My Comments - The Washington Post see my most recent comment over the budget issues in Congress and how the first business needs to be budget for our OIG'S and DOJ to enforce laws against the government's own partners involved in massive hacking and thefts of our tax dollars, that is on going at Medicare.
THIS IS A NON TRADITIONAL BRIEF ATTACHED TO A REMAND REQUEST TO MEDICARE APPELLATE JUDGE.
PLUS the need for budget for real internal audits which is badly needed also to make sure the rights of all are being upheld and that weaknesses that need Congressional or regulatory changes could have been years ago as all would have known what was really going on in side the partners. I am not employed by any company of President Lynn Blodgett of Xerox Management Services nor any of his partnered companies. he and his have no right to say I have no Federal Blue Cross/ Blue Shield not am employed by FECA law, nor to tell others I got a workers comp settlement and retired when his own actions blocks this from occurring. and never occurred. He needs to explain himself and if someone above him is ordering him to do all of this then the legal system says get an attorney and "turn states evidence." As a person of faith I pray for him to do just that and makes things right so this need for continued appeals for over payments created and fight for life itself, does not need to be prolonged.
REQUEST TO REMAND FOR A CONSOLIDATED HEARING ADDENDUM
TO THE PENDING CASE NUMBERS.
Even the premium issues are related to this hacked into Medicare system. When all have been ordered to use it and nothing else, then unless one is up working on cases in the wee hours of the AM every other Tuesday to see the posting come in from my jurisdictional employer, US DEPARTMENT OF LABOR very secured system that has been ruled as accurate by the Medicare appellate judge on case M09-1406 and no change in status to date. Then utter chaos has been created throughout the entire system of processors and appeals processors, etc. The loss of rights has created not only financial hardships, but endangered my life as I cannot get an oxygen supplier and when a tank stops working , one cannot afford to buy one as occurred with me, I am only alive now as my family hauls 200 lb liquid oxygen tanks to a gas company to fills with medial liquid oxygen and finally our son got a zero interest credit card for a year with a high amount credit card he used to buy a refurbished tank and I am making his payments for him on that. this is bankrupting us and I am approved for life for home liquid oxygen by three health plans of which Medicare got illegally dumped onto and then the recovery letters tossed by the contractor and claims never processed at the FECA contractor who is also the managing contractor for all three health plans as well as A CMS and OPM partner, etc. as they all said the claims would be paid if my file set up and input.
VICTIM NOT MADE WHOLE AND MEDICARE PAYS ,MUST RECOVER
All began with an illegal rifling of my file, and I was not made whole from that, even though the US DPT of Labor took decisive nation and contracted out control of files and data as they said' rank and rifle government employees could not be trusted with out files and data. but no one was arrested and was the massive thefts only a ruse to give the contract and put a cloud over the civil servants who always did obey the judges until the next rifling and disappearance. I still have items not processed to be paid and same already approved back to some in 1989. and they are all legally and timely filed and followed up on and judge after judge and hearing offices have stated they are in the file unprocessed so they cannot rule on payment as no initial decisions on each item.
MO9-1406 LED TO HR1063 AND NEED ENFORCEMENT ORDER TO BREAK IMPASSES AND SAVE LIFE.
Now that we have HR 1063 which that appellate decision lied to revival of enforcement of the conditional payment laws for the first time sine 1994, I still have not had the benefits of that used to help me and my family members on my Fed Blues who now have a Medicare card which is my other and their primary payer. FECA law overrides all and is why the posing from them to the COMMON WORKING FILE IS ACCURATE AND CMS CONTRACT FORBIDS IT BE ALTERED AS ITS HACKED INTO BI WEEKLY AND MASS CHAOS AND CONFUSION AND LACK OF CARE RESULTS.
Every claim is an overpayment when the recovery unit does not get the paid claim and this contractor has made it impossible for any oxygen supplier to get paid, also and none in 100 miles will take a workers comp case that this one cabal of over 100 companies now is taking control of all workers comp. not even the concentrator is available , if one can tolerate one, which is cannot.
When an entity as contractor of all can block a supplier from sending in a claim, and even providing the medical necessity form to the doctors, then President Blodgett's management company over at Fed Blues illegally refused to send CMS intermediary the medical necessity approval for life they had and still have and could be used as they had gotten a low oxygen saturation rate of 88% back in 2000. when I got left with no oxygen by Lincare.
But the 2005 Medicare guidelines which compiled years of precedent decisions as the rules have never required this if other conditions are present, but none follow them. they do not require this inducing of a real type of heart attack to get this when other diagnosis are in file. but I did have these low rates sporadically over the years when I got left with no oxygen. and began to die. and then one is put in a real DEATH PANEL. On oxygen , I maintain an 98% normal rate and why one can live for decades, on oxygen, if they can get it. as the progression of disease is greatly slowed. THE WHOLE SYSTEM IS IN CHAOS AND MAKES NO MEDICAL SENSE ANY MORE WITH NO ADVISORY PANEL OF DOCTORS, TO REVIEW GUIDELINES AND KEEP UP WITH MEDICAL SCIENCE. Something that was in the original program and each claims paying company had a doctor on call to help assist and often called ones doctor if things not clear... now its play the numbers game and medicine and science seem to be oblivious to the process that is HEALTH CARE BEING DEALT WITH.
WHEN ILL Blues WAS PERMITTED TO TAKE BACK, MONIES THEY PAID FOR OXYGEN FROM LINCARE AND DUMP ONTO Medicare and then REFUSE TO TURN OVER THE MEDICAL NECESSITY FILE TO ME , LINCARE OR EVEN MEDICARE AS REQUIRED BY LAW, THEM THIS LEFT ME IN A REAL DEATH PANEL. At the time I did not know the same entity was in charge of all of three health plans.
My and our persistent efforts has led to no service and All About Mobility did take over and if it had not been for a regulation that was passed with no input from the small suppliers , who found it passed one day in 2007 that they had to hire a respiratory tech to take care of a few liquid oxygen patients each,, but not the concentrator patients, few could afford to pay for this and it is not a medical necessity at all. few of us will need this until nearer the end of life and may be not even then. when home nursing care might be needed. and should logically be part of that. What has occurred is doctors will not commit malpractice and induce a heart attack to get the low saturation rate, so they send a respiratory tech to ones home, and with out any EKG,induce one. and cause permanent damage in order to get the oxygen to live.
Its very dangerous for one can go I into a type of EKG reading of out of sinus rhythm and adrenal surge that can end life, also, in order to keep trying to breath. THE ANGINA PAIN IS HORRENDOUS AS THE BLOOD BACKS UP IN THE LUNGS AND HEART CANNOT NOT GET ENOUGH OXYGEN. AND MUST BE ENDURED WHILE BEING COMPLETELY IMMOBILE TO CONSERVE ANY SEMBLANCE OF ENERGY. One more time of this, I wonder if I would survive???
ILLEGAL HACKING OF OMISSION AND DELETION OF OXYGEN SAT RATE
ITS NOR REQUIRED BY CMS, AND WITH THE TECHS NOW HIRED, GETS DONE, YEARLY EVEN IF ONE IS APPROVED FOR LIFE AND THAT APPROVAL IS OFTEN NOT PUT ON THE SYSTEM TO CAUSE IT TO BE DONE OVER AND OVER AND CAUSE PREMATURE END OF LIFE AS ONCE DAMAGES HOW DOES A HEART, ETC. RECOVER?
No doctor can do this with out risk to practice and patients , yet if the patients survives they get oxygen to live. These hearings are crucial to in any way stop this real harm to all.
Thus putting many out of business who could deliver cheaper as they just exchanged filled tanks and hired someone one part time to deliver. There are hearings pending on all of this that have not been heard to date. With no internal audits being done, what is horrendous, is not known to CMS unless it comes out in an appeal or hearing.
WHAT HAPPENED THAT HEARINGS DID NOT GET HELD AND BEG FOR REMAND
A HORRENDOUS MIX UP AT THE MIAMI MEDICARE HEARING OFFICE HAD ME SCHEDULED FOR ONE HEARING AND THE JUDGE HAD BEEN GIVEN ANOTHER CASE.
Instead of rescheduling both , and dealing with these issues that are still causing havoc and harm for all, and patients lives at risk, both got dismissed and led to appeals filed with the Appellate board with no answer to date and follow ups have been made and even e mails sent. I had invoked the Teri Schiavo law for the Oxygen issues. and included in that is the remand by the ALJ for River Trust to get the claims from Lincare and RHEMA. as medical necessity clearly met back to 2004, when University of Texas ran a cardiopulmonary stress tests and got a low rate and before that Medicare was required to demand the medical necessity file , by law, be turned over to them from Fed Blues and before that workers comp was paying for life and still is to be and part of the time both Fed blues and FECA were paying the same bills. to Lincare and to the company they bought Health Connections. as a monthly set amount.
Claims they should never have been denied to file and be paid for since the medical necessity , even using the now used requirement of a low oxygen saturation rate had been met even before I became entitled to Part B Medicare on 8/1/2000/.
I HAD NOT LEARNED THEN THAT PRESIDENT BLODGETT WAS IN CHARGE WITH ALL THE MANY COMPANIES ACTIONS' FROM EVERY CONFLICTING END. No wonder he gave the order "LET HER DIE as if it came from OPM when he had controls over there, too. WHY WOULD AND DOES HE DO THIS AND BE ALLOWED TO CREATE A REAL DEATH PANEL FOR SOMEONE?
Even those time has passed, all matters on this have been kept alive and pending by me as all being settled means life or death. I spent nearly 24 months from 7/13 -4/2015 with a defective tank having to lay it down on its side on a dolly and raise it to get oxygen to flow out. as we had no money to buy one, and Lincare and RHEMA continued to deny me service even though one of my doctors, well documented the 88% oxygen saturation rate in 7/13 Only to have the entity in control of all to spew out false gossip that the doctor only put done what has been on records for years. Which the law an rules would be enough. anyway , if any one would follow them. CMS was sending out press releases explaining this and all were being ignored as no internal audits done any more, no one knows what is really going on.
For one with my diagnosis its inducing a type of dangerous heart attack to get that low sat rate. And doctors will not do it as its malpractice. Its why there is an approval for life on this as medically there is nothing that cam be done to reverse the progressive disease. . But when the tank gave out I went to my regular scheduled cardiologist visit and he put an oximeter on me on an echo stress test, and then laid me down as the sat rate went on down as my heart failed ... when one goes back on oxygen the rate then comes back up to normal and documents how one an live with oxygen and die without it. how many have already died in this chaos, created due to no funding from Congress to do any real internal audits to stop this horror. And in the long run home liquid oxygen keeps ones over all medical bills lower. I have only needed to spend only one night in a hospital after a surgery in '07 in over 20 years. A lot of high heath care money saved to pay for home oxygen.
MIRACLE OF THE WELDER
So a doctor , acting on the spot did what was needed to be done to save my life, and the entity in charge as contractor still blocked life.. It was only by Doyle speaking to a welder that he learned about some ways to do some repairs to the tank that I could only get about a 1/2 Liter of oxygen out of at the time. And with super glue and gorilla tape and laying the tank done to the level it did not spew out the top, I survived for nearly 24 months and medically was not good as it was not a consistent 24/7 prescribed liter flow. There was less I could do around home and paper work got delayed until ore recently and trying to catch up.
ONE REASON FOR DELAYS OR THINGS NOT IN BEST LEGAL ORDER IN SOME MATTERS IS THIS DEATH PANEL IN EFFECT AND NEEDING TO CONSERVE ENERGY IN ORDER TO BREATHE.
Repeated attempts to get service from a supplier was met with utter blocking that should never have occurred as we have the paid invoices to prove continuous usage There is also a hearing remand request pending to review the unconstitutional regulation of Medicare not paying when one cannot get a supplier and death is imminent. and the only option is going direct to the manufacturer and many of then no longer sell direct to a patients. Fed Blues and even FECA has paid in the past for this option. Fed blues was paying some up until 1/13 and now they want a decision from Medicare and so far Celerian group is not been processing the invoices attached to the 1490s and says they cannot locate the 2010 and 2011 ones. which they should have on the system; But make no mention of all the rest not processed filed with Palmetto GBA and Cigna Government Services.
HOW CAN ANY PATIENTS GET ANY HELP FROM GENERAL DYNAMICS WHEN THEY HAVE NOTHING? And cannot check things out and neither can ones Congress person as they cannot contact the contractors of the government either. all under one man's control who has decided what the facts are to be and if one dies as a result? And in defiance of 38 agency judges from multiple agencies on me alone. HE IS THE LAW, NOW, NOT CONGRESS OR THE PRESIDENT AND NOT ANY AGENCY UNDER CMS OR HHS, OR OPM,SSA OR ANY OTHER ENTITY. WE THINK IS TO BE IN CHARGE UNDER THE US CONSTITUTION. ALL these agencies have two sets of facts. one that is real and upheld by judges an the others created by? and used daily by all instead under President Blodgett and partners with no regard for a plea for mercy in the matter.
When a patients is forced to file, then where is our contact person that is to process the claims? as we are forbidden to speak to them? And they seem to not know what to do or whom to ask when things like this occur that should never happen by the laws and regulations??? And the providers and suppliers speak to those with info from President Blodgett, et al. and why he thinks he has the real info is beyond me to know at this point. I name him as he is named by government officials as the only source of info for them. THEY DO NOT KNOW WHAT TO DO? No one at CMS knows anything as no one knows what is going on and if they did they could be arrested???
Fed Blues was paying about 60% to reimburse me since 1/1/08, until 1/14 and now wants a decision from Medicare first. And said they would pay for a new tank, but NO MEDICAL SUPPLY PLACE CAN SELL ONE TO A PATIENT AS THEY HAVE TO BE SOLD BY THE SUPPLIER WHO FILLS THE TANK. NOR tubing nor the bottle cup for distilled water, which I now use compounded drops in to replace inhalers that cannot be replaced safely by those now on the market. In many ways, I have done better with these than the inhalers , but innovations in treatments get blocked with no one to rule on acceptance. of these and those claims are pending at various levels also. Some studies say 11 million patients have no safe ones as FDA refused to recognize those with chemical reactions that inflame and are not allergic ones and that cause severe inflammation and life threatening results, too. ( WE ARE EXCLUDED FROM CLINICAL ASTHMA TRIALS AS WE HAVE HEART ISSUES)
One way to effect change in Medicare is to go through the appeals process and if CMS does not change the rules, nor able to legally bend them under medical necessity to save life, then it PROVES TO CONGRESS the need to change the law as occurred with M09-1406 and HR1063. In my case a lot of rules got disobeyed to put me in to this mess. Medicare can legally pay as a conditional payment and long ago should have recovered the money and the pattern in the past is that all would have been made right again if real government employees were still in charge and allowed to obey their own judges as they did in the past.
(More is written of elsewhere on line of real skulduggery that has gone on that is not under CMS per se, but does involve high level HHS officials or former ones. as they were the employer up until I went back out on temporary disability the last time in 1994 and being put on home oxygen is now known should have created a domino effect of on to retirement and schedules award etc. and the illegal rifling of my claims file and other matters at SSA, blocked this from occurring and no criminal investigation occurred that should have as those in charge who could block that were said to be the ones involved. There have been co worker deaths over the years, and is said my medicals proves why as all of us were black listed by the peer review (contractor )before we got to the hospitals back on 1/10.89 and they did not get the tests run to show the toxic fumes and damage as I did do to a mix up as to whom my employer was from a misreading of my health insurance card? I still think, the admission clerk just did it in civil disobedience of her government anything care to its own badly injured workers. But AFGE FEHB got changed in to Port authority until the diagnosis led to the toxic exposure reports being filed with the NJ health dept and the mix up being straightened out led to me being sent home to die and not admitted as I was being prepared to be with mucous membranes burned off and near death already. Rushed to another hospital when stopped breathing., etc. soon after. and more is online of the struggle to get even initial care done by doctors fighting forces that rule the earthly world.???
Many crimes got committed, and many cover ups to date AND MY MEDICAL RECORDS ARE KEY EVIDENCE AND MY WORKERS COMP CASE INDICATES SOME SHOULD HAVE GONE TO JAIL AND NONE DID AND THE PATH TO 9/11/01 was cleared to occur from then on. Every file has been disappeared or hacked over the years in any agency that has part of them.
Another way is for an advisory group of doctors to approve coverages of treatments when there is an issue none can figure out. BUT THE FILES AND SYSTEMS RECORDS HAVE TO BE INPUT AND BE THERE.
My contention is that this regulations of hiring a respiratory tech, was not medically needed, and was nothing but a ruse by the larger companies to eliminate competition as competitive bid came in right afterwards. These services could be done under Home health for those who need them?
The larger companies do not exchange filled tanks and have higher over head to bring a huge tank to ones home and fill the tanks there. Since the largest supplier and the major manufacturer now are owned by Lindegas of Germany, it seems there is a real concentration of power over this. And that gas company will not serve a patient/ Mine has new ownership from Japan, almost stopped selling to a patients, too last year, and death would have been imminent again, but they changed their decision. May they be blessed with good Karma for doing so. Even a local hospital was not going to have oxygen and other suppliers who sold concentrators and provided the green bottles would have had to deal with their competitors gas company.
We were looking for any other company , even hundreds of miles from here to go to for me to stay alive.
I have tried to use the concentators, but its not a therapeutic level and within minutes the minute amounts of ozone causes life threatening inflammation. Even setting it out side does not help as somehow what is around the tank gets sucked right back into the oxygen coming through the tubing to the patients. I AM APPROVED FOR LIFE BY ALL THREE HEALTH PLANS INCLUDING MEDICARE FOR LIQUID OR COMPRESSED OXYGEN. AND WHY IS THAT NOT ON THE SYSTEM FOR ALL TO ACCESS SINCE APPROVED? THE GREEN BOTTLES COST A LOT MORE AND I WOULD NEED 3 A DAY AND THE COST PROHIBITIVE SO RARELY DOES ANY ONE GO THAT ROUTE ANY MORE.
SO HACKING IS BLOCKING RIGHTS OF APPEALS AT THE LOWER LEVELS. AND SO IS NOT ENTERING CLAIMS, AND NO SUPPLIER CAN CALL AND GET THE APPROVAL FOR LIFE IF OMITTED AND WHY/ BECAUSE A NEW COMPANY OR NEW OWNERSHIP MEANS ALL THE PRIER RECORDS JUST DISAPPEAR ALONG WITH ONES RIGHT TO BREATHE? Its been reported that just such retaliatory actions have gone. on. NO ONE AT CMS KNOWS ANYTHING as no one does any internal audits any more.
The Medicare law, allows the patients to file a claim and get a reasoned legal answer. 1-800 Medicare has been sent many of these , by the intermediaries and thus none know the claims have even been filed . I have attached our letters to General Dynamics to ask for them to help stop this 'dumping; onto their call centers. Some have never been sent on to me, nor returned to be processed and I wait for answers to claims and even redeterminations have ended up there. I cannot call them direct so they disappear causing l more chaos.
We have had changes in intermediaries, and every time, we have had to refile claims, and appeals and they never seem to know anything about what they inherited from their predecessor.
THIS IS THE BIGGEST EXCUSE FOR ANY LATE FILING FOR ITS NOT LATE, IT JUST DISAPPEARED IN THE CREATED CHAOS WHERE THE PATIENT HAS NOT RIGHTS TO LIFE AND LIVELIHOOD AS BOTH ARE GRAVELY AFFECTED .
The information giver to the clearing houses is also President Blodgett of Xerox Management services and there over 100 companies and as many other ones with controlling interest and they even own clearing houses and are the management firms for many providers and suppliers, plus they sign up all those to bill Medicare as ALL ARE TO BE ALLOWED TO BILL AS ITS THE LAW. to bill Medicare to get their decision first when one has a Medicare card. FED BLUES AND FECA need the response that Medicare is not primary before they will pay. But instead the intermediaries seem to understand they are to pay the claim first. That is not what we get on an EOB. they need a decision, not pay first. ACS has taken over some of management control of my own medical providers and not just as info giver to theirs and its become difficult for patient and doctor relationships. I have lost a couple over it. as the patient loses in this. without government stopping the interference of medical care. I either sign to knowingly commit fraud or not get care , has occurred a few times. I cannot say I do not know having conducted Medicare fraud investigations in the past, and worked with the programs since 6/68 when the government was much more involved in knowing what was going on. and this chaos could never have gone on so badly for so many years if the government was still in charge of over sight and its not. I do not know all, but I knew 17 years ago things had gone way wrong and was stunned to learn bit by but just how badly for me and all of us. as taxpayers. yet Congress has not acted. And these hearings are the first attempt to put all in legal context to try and prove the limits of the system as it now is for anything to be made right that has gone so wrong.,
THIS GOSSIP AND RUMOR AND MISUNDERSTANDINGS WOULD be stopped by real internal audits of all three health plans which are all government contracts and under the CONTROLLING SAME MANAGEMENT.
WHAT CAN BE ACCOMPLISHED BY A HEARING? Apply the laws, and rules, etc and do as Judge Carter, did , get the prehacked posting from US DEPT of Labor that shows the accurate info. President Blodgett is unable or unwilling to obey 38 federal Judges now and he has even been ordered to post my FECA file from my records and said I did return to work in 1990 and have also stated my accepted conditions again and again to no avail. since he took over in 2002. AND TO ASK ME FOR THE FACTS AS RUMOR AND GOSSIP HAD RUN AMOK.
Since 1/10/89, when injured as an HHS employee and became a type of medical precedent case on toxic and chemical injuries, there has BEEN NO SECURITY OF ANY FILE OF MINE IN ANY GOVT OFFICE OR CONTRACTOR. And a pattern of what 7 US attys' have said it two felonies has only once ended with needed action. and beefed up security. Its one to rifle or steal paper files or hack systems info , and another for the custodian of the records not to report the crime.
Only the FECA office in Philadelphia obeyed the laws.
Nationwide policy has been not to investigate incidents of files gone missing even when its a 27 year pattern of criminal behavior. And of course they have no budget once the contractors took over total control to 'PROVIDE SECURITY OF Records" now controlling the process and outcome by what agency can even see. if not posted. Even Judges orders cannot be obeyed as they used to be and reinstatement of paying and processing occurred. HR 1063 DOES NOT PRECLUDED ENFORCEMENT AGAINST CONTRACTORS AND THE OIGS WERE READY TO ACT IN 2013 ON CASES LIKE MINE when it passed. But it got turned over to the same entity to handle and its worse than ever?? Its been turned in to some sort of Medicare Set aside which is not what the law is at all, ,
And even though there is an alleged missing 1 million dollars per head of many of us older established cases who already had permanent and total medical befits from FECA do to oxygen approved for life, we ended up with Affiliated Computer Call Centers telling our medical providers and suppliers that we each had the million dollars and I DID NOT GET THAT AS IF I DID I WOULD BE PAYING MY BILLS FROM IT AND HAVE A LETTER TO SHOW TO EXPLAIN, ETC. There is no due process or even appeal rights any more on all of this.
And OPM OIG suspects and embezzlement ring and can do nothing without budget and OIG Director Patrick McFarland testified to the fact of no budget to investigate contractors in a 7/13 Congressional hearing on this entity falsifying back ground checks that led to state murder charges of the Naval Shipyard shootings. which brought a piece of all of this to light. Still no budget. And all think I should be contacting OIG and seem to not know they can't do anything if they even chose to. the only option is do the appeals and document what should or should not be going on and pray that HR1063 can be used as it has penalties and fines inherent in it and contractors are not precluded. from them so the need for budget is contained in the recovery of monies process.
All we know is that the Jack Abramoff bribery scandal is involved in some way , where the investigation never got completed at HHS, SSA, DOL, etc. If it led to contractors, they ran into no budget from Congress , also??? A lot of money is missing and no one knows where it is???? that is talking why all of this is going on and letting to go on.
I am in this situation since they took over, due to crimes committed against my files and data in the custody of the government and its contracts, and should have been made whole in the matters. My request for permanent disability from FECA is still pending and one of my former claims examiners at FECA even sent me a follow up letter to remind all its still pending on an open case before she retired in 2009. But no one at FECA has any way to make their own contractor obey the Judges, and laws , etc. As before when my file got 'disappeared', and judges remanded the case, the federal employees obeyed the Judges until the next rifling..
CONTRACTORS DO NOT AND WILL NOT IN MANY CASES. and no one can make them???? HR1063 says yes, and the budget is inherent in the law, as its a recovery action with fines and penalties to pay the recovery costs. The patients is no longer the one to file a false claim suit and few attorneys will take one for less than near 1O million due to costs when no way to do discovery through the civil rights or HIPPAA process. they are not under HIPPAA and our civil rights complaints are not even docketed in and answered and that would give recourse in all of this so the system is really broken for any rights of the patient in all of this. and . and with out all the bills processed through the Judges at Medicare , that got blocked.
Its part of the need to River Trust for the Lincare and Rhema claims as they should never have made me file the protected filings for them, that did not get processed or entered? and paid as their signature is needed??? and PTN etc??? They were required to file all and did not. Palmetto GBA colluded to not cooperate and I had to get the Medical Necessity form and the doctor filled it out in 4/06 from his own test results, and kept a copy in the file. The intermediary and Lincare refused to give one to the doctor. and that is completely wrong and why is beyond me? They would not use it from me, nor get another from the doctor either. All About Mobility did full cooperation when we finally figured out what was needed. But then, they did not understand about conditional payments and the process, and few seem to and all of this training that goes on does not help. In fact we were told that the contractor that did the training told them to ignore all the CMS rules and do as they had been doing. and disappeared the 2005 guidelines based on hears of precedent appeal approvals at CMS in violation of the US Constitutional rights of all to have equal protection. all from 2 or more witnesses is where I got it.
No auditor at that training session either and all done in CMS's name???
I wonder, in all the chaos if River Trust even understood what they were being asked to do and C2C Solutions now has the pending remand even if not on the system, nor in paper form. I have filed this with them but no response. THE PATIENTS IS COMPLETELY DISREGARDED as they contact Pres Blodgett's people and I and our rights get ignored. with no answer,
Medical providers and suppliers are also in a bad situation with no one in the government to aid to enforce the laws. They "get the message to go along to get along to get any kind of payment at all." Another matter that real internal audits would have ended a long time ago.
In over 17 years,the only intermediary that ever obeyed the conditional pay law, was Cigna Government Services,who paid the oxygen claims under Medicare and THEY legally sent them on to the Recovery contractor who sent out letters as they had done others with my self reporting, and THEY DID NOT KNOW THAT US DEPARTMENT OF LABOR PO BOX 83OO LONDON KY was not the government at all, and none in the govt every saw the recovery letters. This impersonation of govt offices and govt officials leads to more chaos as even many govt employees do not know that is not one of their own agency offices they think they are obeying a superior or the government in charge when they heed the words and orders given..
This intermediary no longer exists, having been swallowed up by the others, now. twice and now calls itself Celerian Group as a subsidiary of SC Blue Cross Blue Shield, the parent company of Trailblazers that created the 16 phony Medicare claims numbers on me and a $4 million theft that no one could stop except CMS did not renew the contract in our area. They had engaged in secret deal hacking with Coordination of Benefits (GHI) contract to delete Blues and make Medicare primary on each claims prior to 4/09 when the software hacking system was made a software program to alter the official records on everyone they chose to do so on and it is still used to today. soon after the bi weekly posting from employers. to cause harm and theft to all. Oxygen will not go through and get paid as its under the 1988 labor law to protect rights and has turned in to being used against us now. with the hacking. at CMS contractor.
The systems contractors have not done what is required and no one is allowed to check it out either to know. They are to use the date of injury on cases but use what is usually over 30 months later, the date of entitlement to part A Medicare so claims can go right through and get paid and the dates do not mesh. when all should be going to recovery unit. SECURITY IS INTENTIONALLY BYPASSED.
No one in the govt can even check the security protocols on the system and in 1/06 it was left wide open so that even the well intentioned was able to get in and make changes about insurance when that is hacking as none can change this but the employer. by their contact with CMS. My source was the high level official at CMS in Baltimore who was shocked to learn the security was not on there to block there alterations being done; Plus , I already knew it was not legal to do this.
US Depart of Labor, doesn't even know there is a contract or MOU in existence and refused to check it out, too. ALL of these matters HR1063 has the authority to do now.
Its not interfering with the merits of a workers comp case nor employment matters to enforce what already exists, Even if the workers in the agency do not know about it since they have been denied access to files and facts. its beyond me why my claim examiner had no access to even see the official records, those in DC can??? ITS the software contractor controlling things??? from every end and who do they get all their misinformation from ???? Same one as all above.
Of course all have appeal rights under HR 1063, which so far is been sporadic at best for the injured workers and as patients with a contractor making secret deals to 'illegally dump' onto Medicare./
Please associate all for the judge as we plead for a remand of all to the hearing judge to do what every legally can be done for me and us and so many others, its said this is occurring to that reports are have lost the last earthly battle.
This is not a traditional type of brief but its signed by us and intended to be a legal filing. WE have no money for attorneys, for it would take a huge firm to even begin to do what we have been asked to do. Others have been said to be involved in the same chaos, but maybe they could be granted a waiver for not knowing someday when SSA implements their 2005 MOU with CMS to do these kinds 'against equity and good conscience where they give no personal financial info.
Since I have even done Medicare fraud investigations and been involved on the inside since 6/68 with the programs, I knew early on that something was badly wrong and began to question and find about and forced to file and file and fight for even life against an entity I did not even knew existed and soon found out about bit by bit as few even know inside the government to this day of it and the rest of the nation seems mostly unawares of the direct control they have.
That even the govt has no budget to stop. But the 1980 Conditional pay law, as well as the 1988 labor law that locked the system in for life for total coverage when the liquid oxygen got approved for life. at FECA, does have the revived power now of the original law, that always was the law, to enforce obedience to the laws and rules and put some order back into a chaos that has been created that allows some to steal from our most precious of tax dollars to be used for life to be sustained. as long as it can be. and chooses to be.
You have other submissions from us that mention details of the other appeals and we need to see all is put together.
There is a stack of oxygen claims involved that ACS has had pending for over 17 years, not processed and need to be made part of this. You should already have then in file if the intermediary had posted them over and over..As there is no issue that the total involved in over 100,000 dollars and the total is over 4 million. Since there is no OIG to investigate all of this, what is needed is civil decisions. and that means 17 decisions on the 17 Medicare claims numbers. for the time all got debited form the Medicare trust fund 17 times and 500 witnesses documented all that. and on all claims back to entitlement to Medicare MORE PROOF OF NO SECURITY ON THE MEDICARE SYSTEM TO PERMIT THIS TO EVEN OCCUR. AND WHY ALL THOSE WHO PROCESS THINGS DO NOT KNOW WHAT TO DO WHEN ITS NOT ACCURATE.
There should be history of precedents and rulings, and regulations on the original conditional payment law that are now available to be used. HR1063 is but a lifting of the suspension of the enforcing of the conditional pay law that was put on it in 1994. It does not replace it . But adds penalties and fines which could be done under the original. when actions were grossly wrong.. And I read the first few were four times the amount Medicare had to pay that was not their bill. We have filed our waivers and we cannot arrest or stop this at all, unless one dies without medical treatment.and MY CHOICE IS TO LIVE and OUR CHOICE IS TO LIVE. And even then the over payments get inherited and we have little to leave our heirs, but it would be a place for them to live and grow a garden to survive if needed. Currently , this entity has begun collecting from the very providers they tricked and all need to know we are here as witness for any of ours and much documentation as this is another wrong done to all who are struggling to provide treatment and care as well as the patients who are trying to get it. Seems it might have been a testing? As seems to have stopped???
We know of none of our doctors, etc. that have intentionally tried to steal from the government. but all are paying clearing houses for illegally hacked info and told they must use it as is. Financially this has already ended in bankruptcy and may again and never have credit to buy another tank to fill with oxygen when this one wears out if the USA has not gone broke first from not stopping those stealing from us that have been given unaccountable access to systems and data.
P.S There is a third party lawsuit pending that FECA ordered me to file waiting for all the damages to be totaled in Hudson County NJ. And even though it languishes, that in itself would makes all claims a conditional payment. We wait on the government to do what they need to take the lead on that. to reimburse the taxpayer for all of my medical costs. I think an attorney in Omaha was given the case years ago to act with us and mine for the government and he sent it back to get the damages figured up also.. A copy is in the hearing file submissions.
Linda Joy Adams 10/25/15
CC: Doyle Adams cc: Novatis CC: ACS as US Dept of Labor contractor
CC: Lincare
CC: Rhema
CC: All About Mobility
CC: C2C SOLUTIONS replacing RIVER TRUST
CC: Alan Porwich ESQ
CC: Aetna CC: AARP,CC: Medco ,CC: Caremark CC: Federal Blue Cross Blue Shield HSC holdings of OK, and TX
and many others we will add as we get to them.
CC: CELERIAN GROUP
CC: Sec of Labor, CC:Commissioner SSA, CC Sec of HHS
and over 700 medical providers affected by my one policy with Fed Blues and family members and why consolidation does make sense to get systems security on our records,
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