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 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 25: Cigna govt services Redetermination and penidng cliams and reopen all

Cigna Govt services: The DAB case - M09-1406 affirmed that Linda's oxygen claims were OWCP's yet MSPRC has not listed them on the conditional list on mymedciare.gov that you paid and did send to them and they sent out a letter to ACS, the US dept of labor contractor, jsut as they had on the claims they could locate using the national health ins data base for claims paid by other intermediaries such as Trailblazers who have refused for over a decade to code as a conditional pay for recovery.  The DAB affirmed that you have claims back to 8/1/00 still pending with you to process and pay conditionally as ACS has still not set my computer file, nor input 11 years if oxygen claims because: they would be paid as they were previously for life. When ILL Blues, who had been paying and duplicating some still being paid to the company Lincare bought, took over  OK and TX, NM at the same time ACS did for US dept of labor they proceeded to post false info that there was no owcp and convinced, in collusion with trailblazers, to ignore owcp and have Medicare pay. Your people stated that when you took over for palmetto GBA  in our area they refused to forward all pending claims and appeals,etc to you . The initial start date for you should be 8/1/00 for oxygen, the date of my entitlement to Part B and Lincare needs to be paid conditionally from then through 5/06, when acs lied to them making them think I'd gotten some huge settlement monies  that included their back pay and they stopped service. Rhema came and Lincare refused to turn over the owcp contract which they found out they still had and then All about mobility took over until Lincare became the monopoly due to a discriminatory CMS regulation, etc. Since then my son hauls tanks, and pays out of pocket and I've asked you for reimbursement but the " death panel' rules say that isn't possible and I need an answer as to why patients are left to die who have years of life in them with medical care?
Other supplies that have been paid by Palmetto GBA and others since you took over are for secondary/tertiary issues to the original accepted conditions at OWCP. Due to ACS refusing to set up my computer file and bring on line with the official US dept of labor one, these have yet to have an initial decision even though 6 judges and a hearing office pointed out they were in  the paper file which has disappeared.
Until Linda's 1996 pending request for permanent disability at owcp is processed, Doyle's and our daughter's primary payer is Federal blue cross.blue shield as one in considered an active employee until owcp decides  place them on permanent disability. There are claims on Doyle that are bing appealed and need to be sent to MSPRC for recovery from Federal Blues. Any claims on our daughter should be treated as such, too.
We are asking for a letter of waiver of any overpayment liability against us and our estates as its against equity and good conscience for such violations of laws, judges and govt contracts.

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 15 @ HIPPAA to Billing

Received attached bills and primaries not billed according to these? ACS-shows no record of claims, Fed Blues has been paying claims recently since ILL State AG and US atty went after them and got $25 million for  illegal "dumping" onto medciare which is what they did as soon as Ill Blues took over in TX and ACS took over for Federal workers comp. I advised  in writing for you to call Regional office manager in Dallas for OWCP as she called me recently unaware  of the continual problems that ACS had never set up my computer file and bring it on line with the Medicare computer that shows ( correctly) according to 7 federal judges that I have permanent owcp medical  and should always be billed first. Also past claims all have to be reworked. I'd written and asked your legal dept about a false claims against Trailblazers that paid ever claim k to 1/06,17 times.*Nee your exact claims as billed and what you got back( many got it back on a phony claim #). This is on past written HIPPAA requests and is amended to include these claims. I've e-mailed info to Ms Mabrey on this recently. Civil rights and contract compliance complaints are pending on the contractors. * you have access to other patients whom similar has occurred according to witnesses.

SSA Gets Kudos For Online Claims Application -- Social Security Administration -- InformationWeek

SSA Gets Kudos For Online Claims Application -- Social Security Administration -- InformationWeek one more reason to give Medicare back to SSA. ( even though SSA does have current problems as appeals can go missing off the system without decisions-- but that is more than likely human error)

DME MAC Jurisdiction C medicare appeals process

DME MAC Jurisdiction C where;'s the appeals process for the patient when the claims processor does it worng and convinces the provider/supplier to go along. The patient can get overpaid , too.