violations of civil rights page 29: Standing request to Lincare for services

John P. Byrnes CEO
Lincare Holdings, Inc.
19387 U.S. 19 North
Clearwater, Fl. 33764
Dear Sir: the treatment we both have endured at the hands of got officials and their contractors has been unconscionable. However, it got worse when you wouldn't believe what I was trying to tell you. The judges do and on 2/09 said everyone is to ask me for the facts of the case as rumor and gossip is still being strewn  around as facts. I'm approved for life by three health plans: Federal workers compensation, who paid  the company you bought, health connections and the contract with OWCP should be in my files. Then federal blue Cross, Blue Shield who paid you until Illinois Blues took over in OK, TX and NM and posted false info on their computer that owcp was settled and I had retired years earlier. at the same time Affiliated Computer Services, now a Xerox company, took over processing of paper and bills for Federal workers compensation and refused to set up my computer file to this very date. They have 11 years of oxygen invoices that have never been processed because: the computer will pay them and bring them on line with the official US dept of Labor computer that posts my active employment status and permanent medical benefits bi weekly, by contract with Medicare Coordination of benefits, a Group health subsidiary, and The Us dept of Labor. three Medicare judges, including an appellate judge upheld this as accurate on 9/29/2010 case # M09-1406. The 2 ALJ decisions were ignored by MCOB saying: we don't care what a judge says, nor the law nor their contract. There is a 1980's federal workers compensation law that was passed to insure that when life sustaining medical care is in jeopardy, permanent medical could be approved before work issues are resolved. That pertinent info was not shared with my attorney nor I except for a letter received in mid 90's that oxygen tanks they had paid for was to be included in my estate instruction to return them to US Dept of Labor upon my death.
When Cigna Govt services took over  in my area for medicare, they said all your claims and our appeals were thrown away by Palmetto GBA. They have yet to process them. They did approve me for life, paid the claims from the suppler I had for '06-1/08 when you became the monopoly supplier in my area. Rhema said you refused to turn over the contract with US Dept of labor with health Connections that you'd bought out.They  were the only intermediary that sent claims on to Medicare secondary payer recovery to recover from ACS who ignored them and i filed an appeal to try and get enforcement of the laws which medicare has the responsibility to do by law except it was suspended by former Sec of HHS back in the '90's. Illinois blues, has still not processed the co-pays on those claims, although the initial filing was ' dumped onto Medicare.
I have a standing request to your for services. I have tanks and one stop per month should suffice.
Currently, in order to live, my family has had to haul tanks and pay out of pocket. This is truly a ' death panel ' decision and the public should be aware anyone could get injured and have such disparate treatment.
Compounding the problem in '06 was when your manager called ACS and got lied to about my case and told that I'd gotten some big settlement that included your back pay for services. other defamation and slander got spewed around even more. ACS had the appellate judge's orders and files' disappear.'  out of London , Ky where their contract is to post all paper from any source and definitely not be the decider of cases. Nor are they to set up a ' dummy' offline computer file to charge the US dept of labor to process bills and items and respond that some unknown third party is to pay, yet disparately decide the only type of claim not to input is oxygen; knowing full well the ' gig' would be up. it took some ' nice' persons in the Fl call center to tell me the truth claiming the Director of opm 'made  them do it' yet she had no contract with them and was not paying them? This is the entity that  when Arkansas blues was our blues here their manager called me and said OPM asked them to murder me and they paid you. Your local manager seemed unaware of that in 1/06. the terrible thing that was done was that Ill blues took back all payments back to 8/1/00 when I became entitled to part B Medicare when they should have gotten the monies back from ACS. Lying and abuse of power has been rampant.
Compounding the problem was that medicare was not following oxygen guidelines. Sec Tommy Tompkins got them clarified in 2005 and  when i discovered in 2006 that you had never contacted my pulmonologist nor cardiologist to get the medical necessity forms, i had to get them and take them to my doctor who promptly filled them out and said he would have had no problem completing them at the time I first saw him in 1/2004 except each year your employees took the name of my cardiologist and I thought he was completing them. I see that finally Cigna govt services is having training on the guidelines. The are basically no different than in the past except they are more medcially specific. the old ones just said O2 sat rate Or send in medcial records which could be a clerical nightmare in a company as I have witnessed in obtaining doctors records for SSA disability claims. Some have excellent, organized records and others are barely legible which basically required Palmetto GBA to have a doctor on staff to call every doctor that chose to submit records instead of just using a sat rate. In 1/2004 at a cardiopulmonary stress test the technician had me at 70% sat rate before he stopped and then it took the 2 years to get ahold of the tests from the hospital. In this day and age, they didn"t realize that I was not a patient to fear for going too far. Usually doctors stop the tests when the heart starts getting overworked. yes it took a week  to recover, but the results were there that you needed and communications were being thwarted every which way. in TX, technicians are allowed to run the tests.
Palmetto Gba wanted you to leave the diagnosis code off as that triggered owcp paying the bill. when Cigna first try to pay using my secured Medicare number it kicked it out for having primary payers due to the diagnosis code and being oxygen and the official secured records at the US Dept of Labor. This is a very strong and good law that was passed after a scandal of lives lost at the abuse  of power by OPM. now contractors have resumed those ' dirty deeds and lives are in jeopardy.  They used a phony Medicare widow claim number, declaring my husband dead to pay the claims to by pass the security, but did send over to MSPRC who did send out the ignored recovery letter. ( OPM is the entity in charge of all health care plans in USA in 2014.)
My fax number is my phone number. I plan on living a good many more years if medical care is not obstructed.
The new regional office manager at the Dallas  federal workers compensation office is aware  now that she has not had access to my actual records, etc. their phone number is 214-850-2300_. I suggest you call here for clarification as to what to do. Any problems, please keep me informed.No patient should be treated in such a manner. The Sec of Labor has asked for complaints and civil rights to be filed against the contractors when they treat one badly. Its not easy to ' fire' a govt contractor. The state of Mn tried to fire ACS and they counter sued and the state had to pay ACS 7.6 million and they still have the contract. Proof is needed. Ill Blues was 'gotten' by state of Ill medicaid recently for their dumping onto  them for $25 million. Finally the govt is waking up that for profit companies will ' get by' with shenanigans and take more money then is due if they can. Any one harmed needs to file and present evidence so the contractors will either ' straighten up or have their contracts cancelled and get someone else or go back to hiring civil servants to process and pay claims, etc. Linda Joy Adams

violations of civil rights page 28: Departmental appeals board and Miami Medicare hearing office.

Departmental Appeals Board, HHS for medicare and personnel matters: Miami Medicare hearing office.
Attached are pages  that explain what is on going since 9-29-2010 since the only final, formal decision has been rendered on a few claims paid by Cigna Govt services: Case M09-1406. It appears, the next case on the Trailblazers claims ended up in front to the judge with none of the file and none of the previous decisions) from the Miami medciare hearing office. There was no final decision as no appeal rights, etc. Also, what was re caped would be theft of the medciare trust fund if carried out. surely the judge would not be advocating that. After the first two ALJ decisions on  it seems files increasingly disappeared out of both the Appellate office and especially the Miami hearing office where the govt contractor ( ACS?) doesn't even docket in arrivals and attorneys all over the country are complaining to the staff about files not left intact. I'm doing the best i physically can to meet filing dates on a : death panel decision that has put my life in jeopardy and caused great physical and financial hardship in filing papers and appeals and intermediaries ignoring them. I've asked for an against equity and good conscience waiver of any overpayment liability but  its never answered at any level. There are several hearing requests pending in the Miami Hearing office and no formal answers to any appeals other than the first one. It seems that the letter sent from the Dallas CMS office by a high level official who has been instrumental in on-going violations was the source of the next letter, the only source. its documented she has; asked me to withdraw my federal workers comp claims so medciare could pay my bills, and has had the official line - up changed at medciare coordination of benefits in violation of their contract agreements to have security on an official records which three judges at CMS have affirmed and  9 judges at the US dept of labor. No one explains o medical billing personnel of the legal option of conditional payments which medciare is required by law to enforce even though a former Sec of HHS suspended enforcements and set up  ' contracts.' We've seen, according to some inside experts, over a trillion dollars of medciare truest fund used to pay bills that were never coded for recovery from the primary payers. MSPRC still doesn't seem to understand that they are to enforce the laws against existing primary payers and stop their shenanigans to get out of paying when the law, judges, and entitlements are approved for them to be the primary payers. The last three US dept of labor judges said in 2/09 : ask me for the facts of the case as they were well aware of the ongoing problems with their contractors and CMS's as gossip and rumors got passed around as facts. Most of my bills should be getting paid by OWCP, secondary /tertiary issues should be getting their initial review and appeals if needed to clarify issues. The request for scheduled award and permanent disability field in 1996 should have been approved long ago, but the substantial medical evidence is ' missing ' along with the entire case file at ACS and MSPRC doesn't even seem to know what my accepted medical conditions are listing a few musculoskeletal secondary claims only even after sending a detailed ( including the accepted occ asthma and other related accepted conditons) and lengthy recovery letters  in '05, 07 and 08 which were ignored. My official personnel file is missing and rank and file employees  can't seem to figure out my status which has not officially changed since going from HHS to owcp jurisdiction in 10/94. This was before any w-2' s were issued by SSA as an independent agency. I went to work1/10/89 and something terrible happened beyond by ability to control or stop.( others could have) I have an established , non- controverted case on my 1/10/89 and why all the violations? Three times I tried to work at great physical peril to my life with  EEOC sanctions against HHS-SSA for violations that are not enforceable against another federal agency.  Now, for profit contractors have taken over control of our govt programs and our civil rights have ' disappeared' along with all my files.

violations of civil rights page 27: medicare coordination of benefits. damages

Medicare Coordination of Benefits: On 9/29/2010, Departmental appeals board  ruled that OWCP needs to get Linda's claims first and affirmed the two lower judges ruling that fed Blues is also a primary to Medicare. yesterday, i was able to access mymedcaire.gov for the first time,  unknown what claim number all the claims are under) and say only a few muscular skeletal claims listed as conditional under he Medicare secondary payer recovery unit. There are secondary/tertiary claims pending with owcp but until ACS set up my computer file and bring it on line with the official us dept of labor computer, nothing is happening and hasn't  for a decade since Ill Blues took over in TX, NM, OK and ACS-Xerox took over for the us dept of labor is a real ' death panel ' decision against me. ( ACS-Xerox has 11 year a of oxygen invoices they won't input as the computer will pay them and bring the file on line as I was approved for life.) Hopefully you know understand that your contract violations with CMS and Us dept of labor in allowing any one and everyone to alter the official bi-weekly posting has almost cost me my life and and extreme physical and financial hardship and reataliations. You still show the wrong date of injury and this has led to mass chaos for billing personnel and obstructs medical care. ALL my claims are for either accepted conditions at owcp or for claims pending, sometimes for years in defiance of 6 appellate Judges and hearing officers who have remanded the case pointing out they have never been reviewed. only to have ACS ' disppear' the judges orders. Even their CEO misled the new Reg office manger when he contacted her over a year ago and led to more hardship. You have had a duty to hold fast to your contract and secure the official bi-weekly posting. Your protestations that you didn't alter them is defied by hundreds of witnesses an has led to claims not getting sent on to MSPRC and  both your parent companies stopping in recovery back to Medicare which the US atty called a ricco situation.
Now the same thing is happening with Doyle's and our daughter's claims, one of which ended up dumped onto medicaid her third, payer. For them, Fed blues is primary per the same appellate decision and Medicare secondnary until the 1996 request that is still pending unanswered at federal workers compensation for permanent disability is approved. ( not even been seen)
All this because the 10 year lease needed to be signed on my injury work site in 1998 and I had to ' disappear' along with the 4 years I tried to work in considerably pain and with health declining as promised accommodations not done, yet receiving awards for what I was able to do.  You were the first one I sent an appeal to years ago, as crucial to the underpinning integrity of the health care system as the former Sec of HHS set it up in the '90's.  My son is hauling tanks and paying our of pocket over this as Lincare is now a monoopy supplier in this area and is refusing service until the ' govt programs' are again in compliance with the law? Congress gave this authority to the govt and it passed this responsibility on to you. Please never alter official records again. For the last 2 years, there has only been @10 min every two weeks that its been accurate before you deelted my Fed Blues. off our records.   a decade of such ' death panel' decisions  has to stop. This has put my life in jeopardy and obstructed medcial care.Now for my family. Explain to billing personnel who beg you to alter the records how to process a conditional payment which is the legal option. That's what conditional payments were passed by Congress to do: stop these shenanighans. Medical subrogation is something entirely diifferent and doesn't pertain except for those pending medical issues. not yet seen at owcp. Why aren't all the cliams listed until OWCP pays?

violations of civil rights page 26:redeterminations pending and reopen all and send to msprc

Wisconsin Physicians, part b intermediary, OK: ON 9/29/2009, the Deptmental appeals board issued a final decision; case M09-1406 that affirmed that, for Linda, OWCP gets claims first then, Fed blues is primary as the two ALJ decisions in '08 and 09 affirmed for any claims related to a pending secondary //tertiary issues with federal workers compensation.  You have yet to answer any of the redeterminations that have been filed with you , the first was for the '07 physical therapies and your notes indicated that you were intentially mis lead by govt officials and govt contractors and used a phony Medicare number to by pass the security on the system. All of our medical providers. suppliers have been treated such in violation of civil rights, and laws and entrapment  into violations over my persistent protests and filings. Some of the claims are now listed on MSPRC's on my Medicare .gov, which i was able to access for the first time yesterday , but won't say which of the 17 claims numbers it was posted under. I'm not aware that your company every did multiple thefts. ACS-Xerox still won't set up my computer file for OWCP so even initial items can be reviewed, etc. and bring it online with the official us dept of labor computer that shows the permanent medical benefits. However, Medicare coordination of benefits keeps posting the injury date wrong adding to more mass chaos . Ir 1/10/89. No bills for my accepted conditions are listed that Medicare and fed Blues have paid. ACS and ILL Blues took over in our area at the same time and immediately all claims got ' dumped ' onto Medicare in a very illegal manner.  Any claims from my husband and daughter are fed blues primary and Medicare secondary. Please reprocess and send ALL the claims you paid on me to MSPRC to list; as only a few are there. Please send me a response to my redeterminations requests that this has been done. Do you have a reconsideration contractor yet for OK? My request to your Vice Pres has never been answered. name and address please for future use, if needed.

violations of civil rights page 16 Appeal to Federal Blue Cross/Blue Shield of ILLINOIS,TX,OK, NM

Attached are a recap summary of all claims back to 8/1/00 which are currently appealed or are new items received not paid correctly. All claims need to be referred first to federal workers compensation and your contact should be the regional office manager in Dallas, TX, not the non- compliantcontractor as to how this can be facilitated. New actions since your last, inaccurate decisions based on false and incomplete information. Remember you are alleging OPM' past director gave you one set of ' facts' and ACS, the paper controller and claims processor for US dept of labor, claims they were told an opposite set of 'facts' by that same director.  Trailblazers has been non cooperative with judges, etc. but Cigna Govt services did cooperate and the only Final decision was issued by Medicare's appellate judge on 9/29/2010 was based on the  internal documents that were withheld from you, even from the officials at OPM? , by that director. Federal workers comp gets claims first. Then you and last would be Medicare for any co- pays or deductibles on medical issues not yet reviewed or accepted  yet. All conditions accepted or filed on 1/10/89 injury . HIPPAA reqeust for written recap of who said what, when to solve. not yet answered.

violations of civil rights page 14 (see attached) 100% coverage HIPPAA request from billing

These are 100% coverage under  my Federal Blue cross Blues shield contract. If you didn't code this that way then it would be federal workers compensations bills as claims are filed as secodnary issues for the permanently accepted conditions. I've advised you to call The Regional office manager in Dallas for federal workers compensation as to her progress in getting Affilitated Computer services to get my coumputer file set up in compliance with my permanet medcial beneftis at owcp that posts bi-weekly to the medciare computer and what to do with current and past claims after she called me recently.
Why is this preventative care?: Even though some injury related problems can ' show up on the tests'; these tests are well known to detect conditions that I don't have and catch them early such as breast cancer, etc. and are the reason that they are part of the preventative care contract with FEHB. Medicare always second.
HIPPAA REQUEST: I want copies of exact claims sent to OWCP, Federal Blues and Medicare and a written recap summary of why these tests were not billed under the preventative care. I don't see the claims listed on the ACS-billing system at owcp at all.  No response to request on  bills paid 17 times each by Medicare back to 1/1/06 and that you did not get the 16 extra pays. Refer to notices and requests to you.

Joe Davidson - Battle royal over federal worker pay

Joe Davidson - Battle royal over federal worker pay see my comment

Violations of Civil Rights page 13 accident report

Took a nasty fall and left lower leg and knee on ice. happened at 10:15pm 3/6/11. I've been power wheelchair confined since 1992 and have none currently. In 2005, my cardiologist wrote prescription and none of the suppliers will even talk to me until I get the problems with insurance straightened out so they know whom to bill. Medicare and others used to allow a predetermination. Now if they provide the chair, they may be caught trying to find out whom will pay. The diagnosis for the chair is my occupational asthma which makes it workers compensation. However ACS-Xerox won't set up my computer file and bring it on line. Ill Blues took over their ' franchise in TX, OK and NM at just about the same time and both are ' dumping onto Medicare which would be considered theft if Congress hadn't given all govt contractors immunity from prosecutions. I'm mostly home confined and have had tables, chairs etc. near where i walk to 'catch' my self. Somehow, some soap had fallen off a shelf, breaking the cap and it had spilled on the floor and I did;t see it and slipped. If not better by AM will need to see if doctor can see me. Last time that doctor's claim got paid 17 times by Trailblazers and him only one overpayment. Still under appeal and DAB won't give final decision. That CA1 @CA2 have yet to be looked at by OWCP and its been over 4 years.

Violations of Civil Rights page 9( dear Doctor)

Illinois Blues ( our blues in TX, OK and NM) has just had to repay Illinois $25 million for similar tactics on claims there. This is an established case with  approved treatments well established since 1/10/89. I have taken you letter and bill and filed them with Federal workers compensation. Two months ago, the  new regional office manager called and said that wen she was contacted by Lynn Blodgett President and CEO of Affiliated Computer Services now a Xerox company he did not inform her that her office computer file had not been o=updated since 1998 and at that time actually documents were not scanned in but maintained in paper files. She wasn't even aware of numerous appellate judges' remand orders  as  ACS had never set the file up properly. In fact , in 2/09, the three judge appellate panels ruled: ask me for the facts of the case as they were well aware, no one at OWCP had a clue what was going on in my case due to routine ' disappearance of files. Theses ' disappearances in multiple agencies has been routine since 1/10/89 since I was injured.
Over 20 years ago, Medicare became the final authority on which health plan is the primary to Medicare. Ill Blues and Medicare's own contractors are in defiance of  their own judges. Insiders say there over a trillion dollars owed back to Medicare by primary payers. The more rulings and documentation, the more  my medical care gets obstructed by them.  Trailblazers began turning your claims into 17 ,started 8/08 on every claim back to 1/06. ( documented by 500 witnesses at 1-800 Medicare) by creating 15 phony Medicare claim numbers and using an illegal offline computer system hidden from the contract auditors. Congress has passed laws giving contractor criminal immunity. The investigators form the Justice dept and Medicare's general counsel can do nothing without Congressional action. Internal audits are also prohibited. Civil rights and contract compliance are available and  followed their advice and filed both. OPM has no contract compliance compliant process and they gave contract to Blues. Please don't stop this ' whistleblower's care.