Katherine Archuleta Steps Down From OPM - Pay & Benefits - GovExec.com see my comment to article.
"THERE SHALL BE WARS IN THE HEAVENS AND INFO WILL RUN TO AND FROM"
For about three weeks it appeared that the hacking of the Common Working File at Medicare has been stopped. And that the OPM posting that came in later was used to delete my Federal Blue Cross Blue Shield for self and family rather than just being another posting that three on my policy who also had Medicare cards have it.?
This allowed full control of our health care and interactions with medical sources to be done by President Lynn Blodgett of Xerox Services over a 100 companies which one of them is the systems info for OPM and another is the management firm for our Blues. The US Department of Labor posting comes from the official records, there and NOT FROM A COMPANY OF HIS. although the first company of Xerox? Affiliated Computer Services has total control of all the FECA program and has compartmentalized it to the point that my own claims examiner has no access to any files, but what he wished them to have and they can't even have access to their own judges remand orders?
OPM has "sets of books , too." The official ones that a few at the top can access but then those that actually work cases, and give out info to those who can legally have it have the hacked into altered version of Pres. Blodgett.
So all three of us get overpaid to Medicare as all billing and claims processing contractors are lied to and told to use the CWF as it is and with no Blues on there and the FECA ignored as the date of injury is the wrong date for nearly everyone so it gets missed. by the system that any claims should go there first. Medicare has a safety net called CONDITIONAL PAYMENTS where Medicare can legally go ahead and pay when the primaries decide they do not want to . This labeling sends it to the RECOVERY UNIT to start a legal due process of sending out a letter to the primary and then all parties get to have their say, etc.
Three Medicare judges have already ruled that the official posting from US DOL is accurate as they got the internal docs. And it is. One of the basic workers tights in the USA is that injury does not end ones employment until workers compensation decides that one is permanently disabled and there is a compensation for that. Federal Employees Compensation Act is no different. There is a sum for loss of use of body parts, which is a negotiated amount for internal injuries and then one can chose to either take all the monthly checks for the average life time of a woman or man in a lump sum, or just go ahead and draw checks for life and dependents then draw a survivor payment.
This was filed for in 1996 and has yet to be processed.
One can do a word search at the top of this blog to locate other articles where I have discussed all of this in more detail.
Every claim paid by the Medicare contractors has to be appealed as its an overpayment since RECOVERY WAS ORDERED TO STOP RECOVERY PROCESSES BY PRESIDENT LYNN BLODGETT a few years ago. That order was never known to me until after it occurred. And one day pulled up my self reporting page there and found it hacked into and most info gone. Leaving only a more recent knee injury left that is tertiary at best. INTENT TO MISLEAD ANY BILLING PERONS THAT WOULD ACCESS IT. I GOT NO DUE PROCESS. He gets the notices that go to the US Department of labor and 'disappears; then . He is not a government official but all of his employees and partners employees are forbidden to let any one know they are not official employees of the government . Its one way this has been kept so well hidden for so many years. Even real government employees often do not know that the person they speak to or send info to is a contractor.
Most call centers are his people. an when one asks who they work for , one gets lied to as they say they work for , not employed by. and if one asks what is the employer name on their W2 they get offish. Feds know that our status is no secret, and even our salary and leave records can be obtained by the public. if ones file has not disappeared as mine and apparently 84,000? have. he gave a verbal order, is what I was told and ? all work stopped on my case by our workers compensation liaison
And that also meant not working on and hacking into Social Security claims as well.
So, my last blog was the GOOD NEWS of the hacking may have gotten stopped via OPM?
But BAD NEWS arrived last week.
Humana is Doyle's Part D plan and he has it as well as Fed Blues. Humana had made a deal with Walmart so that all got in on the small co pay for generics and Doyle does not have the super chemical sensitivity as I do and usually have no issue with added ingredients in meds. But is has obstructed the best ones at times for him.
But Walmart has not been able to double bill both plans and we have had co pays due for years and we keep trying to get them paid and WITH NO ONE WORKING CASES AND NO COORDINATION POLICY FOR FEDS yet on our employer health plans with Medicare part D as we have had for years with Parts A and B we are owed a lot of money we could badly use right now. So Medicare gets billed for the drugs and President Lynn Blodgett pays them under Medicare only and then never labels any as a conditional payment and never sends them to recovery .
For 5 years, Humana insists that Doyle does not have Fed Blues and our last letter to then posted here is another response to that. But another letter came dated 11/19/15 from one in their grievance and appeals department which I have yet to know for sure if its a HUMANA or An ACS employee of Pres Blodgett.
The letter indicated that the Blues was on there as primary and then instead of following the instructions they have had to just use the CWF as posted, they began investigating for the first time in 5 years. Later in the week we learned more of what went on. Apparently , a call was made to President Blodgett's people at Fed Blues which has never had access to see the CWF. And they should have it as they have to coordinate. EVERY ONE ELSE HAS ACCESS, so why wouldn't they be allowed to see it? It was from his people at Blues, that the order to Hack came to delete it, via OPM system? years ago. And they were the original ones that lied to Humana of whether Doyle had the Blues??? as back in 2/10 some real lying went on and all said it was from President Blodgett et al. I just share what we have been told and written to. If he did not do all this, then he needs to get involved in this cyber war, its reported he is carrying on against me and mine. My prayers for him to be the ultimate whistle blower and tell all and make things right for me and mine.
Then Humana indicated that a call was made to Recovery and Coordination for Medicare, which is Emblem Health International , formerly Group Health which has owned every ones medical data from all health insurance and owns the Common Working files as a contractor of CMS. And is forbidden to hack and alter info that comes in from an employer to the CWF. But the systems security protocols, we the taxpayers, paid for are not in the system to block even a 'well intentioned person' from hacking in and altering the info on the policy and employees status as mine has said employed and will until the judges are obeyed. and my case can be worked at FECA.
Instead of Emblme Health altering the records, as they have done for over 17 years on my case, they did not do so. THEY WERE BLOCKED OR ORDERED NOT TO ?
Instead, the letter made no mention of these calls and she went in but she did write that she changed the records at HUMANA. As if that was all she thought she was changing. First of all she is not to be changing any thing anywhere. and if she did , then its would be part of processing all claims paid on Doyle back to when he signed with them as a conditional payment,. Just print out all the clams and send them over to Recovery unit . That did not occur. And SHE GOT TRICKED INTO HACKING INTO THE COMMON WORKING FILE AS THE OWNER , EMBLEM HEALTH WAS NO LONGER ALLOWED TO DO SO. OR BLOCKED?
Obviously, not every one is yet blocked , if Humana did it.
I spent nearly 6 hours over two days on the phone with Humana etc trying to get any one to even begin to understand the law. I had one tell me that one could not sign up for a part D plans if one had a health insurance polity with a prescription drug plan. and she did not mean another part D. And the whole of them did not begin to understand that they were hacking in to the national data base billing system. No one has any CMS instruction manuals, or the laws, and rules and regulations either and all they have is the verbal instructions passed on from President Blodgett and his companies that have done a lot of unethical , unconstitutional and even illegal things already in all of this and no one in the government knows anything as they do not wish to know? But act scared to death that China might have peeked at their records? CHINA HAS NOT ALTERED INFO THAT BLOCKED MEDICAL CARE HAVE THEY ? As this bunch has done to us in all of this.
We thank those billing people and claims payers that did go ahead and pay the claims, but, when you did not treat them as a conditional payments you got all of us in trouble and at legal risk for over payments and some at criminal risk if any intended to by pass the legal process and do an illegal dump on to Medicare. Even if it means TRICKING HUMANA OR ANY ONE ELSE WITH ACCESS TO HACK INTO THE SYTEM AS THEY DO NOT WANT TO BE ON RECORD AS DOING SO ANYMORE? .
How could some be intelligent enough to get a job in management as they were and yet be so badly trained? Its common through out President Blodgett's companies and partners. No one reads? what is sent out by CMS which any one can get on line. as I do .And all CMS contractors should be following the agency policies and procedures.
The disconnect is horrific and life threatening in too many cases when one is speaking of health care being obstructed as it can occur when no one knows whom to bill first and follow that plans protocols and what they pay for. etc. and all under the management of Pres Blodgett from one conflicting end to another. if this is not him as reported to be, then he needs to speak out!!!
Finally, another supervisor of Ms., Hunter, began to understand the seriousness of what they had done as they were committing fraud against the taxpayer and Medicare. At no time did any one mention that for 5 years, they were denying that Doyle even had Fed Blues through me even though we had sent proof he did and ignored it and ordered to use the CWF. But when it was accurate, they chose to ignore it?
NO ONE KNOWS THEIR OWN JOB AND then tries to do every one else's job. is very common and not just at HUMANA. THEY GOT TRICKED INTO HACKING? The manager did pull up the definition for a conditional payments, but she did not seem to have anything more than that general definition. She should have specific info as to how to enter it on the system , etc. More than even the general public can access at home. She did not seem to have it or have any process for her people to follow. Little has changed at ACS since over a year ago ad it was discovered by me and others at CMS that for 9 years, nothing had been sent to recovery by them A real Medicare free for all by all the other health insurers and liability insurers too so they are staring a pilot project about an end result of Medicare set asides when they need to start at the beginning when they is any indication in the patients chart of another party to pay first and code it as a conditional payments then to either recover the monies now to Medicare or in the future with all the bills ready to be asked for when its decided who would pay, such as in a car accident . I really have not retired when my work is sharing what I know and been trained to do for years, myself. when this not knowing just would be inconceivable that all did not understand a basic law that makes every one behave in the whole health care industry. It was 1994 when Sec of HHS Donna Shalala sent out a memo we all got and said 'the insurance industry could 'police itself' and suspended the enforcing of the law. I who had been there before 1980 and the law passed, knew how bad it had gotten then with all doing 'illegal dumping; onto Medicare. Even some employer group health plans were set up as scams that never intended to pay primary and sold to companies who hired many senior citizens. and didn't until the US Attorney got them stopped and they folded up. but what went on years ago, pales in comparison to the lawlessness that is now going on. with use of cyber warfare to fight with.
Congress has to get a handle on what is going on and has ignored it for nearly 2 decades. now.
This process and procedures, etc. is what is straightened out in doing real internal audits. Its called making sure the constitutional rights of all are being upheld. And all is brand new to the companies dealing with Part D Medicare, 9 years after they began paying claims. or ILLEGALLY PAYING CLAIMS. as THEY WERE NEVER TOLD?
Emblem Health is being paid by the taxpayers to make do all of the work that HUMANA and all the others have found dumped onto them. All of the CMS claims processors, etc. seem to be having Emblem Health's work dumped on to them and why are they allowing it to do on? All Humana or ACS? had to do is what Doyle and I as his non attorney representative. had been filing for years asked: , print out all the claims paid and send them to recovery as a conditional payments. WHY ARE THEY NOT ALLOWED TO DO THE LEGAL JOB THEY ARE REQUIRED BY LAW TO DO?
This sounds like some kind of black mail or coercion going on ???? And Humana is only one of all over a dozen insurers we have dealt with since the over throw of the USA into President Blodgett and his partners and handlers and owners.... Or is the appeals and grievance units for all the Part D insurers really ACS employees? This is still not really clear to me??
I name him as he is the one named by high level official s as they have no access to files or data any more except through him.. Snowden worked for him through one of his partners, too and wish that man had blown the whistle on this over throw of the government rather than sharing some gossiping among foreign leaders. He might not be hiding out in Russia on treason charges, but praised for being a true whistle blower.
Maybe even as a presidential candidate, since all kinds of people are running this time.
Choices get made and some are not always the best ones? by too many....
My last request to Humana was to process the appeal as conditional payment and change the records back to the way it was as Doyle's medical care is obstructed for two weeks until the next post. The supervisor, finally understood, I think that. Ms. Hunter has actually changed by employment status and that is why there is a set legal process to follow at recovery, Ms. Hunter is not my employer, neither is ILL Blues, nor is HUMANA. How would they even know my status. Its why US Department of Labor has official jurisdiction as they will know when I am truly retired and the way Blodgett is being allowed to take over the nation, that may never occur in this lifetime on planet Earth.
I do not know what HUMANA or ACS will do now?
Doyle has a letter that either has to be answered as a reopening or a reconsideration. There are new CMS rules next years, and this first step appeals is Humana's chance to make things right and legal, or they could be in trouble with fines and penalties and they do not seem to understand this at all. Few do except those doing the tricking of all of them. Humana's and all the other billing people and clearing houses and claims processors for the contractors of the government have very little effort in all of this. Pay the claims as a conditional payment by Medicare and then no pharmacy, doctor, etc. is at any legal risk and neither is the patients and NEITHER IS HUMANA not NOVATIS, NOT CELERIAN GROUP NOR AARP, NOR AETNA or all the others we have had as insurers since we also had Medicare cards. and they do not seem to understand this at all. You are being tricked into doing the work that is part of the legal process at Emblem Health International 's Recovery and Coordination unit for Medicare.
By every one being tricked on this, it makes it harder for those at CMS to decide whether a contract is being upheld by them or they should be replaced the next time the contract is up for renewal. That is one thing CMS is still allowed by Congress to do. Since there is no budget for either a real internal audit to know what is going on there, nor any criminal investigation or prosecutions if real crimes are occurring. WHICH IS WHAT WE HAVE BEEN DOCUMENTING.
The next day I was able to get one party in the Boston regional CMS office to transfer me to 1-800 Medicare. which has access to all the claims info . They have more than any other group as few have access to know much of the whole. The Dallas regional office would not cooperate on this.
Since 4/09.we have had two phone lines into our home not be answered by them. We get an answering machine that says in two days we will be called and then no one has called in 6 years. All because I found out that of the thousands of fraud reports 500 witnesses filled out, not one made it to Washington DC to be docketed in as all against a contractor of CMS are to do there. And then they were forbidden to 'see' fraud or report it again on any one . as for 2 years they had been documenting what they called a trillion dollar theft of Medicare. I just know it was about 4 million on mine by creating 17 Medicare numbers and taking all claims back to 1/1/06 and paying them 16 additional times and monies diverted in 8/08 and then it did not stop until 11/12 when contract ended at Trailblazers.
They can only see records back 3 years, so all of that has disappeared from view, but as any one knows the over payments are still in there and the money is missing.
My letter to the Chair of General Dynamics which bought Vangent, 1-800 Medicare, has never answered the letters posted here on line. But I did get through and a professional acting woman pulled up Doyle's records after he gave permission for me to speak to them.
Our CMS 1696 should be posted, but have not been. so we can peak for each other. And appeals are not on there and neither are judges rulings. that are permanent for life as mine is for liquid home oxygen as its more than 3 years and more than 5 years back for even the claims processors at Celerian Group that pay oxygen claims know I am approved for life . Since I am still alive, that should never disappear from view.
One more reason, I have no oxygen supplier and am in a life threatening situation should this 200 lb tank my family takes to the gas company fails, and we are going broke as President Blodgett will not let Blues pay part ?until Medicare processes claims first and that's been blocked for 2 years. Blues had been reimbursing me about 60%.And the suppliers will not come blocked directly by President Blodgett.
So /'let her die' order is being carried out, in a very real DEATH PANEL. And Medicare already ruled its FECA's bill but President Blodgett would not respond to the recovery letters from Recovery for Medicare and never officially responded, nor gave them to any in the government to answer as they would be required to do. Just gave the verbal order to hack and delete all the recovery efforts and NO ONE NOTIFIED, NOT EVEN ME until one day I found all missing on line , even my self reporting. page. I had spent hours completing even with ICD 9 codes etc..
Oxygen is a big item for injured workers which President Blodgett has formed more companies and now has nearly every ones in the USA, not just feds. Under a 1988 labor law, when workers comp puts one on home oxygen for life, as I have been and approved by all three health plans even Medicare., then 100% of all medical care is workers compensation's responsibility. As no healing of any kind can occur, without oxygen. Even more simple for all if the system showed this. President Blodgett has successfully hidden all the timely filed and unprocessed oxygen claims since he took dover 17 years ago. Even Blues never posted all they paid on their claims. and that makes no sense, either. but it does when its Fed Blues under President Blodgett's management company?
President Blodgett's own manager told me this and others have too, since. as the rest of her quote was ....."the gig would be up and we would have to pay all of your bills...." This is apparent skulduggery that started inside the US Department of Labor years ago. before ACS even took over in 2002? One of those laws, few of the rank and file workers who process claims, were informed of. Its not the first time, laws exist and no one is allowed to follow them THIS IS CONGRESS'S OVER SIGHT RESPONSIBILITY TO SEE TO IT THAT LAWS THEY PASSED ARE THEN CARRIED OUT. Lives are at stake and so is livelihoods and it can occur to any one at any time.
Every president since I went to work for the US Civil Service in 6/68 could be impeached for not doing their job in this basic duty . Yet, it seems some laws are passed and then ignored with the full blessing of Congress in the matter??? And decades later they get passed again and may be carried out or not. GOVERNMENT DOES NOT WORK WHEN THE WORK IS NOT DONE.
Polls say we the people are not happy about what is going on , yet we keep sending the same ones back to office that never did what we want them to do? So the real fault may be with us. as we shirk our duty to ourselves.??? But its not easy to know who is trying to do what is right and who is trying to deceive us with the big money spread around with all kinds of persuasive tactics being used. and not just in flashy TV ads. Politics has become a science of mind manipulation of the masses. We can only try and do our best as voters, but we must try.
So at 1-800 MEDICARE the woman told me that Fed Blues was on there, but was now showing as Medicare was first. HUMANA GOT TRICKED INTO HACKING INTO THE COMMON WORKING FILE BY THE OWNER CONTRACTOR. Or if Ms. Hunter works for ACS then they did it through another side system? At any rate, the system is not secure.
I then said it had been hacked and she said THEIR ORDERS NOW ARE NO ONE IS TO BE ALTERING THE COMMON WORKING FILES ON ANY ONE AT 1-800 MEDICARE ANY MORE. They used to do it for me and change it back prior to 4/09 when OPM system? began being used to hack in and just delete it?? EVERYONE USED TO DO IT! And few had any understanding of all the rules and laws and none had the policy holder as an employee to even know what their status is..
I then told her what had occurred at HUMANA and asked her to file a fraud report which they are bound to do . by their CMS contract. Any one is supposed to take the report and send it in, She did not say she would not do so. I had called Goldman- Sachs 's company and partner of President Blodgett at HHS that does the fraud intakes and they hung up on me. I then called them on the line on the Fed Blues policy and they did take a report and gave me a confirmation number, but its just an ethics reports and they were trained to make it sound like something different than it was. That was another few hours on the phone. So I was very ill from all the exertion and talking a lot gets my sinuses bleeding, too. so had to take some Vitamin K. Almost every company in the world has them now as their complaint line. or EEO intake party. for their own employees. We truly HAVE ARRIVED AT A TIMNE IN HISTORY WHERE ONE CANNOT BUY OR SELL UNLESS ONE GOES THROUGH THIS BEAST OF A SYSTEM THAT HAS BEEN CREATED OVER THE LAST FEW DECADES. A system where human and individual rights seems to be missing.
Maybe my letters to General Dynamics head had some impact, But we still have no direct access to call them.
We cannot call Recovery unit either, nor even Coordination as they do not want their workers doing their jobs and trying to make things right and begin the recovery process.
If Congress knew there were a few trillions dollars owed back top Medicare, wouldn't they be trying to pass some budget?? Instead of trying to cut care and payments to doctors?? Its now been 23 years since the conditional payment law was enforced and the looting of Medicare began and got worse over the years. The actuaries did not get the math wrong years, ago. THEY DID NOT ACCOUNT FOR CONGRESS ALLOWING THE BLATANT THEFTS TO GO ON AND ON. And then keep making Medicare going broke as an excuse to give more and more to be stolen from it. And then have an FDA that keeps allowing things that make us sicker and sicker be used and eaten instead of keeping up with science that knows better and better how to keep us healthier.
SO TO ALL THOSE BILLING PEOPLE OF OURS, JUST DO A CONDITIONAL PAYMENT TO MEDICARE SO WE DO NOT HAVE TO KEEP FILING APPEALS .
I was so exhausted after all of this and then had a sinus infections. etc. Thanksgiving was good, and Doyle baked a turkey and we are still eating left overs the family did not finish up.. I WAS TOO ANGRY TO WRITE THIS AS I HAD THINGS TO SAY, THAT COULD NOT BE PUBLISHED IN POLITE COMPANY. Now back to going forward; ALL: TIME IS NEEDED AS THIS IS ONE MORE THING THAT CAUSED EXTRA TIME TO BE NEEDED.
We are in a real cyber war, and my family is in the middle of it trying to survive. A war when they can take a person in a contractor and trick them into hacking into the billing system used by the entire nation. so that ever one that has to do anything for us , will get illegally hacked into.
The system is not secure as it was paid to be. The code for a conditional payment is to be there and that is all that is needed for all. Bill Medicare and code as conditional and then let the legal due process wind its way through all. No more is needed but that as its the Recovery Unit that is paid to take care of this. And if there secret deals get exposed and broken , then that is what should occur as there is not suppose to be this blatant stealing going on.
If this has been some secret 'bail out' of some insolvent insurance companies, then maybe its time to look at some other way for all to have the health care that 21st century science has made known to us. and be there for all of us. That is all we have asked to be done for over 17 years on this. Not be over paid when we have no way of enforcing the laws, our own government and three presidents have decided not to enforce.
Patients have rights and we are part of the claims processing, too . even if the HIPPAA law does not apply to government contractors or government officials who need to stop being afraid and start opening up to Congress. Why won't the heads do this?
All I could do to work through my anger this week is pray to YAHUSHA whom we Christians call Christ Jesus that He take this burden and show me the way to work through it all. Its the only way to internal peace and even those who do not have a faith where they pray could just think good thoughts goodness and love for each other. Now if all those involved in the USA in the health care industry will just let the legal system wind it slow way forward, then we may be able to reach a summit where all can have good health care and all be fairly compensated as we figure out the best and most efficient way to achieve all of this. We do need to work together so that the free labor of machines is shared by all to ease the burden for all of us. VOTE its the first step to collaboration.
Linda Joy Adams 11/30/15
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