wehre all can supply as before and compete for patietnts. The competitive bid process resulte din a second regulation being passed in 1/08 that eliementate those that could do it cheaper as te small suppliers were just exhngieng filled tnaks and most only had a few patients and could hire a paret time person as I had and just call his cell phone when I was withit a day of being out. the second regulation was addressed in the ciciv rights ocpalints as thre is no need for a suppeir of liqiu osygen to have to have a reapiratory echnician hired to come to nes o home to induce a hear attack or other organ faialuer to get a low satuaration rate every two years when the medare reugaltions do not reqire it after approval for life and reocrds sohoing continueous useage as my reeipts filed with Celeiran do over the yars and most need an answer even if to say must have a suppier to get medcire to pay. Why resoeroaty techs are not listed as part of home health is a mystery to me as most of us will not need such unitl nearer hosopice tyepe care. Medaire payments for home oxygen seem way out of date with what is going on in the modern medical world. No linger does one get oxygn for three eyars andthen die. I'm now ieng told that when one has an injury like mine, one is an oxygen patients for day one to stop any further damage to other organs such as heart and kidneys. And my contention is that some forms of work might be able to be done if all the reaosonable acocmaodations are provided IN THE EARLY STAGES OF A PROGRESSIVE DISEASE WHIHC OXYGEN ONLY SLOWS DOWN. So far, any cures, such as from stem cell therapy have not been appoved as helpful in curing or benefiting. BUT ONE CAN ALWAYS HOPE FOR A FUTURE WHEN SUCH CURES DO OCCUR SOON AFTER SUCH AN INJURY----
SO the reference numbers on the letters are, K189412901,K189413001.K189413401,K189412101K,189413201.
It does seem 'odd' for these to be sent at this time. As all the other bills have been sent to Blues and to medicare and medicare had to pay primary? I have qewusiotned why the co pays from Blues have not been applied to the early dedudctible for years on any of us on the federal blues policy. Medicare just is not the primary and in the chart on page 138, of the blues contract, the psitng form the us dpet of labor and the laws themselves show me as active duty unti ACS allows the process to go forward for me to get retired by my clims eximener ieng able to compelte the process which is a major undertaking not of my making of an almost 26 year back log.
Where CEO Lynn Blodgett got the idea thjat I had gotten a setltlment and retired is something I wish he would tell me so we can find out if there was a million dollars stolen form me and other in what the OIG for OPM inspector had said was a susuepcted embezzlement ring operating and go find the money or what ever was to have occurred when ACS got the contract. I NEVER GOT ANY SUCH MILLION DOLLARS. SO WHY WERE THE ACS CALL CENTER EMPLOYEES SAYING SUCH? ON ME AND OTHERS IT WAS SAID ABOUT?
Have lives and livelhoods been put at risk over more illegal skuollduggery going on?
In my case, there could still be a slim chance, to reocveor the monies frm eht thrd party law suit for the taxpayers. Its another unresolved matter, held up over all that has gone on which wasbeyond my control to stop as I can not arrest anyone, cancel a govt contract not provide 24/7 secuduty of my govt reocrds inside the govt and their contractors.
I have been writing on this for sme time, now and am ver tired and its needing spellchecked etc.
I have treid to cover all the issues that are already in the various filings and in Vioaltions of vivil right pagea 1-47. These are references to sections, but set it up as pages. And have done updates as comments to them. Also, attached are several pages Doyle wrote and we both signed that have been filed recently also. I am pleading for a positive concludison to all of this. The law is clear that Federal worekrs comp is the over all law and that process must be allowed to go forward and I need to be able to breathe to assist in any way possible and so is my family who have had real fincnial hardships to suffer over all of this as well as constantly hauling liwuid oxygen tanks, and copying and filing and writing and stamping so I can avoind as much of the ink and ppaper as possible, And I am not able to do this full time either. I am having some chest pains right now and do need to rest, but not filing andproceeding is not going to help my right to life to continue either. .
Please do understand, I wish to cooperate fully in complying with all the carous jduges orders and laws and pray you will also. This impasse has to cease of who is in charge in this nation , the govt contractors, or those who pass the laws, and are to carrying them out along with the jduges to clarify. The later is what our US constitiuion requires and not some 'deals' made to get around the laws. Laws are not secret ones in this nation with regard to any of the programs mentioned here so its pretty clear that M09-1406 is to be upheld. AND I AM REQUSTING THAT HR 1063 BE ENFORCED IF ALL THE PARTIES DO NOT COOPERATE. THOSE BEING GIEVEN WORNG INFORMAITON SHOULD GO AHEAD AND BILL MEDCIARE BUT SEND THE CSLIMS MANUALLY TO THE MEDCIARE RECOVERY / UNIT AS FOR YEARS, I THOUGHT THERE STILL WAS A WAY TO CODE THIS ON THE SYSTEM, BUT APPARENTLY, THE LAST SSYTEMS CONTRACOTR DID NOT PUT ONE ON THERE FOR ; PRIMARY PAYERS WON;T PAY AND SEND TO RECOVERY FOR MONIES TO BE REPAID TO MEDICARE BY THE PRIMARY RESPONSIBLE ON ALL THREE OF US.
The judge also stated on M09-1406 that the patient is overpaid for the wrong actions that have occurred, but we have filed Forms SSA 632 per the 2005 agreement between SSA and CMS to process this kind where one does not give personal financial information and states its 'against equity and good conscience for us to be overpaid; You all well know, how much we have tried to stop what has been going on. All we have asked is for needed health care and if Medicare is being forced to pay to code these as a conditional payment, or to treat as such as Cigna Government Services has been the only one that even sent the paid claims to them as the other letters were done on their own by the recovery office in Detroit before they moved to Oklahoma City by using the info from the National Health Insurance data base, which has other patients records co mingled with mine, and since its an Emblem health contract its not under HIPPAA. But they did get much of them and sent out the same letters and ACS ignored them and never shared them with anyone at the US Dept of Labor we are aware of. So Cigna Govt Services legally correct actions, allowed us to be able we go ahead and get the judges' clarifications and HR 1063 as it clarified it even more for Congress and the President. They knew, because when they went to pay the claims under mediare the rejected as that item is coded for a primary payer Federa Workers comp and the reason it is an open case with perement medil bennfifts and evey healtin gproess eeds oxygen and why all my clims need to go to federa lworkers comp first for a deidiosn was to t wehter they are to pay them and any non payment has to been sent with appeal rights and so far ACS has not followed the basic consittuitnal rights of all in how that is done,, either usig some form of offline dummy system and saying some third party should pay when none exists other than whartever they show for the million dollars which none of us or my attorney have ever seen or know of and no ones seems to know. All I do know is that the party at the US Dept of Labor that gave the contract to ACS was convicted as part of the Jack Abramoff bribery scandal and he also issuedthe order not to post my file and to Let her die and said it to me directly and added because I was old? he pled to a guilty for not reporting his being wined and dined and given sports tickets by Jack Abramoff, but no one has ever investigated ,we are aware of. The misdemeanor plea came soon after the 2/09 appellate judges orders to post using my records , pay and ask me for the facts of the case correcting the misinformation saying I did return to work in 1990 and listing all of the accepted conditions which had disappeared? and after I posted an open letter to CEO Blodgett in 4/09 online at the washingtonpost.com and one can read it there. I sent a copy to him and never have been allowed to speak to him before or after that. But it was after that he began giving out misinformation to all the agencies on me.And govt letters written quoting him as his misisnformation was followed and not the jduges orders. If a million dollars a head went through and disappeared? If it did, should I face death due to it and loss of livelihood. we do not live a high life style, but what had been awarded would allow us some financial peace of mind and our dependents have suffered as we were not able to help them as often our son has had to help me out to stay alive by paying for oxygen.
Other parties will get a copy such as al the Part A, B, and D medciare claims processors who have already been notified by us to send all the clsims paid on us by medcicare as primary and all of mine to the Recovery/Cooridnation unit and they MUST STOP ALTERING THE COMMON WORKING FILE. FRO THE OFFICIAL GOVERMENT BI =WEEKLY POSITNG THAT THE MEDCIARE JDUGES AND WE AGREE IS ACCURATE AND SO DID THE OPM OFFICIALS WHO ACCESS THE OFFICIALS RECORDS THERE AND THAT IS NOT THE GOVT CONTRACTOR CALL CENTER EMPLOYEES. TRYING TO FIND A NON EXITENT RETIREMENT DATE ON AN OPEN FEDERAL WORKERS COMPENSATION CLAIM WHICH NOT POSITN THE FILE DOES NOT CLOSE IT.
Yours truly,
Doyle, Linda and __________ Adams
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