The Kaiser Papers Newsletter for October 2007 |  |
In This Issue:
There is Big Money to be made in Workers Comp by Dina Padilla
Medical Ethics by Sharon Rushford "We Can Do Without TeenScreen" by Mr. Tony Zizza
The Continuing Tissue Transplant Situation at Kaiser Permanente Woodland Hills by Hillarie Levy
Dr. Phillips Writes about his Personal Experiences with Dr. Hamid Safari of KP Fresno by Dr. Charles Phillips
Medicare as a Secondary payer by Jupirena Stein
Someday California May Get Around To Enforcing Consumer Health Care Laws by Vickie Travis
There is Big Money to be made in Workers Comp by Dina Padilla
Medical Ethics by Sharon Rushford "We Can Do Without TeenScreen" by Mr. Tony Zizza
The Continuing Tissue Transplant Situation at Kaiser Permanente Woodland Hills by Hillarie Levy
Dr. Phillips Writes about his Personal Experiences with Dr. Hamid Safari of KP Fresno by Dr. Charles Phillips
Medicare as a Secondary payer by Jupirena Stein
Someday California May Get Around To Enforcing Consumer Health Care Laws by Vickie Travis
There is Big Money to be made in Workers Comp 
It
appears that the Blackwater mercenaries-ex-military may be a privatized participating trend that started in workers comp years ago.
After years
of perusing QME-AME-IME medical legal reports, many
of the doctors who wrote these reports were also simultaneously active in the military which in that time period was a violation of 10 USC code. This section of 10 USC pertained to the use of military physicians in non emergency situations. The active military doctor could not exam or treat a patient unless in the event of a national emergency and then only until private doctors entered the scene! One particular active navy seal doctor that Kaiser sent me to would come in once a month and do 5 exams at a time in the Sacramento area. He was flown in and out from West Virginia on a military airplane via McClellen AFB now known as McClellen Park here in Sacramento. McClellen AFB was closed in 7-2001. This worker comp fiasco started at the latest in the early 90's and very possibly earlier! None of these military docs would display their medical licenses and injured workers/patients were forced to go to these doctors, or they were threatened with loss of their benefits-which they ended up losing anyway - by self-insured employers like Kaiser and which was paid for by TPA's - Third Party Administrators like Associated Claims, Athens, now called Jenkins Athens in Walnut Creek, Ca.; one of the few towns that TPA's reside in. One exam can generate on the
average $1000.00. The employer can
and does force the injured worker/patient to go
again and again which causes the military doc to review
even more treatment reports
including his own previous reports.
So how much money can the same QME-AME-IME doc make? About
$5000.00 a month for 5 exams? While on active duty? They charge by how many hours they spend reviewing these VOLUMINOUS files. These files only get voluminous because the patients/claimant real treatment is denied and other collusive doctors (referrals by the comp docs) can just keep prescribing treatments like heavy doses of pain meds that do more harm then good and blood tests that tell a medical history unrelated to the original injuries - evidence based medicine! The patients will be forced to go again to the QME for more reviewing and since the real treatment is denied, then their disabilities are hidden forever thus denying them their rightful compensation. The worker comp docs make thousands upon thousands of dollars! Do they declare that money on their taxes? What would they spend that money on? Maybe a few personal items such as big boats, top of the line motor homes hidden on former AFBases - ANOTHER REASON FOR PRIVATIZATION!!!!, AND homes in Incline Village Ca that are cared for by illegals.? And in some agreed reciprocity, send some of that money to mercenaries in Irag or wherever? So injuring workers is profitable for self-insured employers like Kaiser for profits to military doctors with no accountability as to their real worth and a trail of money going to privatized companies like Blackwater? Oh! And Erik Prince, the founder of Blackwater! HE too, was a navy seal like the above worker comp doc! Do TPA's like the ones that represent Kaiser report all the
TPA's insurance money that have gone to military docs? Do
they report ANY of the TPA's insurance money they spend that go to defense attorneys to litigate injured workers or is THAT money also rerouted to places like the Cayman Islands and then off to places like Europe, the Mideast and the far east for mercenaries to DO as they please? Nothing is more despicable then a revolving door of injured workers to generate money for war mongers! Dina Padilla may be reached at: dina@comcast.net http://workcomp.kaiserpapers.info/ http://hometown.aol.com/V1BEST/index.html Medical Ethics By Sharon Rushford  We must get ethics back into medicine even if it is one doctor at a time.
Most people mistakenly assume his or her doctor has taken
the Hippocratic oath, however, many physicians have not. I had always thought
it was mandatory to be licensed to practice medicine, sort of like swearing to
defend the constitution when taking public office. The profit sharing system of the Permanente and its
physicians is an enormous conflict of interest that most of its members are
unaware of. The profit motive conflicts
with the Principles of medical ethics. Kaiser physicians who speak out are at
risk of losing their profit sharing retirement funds if it is found they; “The
Participant performs any act or engages in any activity, the principal purpose
of which is to damage or discredit Health Plan or physicians …”. The profit
motive at Kaiser Permanente puts profits above the well being of its members.
I am reminded of the ethics of Bobby Kennedy when Ted Kennedy eulogized his brother saying he (Bobby): “Saw wrong and tried to right it, Saw suffering and tried to heal it, Saw war and tried to stop it” Then I see the ethics of Kaiser Permanente: Sees wrong and tries to cover it up and deny it. Sees suffering and continues to profit from it Sees war (any dispute between Kaiser and its members) and tries to win it at all costs. The Principles of medical ethics must not die so that Kaiser profits can THRIVE.  Sharon Rushford may be contacted at: srushford@rushfordconstruction.com Be sure and read: Dr. Phillips Writes about his Personal Experiences with Dr. Hamid Safari of KP Fresno.  The news stories of this month on the obstetrician and
"perinatologist" Dr. Hamid Safari of Kaiser Fresno reminded me of my several
interactions with him during my 18 months of ER work at Kaiser Fresno
1997-1999. So I have a few comments to add: 1) he was extremely arrogant; 2)
he liked to apply rules that kept patients out of the
hospital Kaiser's primary money making goal - even though it put
pregnant women at high risk; in one case a woman with excessive
vomiting suffered her third miscarriage related to his blocking of
admission; 3) he had no hesitation to cause extreme pain - the opening of a full
C-Section incision without giving an IV narcotic first to block the pain; I
heard the screaming, saw what he had done, and told him in the hall that I was
ashamed to share the same profession; 4)
that he was part of a department that tried its best not to come down
to the ER to solve OBV-gyn problems and in particular told us to call
the general surgeons instead for problems with potential miscarriage
below 23 weeks gestation - as if those fetuses who might have limited
brain function due to being too early should be viewed as abdominal
tumors. Thus I have no problem believing that he was just as bad upstairs in labor
and delivery - the mixture of arrogance, do things too fast, ignore pain
control, keep people out of the hospital on phone calls, delay expensive
treatment like C-sections, and generally keep patients at risk. Pregnant
patients at risk generally mean their fragile passengers put at risk.
The episode in question of pulling a head so hard as the shoulders got
locked up at the pelvic outlet (shoulder dystocia) so as to severe the spinal
cord is awful. I have not heard of it in my decades in medicine. But as Charles Ornstein, LA Times reporter who should get the Pulitzer
Prize for his Kaiser articles, stated - the real story is about how Permanente
can keep such rotten apples. To me it is about a rotten barrel - one that
attracts and keeps rotten apples. The principal motivation for physicians at Kaiser is to "vest" in the
partnership so that they can work their way toward the $15,000 a MONTH
retirement program after 20 years. The key talent needed is to say "no" to
expensive care and keep the patient/passenger at maximum risk. The legal
department through Risk Management will have Cleaners who can mop up the blood
and guts and cover up the problems that happen.
The errant physicians actually rise in the ranks to the top because they
have proven that they will follow the "group ethic" of business rather than
the Hippocratic Oath of patient primacy. It is almost like the Mob or a
gang in which you have to have some hits to get ahead. Or else how
can you prove yourself to be worthy of the partnership? The real story is the vengeance Kaiser heaped upon the physicians who
finally - not quickly - found that Dr. Safari was so dangerous as to pull
them into the tar pit. Rather than being at the top - as the "high risk
pregnancy" expert - he was the "high risk" physician making the whole department
stink. One of the physicians got out of the business. Another
commutes to work; 2 hours each way - seeing his family on weekends. All
seemed to have lost "bonuses" for speaking out. Permanente runs Kaiser. Permanente is a sick corporation with
the goals of fooling the public with white coats. Long training is turned
on the public to give the illusion of care. Increased death follows
increased risk from their many strategies of doing less to make more. This
year KP will make some $2 billion in profit - half goes to the physicians.
My own recommendation is that the top Permanente leadership go to jail
for a long time. They have spent 60 years in perfecting the illusion of
care and many innocents die. All those who have spoken up against
Permanente should be called back in to be part of the solution - a new medical
care organization that forces white coat physicians to live up to the white coat
ethic. Charles Phillips, MD, FACEP
Cross Referenced with: Dr. Phillips may be reached via e-mail at:http://californianews.kaiserpapers.info/kpchildrenstories.html http://californianews.kaiserpapers.info/noonewouldlisten.html original source - http://tinyurl.com/2b4xf9 related story - The United States has a sharply higher rate of women dying during or just after pregnancy than European countries, even some relatively poor countries such as Macedonia and Bosnia, according to the first estimates in five years on maternal deaths worldwide. - http://tinyurl.com/2bk4ue mirrored for historical purposes and supporting document at: http://nationalnews.kaiserpapers.info/materialdeathrate.html Kaiser Responds to the above article at: http://xnet.kp.org/newscenter/kpresponds/2007-10-15.html and we have mirrored the response for historical purposes with brief commentary at: http://californianews.kaiserpapers.info/kaiserresponds.html CPhil49401@aol.com A note to all from Vickie - Someday California May Get Around To Enforcing Consumer Health Care Laws This past week, here in Southern California we have
had a number of wild fires. Most of which appear to have been caused
by arson. Mr. Garamendi was on the television a short while ago
explaining how California would be prosecuting to the full extent of
the law anyone caught committing fraud against an insurance company.
Not one single word came from his lips about what California would do
if any insurance company were to attempt to defraud a citizen.
Unfortunately for the citizens that is the general rule on how these things are handled in California. The citizens just don't have as much money as the insurance industry does when it comes to campaign contributions. That probably has a lot to do with why there is no real enforcement of any law having anything to do with insurance, especially automobile and health insurance in California. It has been this way since I started paying attention on September 11, 2000. Since that time I have learned that in other states and at the Federal level for the most part everything we were taught in school is true when it comes to how government is run. Chain of command, who oversees which departments and who is truly responsible and assumes responsibility for their job at the various levels. In California we have a person called "Mr. Up Stairs" and he seems to order investigations stopped or to never go anywhere. Government employees in California appear to fear "Mr. Up Stairs." He must be one "bad" man. The only office that has not told me about "Mr. Up Stairs" is the Governor's. I am pretty disgusted these days with this once wonderful state that my family had helped develop just about since it was first created. Seven years ago, on September 11, 2007 Kaiser killed my father. His assigned nurse that Kaiser refused to replace when they were requested to do so, bragged openly that he was killing my father to get his bonus at the end of the month. When we blew the whistle on this outfit they cut off all his medical care. What they didn't tell us and what we needed desperately to know was how the for profit system was going to do it. My father died from a potassium overdose and a septic infection. The infection was openly caused in the presence of family by the visiting nurse. The potassium, which is a food product and which anyone can purchase at any vitamin counter is deadly. Because it is so easy to obtain we did not realize how dangerous it is. Potassium paralyzed my father as it does anyone that should not be taking it and for anyone that has medical professionals overseeing their care that don't do their job and monitor the potassium levels in the body that they have prescribed. What happens next is that the person in this position has their heart and their lungs suddenly stop working while their mind remains crystal clear. They know what is happening and they are justifiably terrified. Until recently a person could die from this, or be poisoned intentionally by this product and an autopsy would unlikely show what had been the cause of death. We learned through Dr. Charles Phillips months after our father's death what actually happened. We also learned at that time that Kaiser personnel had attempted to alter the pharmaceutical records but were unsuccessful. We knew what had happened and had to prove to ourselves that inconceivably the government in this state is just plain crooked when it comes to investigating these types of things and enforcing the law, especially if Kaiser is involved. The Enforcement Division of DMHC told me that with my father's case it was enough to pull Kaiser's license and that they were going forward with it. I was asked to contact reporters and tell them about it by DMHC. I did and you know what happened. DMHC denied it. How silly of me to have trusted them. Then Kaiser and the State of California went to great lengths to prevent us from obtaining a copy of our father's medical records. Obviously they had something to hide. We all knew that. For five years there was a note on those records, stored in Kaiser Legal/Legal from a conservator, a Mr. Dan Stubbs. He was not a conservator for my father at that time but he put a note on those records that they cannot be released to the family. Dr. Charles Phillips also learned that first hand from Kaiser. Kaiser didn't care when shown proof that Mr. Stubbs no longer had anything to do with our family. Kaiser just wanted to hide the records and prevent the truth from being known. Kaiser and DMHC waited until a court of law ruled against us which is still not clear as to why that happened to us and then two days later just handed over the records. The records show exactly what I have written above. The potassium and a septic infection were the cause of death. The records were then shown to the same government agencies that had been asked to investigate before and this time around they said (a) the case was too old, (b) the records were incomplete, (c) they didn't want to bother. Yes they used those words and yes they put it in writing. Two agencies, the Board of Nursing and DMHC said never to write to them again. The Medical Board openly discussed while we could hear them, as to how to prevent us from finding out what happened. They later also said they would never investigate. As I had never been discourteous to any of them, I wrote again anyway to them all. LAPD also conducted a Federally Funded investigation and said we are right but we have to wait for them to decide what to do. That was a year ago. We are still waiting. The Federal Government ordered the State of California to investigate this along with several other Kaiser cases last year. The Federal Government feels this and several others are murder cases and really bad medical care. The State of California said so what, we don't have to and they haven't. Three or four years ago The University of Virginia brought out the now famous Nixon Tapes, where Nixon jumps at the idea of the for profit Kaiser and Permanente. I think that I have spoken to just about every reporter from every major newspaper in America about that tape and no one cared all that time until Mr. Michael Moore saw the truth behind it. The media all said that it happened too long ago and they didn't care. Mr. Moore realized how very important it was for the entire world to hear that tape. I am very grateful that he was able to incorporate it into his film "SICKO." It made a lot of people wake up and hopefully has helped save some lives. Last year this time I received some very scary telephone calls. One individual was attempting to extort and another graphically explained what would happen if I continued participating in the radio program I had at Tropic Wave Radio. I shortly thereafter resigned from the station. They were not happy about it and neither was I but I also believed it was the right thing to do. I also received a phone call from an alleged patient victim wanting help in the same week. During that phone call this person repeatedly asked where my husband worked. I finally told her. BTW, I have caller ID and none of these call numbers were blanked out. At the time my husband had something to do with allowing Kaiser's entry into the County which he worked. You can guess what started happening next. Of course our suspicions and those of some SEIU employees are pure conjecture. For several months after this I went back east and traveled a bit. I needed a fresh perspective on this entire situation. I wrote a book and had it published and tried to think of other more pleasant things. While I was out of state the KaiserPapers was seriously vandalized. I returned in the Spring of this year and have remained cautious. Upon my return a software program was found to be running on the server itself that created a denial of service attack and was used to manipulate the numerous defaced and altered web pages. The people that this program originated from were confronted and we found another web host. We also now have enough bandwidth I understand to handle any of these problems in the future. The company that we are now with will prosecute with any future actions. There was one minor attempt but as I said they would - the company took care of it immediately. A month ago, in September 2007 another phone call was received and the police have now taken it seriously after they heard it. Three other people, non family members, were frightened when they heard it. I guess we are just supposed to wait now. For what I am not sure. Another person, one that also writes in this newsletter, has begun having similar things happen to them over the past few months. I am pretty sure that the source of the problem is the same. I am also pretty sure that for these antics to even be taking place that someone involved with Kaiser is concerned enough with the information we all have made public to go to these lengths. I don't know where this is all going but I am going to continue to obtain justice for my father and the victims of Kaiser. I am sure that the other person now experiencing vandalism, harassment and attempts of intimidation will continue as well. I would like to think that some day in the very near future "Mr. Up Stairs" will get caught and then the really good laws created by good people that we already have in California will be enforced. Vickie Travis may be contacted via e-mail at: vickie@kaiserpapers.info |  By: Tony Zizza
"It's about hoping, it's about dreaming, it's about never not
believing. It's about taking a walk out on the wall, and....never
looking down. It's about living, instead of dying, it's about spreading
your wings and...flying. It's all about trying."
--Pam Tillis, Country Music Superstar
I think it goes without saying that the last thing we want
children to do is stop trying. This is especially true given the
stark reality that far too many children these days possess an unhealthy sense of entitlement. Not to mention, they have an insatiable urge to seek instant gratification no matter the consequence. As parents, we own a duty to insist that children do their best.
We must show them how to work towards the proverbial "stars." Think
about it. Even if children do not make it to the stars, at least being
half way there, is a lot farther than they ever would have been if they
only worked towards satisfying low expectations.
So, yes. It's all about trying.
We can do so much within our power to raise children with a proper
sense of vision. Raising children to be at least semi-normal takes
plenty of hard work and dedication. We can ensure that children live a
life full of good mental health. This often takes making an effort
to be aware of bad mental health programs/ideas within our culture. Certainly, there are things that children - especially those in
middle school and high school - should live without. Low frustration
levels. Low resistance to peer pressure. High regard for the easy way
out. High regard for bashing this great country of ours.
Let us not forget to mention something else that children and their parents can do without. It's a child suicide screening initiative that goes by the slick name of - TeenScreen. TeenScreen claims it is needed to screen middle school/high school
students so potential suicides can be prevented. But then again, what
can we really believe that comes out of Columbia University anymore?
If you can allow the President of Iran to speak at a once honorable
institution, the chances are quite good you're lying about what
TeenScreen does. No, TeenScreen does not prevent suicide. In fact, it
turns normal to semi-normal children into mental health patients.
Yeah, right. This is just what we need more of!
TeenScreen operates in 43 states, and at 450 locations. Mostly
middle schools and high schools. These children are fresh meat for
those who want to provide more young minds with more psychiatric labels
and drugs.
TeenScreen is a multi-level process that does not simply end after a young student takes a computerized ten minute questionnaire. God help us all if this is the working standard of psychiatry today. Now, if certain responses are received, students are referred for
mental health services. Mental health services that you know damn well
include psychiatric drugs. I mean, what else do mental health services
have to offer these days other than - drugs? Parental consent here is
a scam, and you must know something is wrong about TeenScreen since
NAMI thinks there are so many things right about it.
Interestingly, and what seems to fuel support for scams like
TeenScreen, are lies concerning the number of "youth" who are either
suicidal or have other mental health issues. It seems the percentage
changes daily. Perhaps it depends on where you get your news. It's
safe to say that the average accepted lie is that 20 percent of
America's youth could be defined as having a mental disorder. To make
matters worse, there is a second lie. And that lie goes like this -
only 20 percent of all youth who can be "identified" as mentally ill
receive mental health services.
Sorry, but I think that number is a lot higher. Consider all the
children in this country who are on drugs and forced into therapy. In
some school districts, I wouldn't doubt that half the student body are
improperly drugged, labeled as mentally ill. All the while, we are led
down the slippery slope of this "pill for every ill" mind-set in an
alleged effort to quell the alleged epidemic of youth suicide. Talk
therapy - yes. Psychiatric drugs and labels for growing brains - no. We must do something hard and fast to prevent programs like
TeenScreen from entering even more states and locations. Shouldn't we
wonder why they operate so secretively? Shouldn't we wonder why so
many folks on their advisory board have ties to Big Pharma? Shouldn't
we wonder why so many of the organizations that support TeenScreen
directly benefit from its referral system? So many contradictions. So many questions. So many platitudes.
Life is all about allowing your children to spread their wings and
fly. It's also all about knowing things they should stay away from.
After all, they're your children, and YOU know their mental health
better than any other weasel who claims to be a "mental health
professional."
We can do without TeenScreen.
Zizza is a freelance writer who lives in Atlanta, GA. He writes
frequently about mental health issues and popular culture. Reach Tony via email: tz777@comcast.net http://behavioral.kaiserpapers.info/ The Continuing Tissue Transplant Situation at Kaiser Permanente Woodland Hills by Hillarie Levy  In regards to the continuing situation concerning Kaiser Woodland Hills
violation of the Violation of Health and Safety Code 7154(b), (allowing the same
physician that pronounced my daughter Robyn dead try to procure her corneas for
donation. What makes it worse is that her corneas were ineligible do to cancer)
and California Probate Code 4733(a), (physician ignored Robyn's Medical
Directive in her chart and requested her corneas), the response from Kaiser Area
Medical Director Shirley Suda MD was shocking!Her response was as follows:
"We are sorry you are not satisfied with our investigation and
actions. We feel we have done what is appropriate for this situation and
have confirmed this with Jeff Fleming, Director of Family Services at One
Legacy."
http://robynlibitsky.kaiserpapers.info/kaiser-responds.html Dr. Suda's response to Mr. Fleming's correspondence is untrue and
shocking. How does she get away with twisting the facts? It should be
noted that Mr Fleming 10/05/07 response to me concerning this situation was
unflattering at best. In fact, according to Mr. Fleming' correspondence, he
indicated his disappointment with Kaiser's acceptance of this illegal action, to
the point where he felt it necessary to intervene! Currently Kaiser is
being reeducated under Mr. Fleming's guidance. Continued oversight will be
necessary as Dr. Suda's letter indicates her intention to defend and excuse this
violation.(Mr Fleming and Dr Suda's letters can be viewed at
robynlibitsky.kaiserpapers.info Where is the DMHC? Certainly this is not the response the DMHC expected
after their highly publicized review and fine! Although Director Cindy
Ehnes received this information, she remains eerily silent. Could it be
that once DMHC fines Kaiser they wash their hands of the problem until the next
horrific Kaiser disaster, that is covered by the media, arises?
Not only am I not "satisfied" but I am embarrassed for
California that Dr. Suda would actually respond with this inaccurate 3 line
letter and the DMHC finds it acceptable! Hillarie Levy may be reached at: Hillarie@kaiserpapers.info http://robynlibitsky.kaiserpapers.info  From the desk of Jupirena Stein:Medicare as a Secondary payer. Kaiser's Mandatory Binding Arbitration System/the injured patient/ Do you or anyone you know have dual health coverage? If your answer is yes; you must read this. This is about MSP, Medicare Secondary Payer and COB, Coordination Of Benefits. Retired
judges, attorneys and HMOs involved in the Medical
Malpractice/Mandatory Binding Arbitration -
“Business“, have found an open door to medical/legal
fraud against our federally funded health care program and Kaiser's
patients victims. They
work together, willingly and knowingly favoring big HMO’s
and neglecting Medicare beneficiaries of their legal rights also, setting the big HMO’s free of any future medical care financial obligation . Professor Malcolm Sparrow of Harvard's Kennedy School of Government is an expert on the subject of Medicare fraud. He has a name for this kind of thing. "Medical Insurance Liability Fraud against Medicare." I am going to explain but first, lets have a look at all pertaining laws. Source: www.cms.hhs.gov/medicare/cob/msp Medicare Secondary Payer (MSP) is the term used by Medicare when Medicare is not responsible for paying first. The private insurance industry generally talks about “Coordination of Benefits” when assigning responsibility for first and second payment. Precedence of Federal Law. Federal
law takes precedence over State law and private contracts. Thus, for
the categories of people described in the regulations discussed below,
Medicare is the secondary payer regardless of state law or plan
provisions. These federal requirements are found in Section1862(b) of the Social Security Act { 42 USC Section 1395y (b)(5) }. Applicable regulations are found at 42 CFR Part 411 (1990) Pre-1980 Legislative provisions. Until 1980, the Medicare program was the primary payer in all cases except those involving workers compensation ( including black lung ) benefits. Medicare was also precluded from making payment for services paid for by the Department of Veterans Affairs or other governmental entities. Workers Compensation:-------------------- Effective July 1, 1966 Veterans Administration Benefits (VA)---Effective July 1, 1966 Federal Black Lung Program:-------------- Effective July 1, 1973 Post-1980 Legislative Provisions Since 1980, a series of changes in the Medicare law have also resulted in Medicare being the secondary payer for individuals: 1 - Who is age 65 or older and working with coverage by an employer-sponsored or employee organization group health plan. 2 - Who are age 65 or older and who are covered by a working spouse’s employer group health plan (EGHP). The working spouse can be any age. 3 - With coverage under automobile, no fault, or liability insurance 4 - With kidney failure. 5 - Who are disabled and have coverage under their own large group health plan (LGHP) because of their current employment, or who are disabled and have coverage under the LGHP of a family member who is currently employed. An LGHP is a plan provided by an employer who employs 100 or more persons or a plan belonging to a multi-employer plan were at least one employer has 100 or more full or part-time employees. Automobile Medical or No-Fault Insurance: Omnibus Reconciliation Act of 1980, effective December 5, 1980. End Stage Renal Disease (ESRD): Omnibus Reconciliation Act 1981. Other Liability Insurance: Omnibus Reconciliation Act of 1980, effective December 5, 1980. Medicare is the secondary payer ( 42 USC Section 1395y(b) ) of claims for medical items and services to the extent that payment has been made or can reasonably be expected to be made for items, for services under homeowner’s liability, malpractice insurance, product liability insurance, and general casualty insurance. This insurance is sometimes called “ medical payment coverage”, “personal injury coverage,” or “ medical expense coverage,” and must be billed first. Beneficiary/Attorney Responsibilities when a beneficiary has an Accident/Injury. The
Medicare Program advises both beneficiaries and attorneys that payment
for medical expenses arising from an accident/injury can only be made
on the condition that they pay Medicare back from any
proceeds received from a third party settlement, award,
judgments or recovery. The centers of Medicare & Medicaid Services (CMS) awarded the Coordination of Benefits (COB) contract to consolidate activities that support the collection, management, and reporting of other insurance coverage of Medicare beneficiaries. NOTE: - Mr. Bruce Albion Bailey, my former attorney, did not inform MSP about my lawsuit. I did. Should Medicare make a payment for medical services when another insurance is primary, (42 USC 1395(b)(2) grants Medicare a priority right of recovery which may be exercised directly or through subrogation. The superiority of Medicare’s recovery right over other entities, including Medicaid, derives from the Medicare Statute. The Secretary has issued explanatory regulations for these provisions at: 42 CFR 411.20 Basis and Scope, Statutory basis (a) (b) 42 CFR 411.24 Recovery of conditional payments. 42 CFR 411.26 Subrogation and right to intervene. 42 CFR 411.50 General Provisions. 42 CFR 411.52 Basis for conditional Medicare payments in liabilities cases. 42 CFR 411.53 basis for conditional Medicare payments in no fault cases. 42 CFR 411.52 Basis for conditional Medicare payment in liability cases. “If CMS has information that services for which Medicare benefits have been claimed are for treatment of an injury or illness that was allegedly caused by another party, a conditional Medicare payment may be made.” IMPORTANT! REMEMBER THIS - Source: http://www.adminastar.com/AboutUs/AboutUs.html Question: -Does a settlement made between the beneficiary and the liable party bind Medicare to that settlement? Answer: The fact that a settlement has been reached between the beneficiary and the liable party DOES NOT BIND MEDICARE to that settlement. Medicare DOES NOT RECOGNIZE A SETTLEMENT that appears to have been designed to circumvent Medicare’s recovery interest. Question: - Will Medicare pay claims related to the accident/injury submitted after execution on the Release Agreement Form? Answer: Assuming that the settlement, judgment, or award did not include payment for future medical care, Medicare will pay claims for services provided subsequent to the settlement date. ABOUT N.G.S. National Government Services (Former UGS- United Government Services) UGS became NGS on January 1st, 2007. NGS is a private company that pays medical bills for Medicare part A.. UGS is my leading contractor. The National Government Services, LLC TEL : 414/226-6004 FAX; 414/226-2603 (now disconnected) 401 West Michigan Street Milwaukee, WI 53202-2804 is a wholly-owned subsidiary of government Health Services, LLC, and is part of the Well Point family of companies at 1 Well point Way, Thousand Oaks, California 91362 Mr. Timothy F. Cullen, TEL : 414/226-6004 FAX: 414/226-2604, was the Chairman of the Board of United Government Services, LLC (UGS), he is also a Vice-President of Cobatt Corporation. I want Mr. Cullen to explain to me why NGS (former UGS) is paying ( with federal money) for an injury that Kaiser Permanente is legally responsible for (the judge found Kaiser guilty.) In 2004, I filed a complaint with CMS stating Medicare was secondary to this injury and I as a Medicare beneficiary, believed Medicare should NOT PAY for any of these services related to this injury. I requested CMS NOT RECOGNIZE this award and consider ALL payments of claims pertaining to this vascular injury, - BE CONDITIONAL. Joan M. Fowler, acting Director of the Division of Medicare Coordination of Benefits from the Office of Financial Management/Financial Services Group, states on a response letter: “ Binding arbitration means that you are legally obligated to accept the findings of the arbitrator.” During a telephone call, Joan Fowler became dead silent when I argued with her: “ Perhaps I am bound to the judge’s fraudulent silence about my future medical care.” But I know Medicare is never bound nor obligated to accept ANY fraudulent award or settlement and the statute of limitations never runs out for ALL Medicare purposes. In 2005 I filed the same complaint with UGS (now NGS) Claudia De Cea, manager for MSP/UGS responded in a letter dated March 4, 2005: “ I would like to note that Kaiser’s arbitration rules were based on a commercial plan, and therefore, Medicare in its recovery actions may not have been provided extensive documentation on the aspects of the arbitration, which resulted in an award on November 27th, 2001. Here’s a copy of UGS/MSP ( Medicare Secondary Payer) Note: My attorney did not report this injury/award to Medicare, - I did. “Time to tie up those loose ends into a beautiful bow.” This is how Kaiser Permanente, their attorney Mr. George E. Clause, my attorney Mr. Bruce Albion Bailey and retired judge Rebecca Westerfield committed fraud against me and Medicare: Patient (Pt.) has 2 health insurances. Being one just any health insurance. More commonly a HMO, the - primary payer and the second, -Medicare, -being Medicare a Secondary Payer (MSP) (millions of Pt's are covered by 2 health insurances. MSP is under protection of Federal Laws. Section 1862 (b) of the Social Security Act -42 USC Section 1395 Y(b)(5) Regulations found at 42 CFR Part 411 of 1990 Patient gets injured while under the care of his/hers primary health insurance, (HMO). Case goes to Kaiser‘s mandatory binding arbitration. Attorneys quietly, in an almost undetectable way, connect both health insurances within their Legal Briefs (Pt's almost never ask to read the case's legal briefs) The judge signs hers/his final word but, stay silent about future medical care. And ...voilà ! The burden of future medical care is successfully and illegally shifted to our federally funded health care system, -Medicare. I spent 6 relentless years investigating "why is Medicare paying for my extremely expensive future medical care, when my injury was caused by Kaiser Permanente?" Six long years and countless hours of studying Kaiser’s arbitration system and Medicare laws. But now, you don’t have to do the same! You now know that this simple question, has a simple answer. Fraud! I was able to collect literally, hundreds of medical/legal documents that supports my words. The FBI has registered this case under possible Health Care Fraud case # MM 209-0, and the HHS/OIG is investigating. The attorney representing me, Mr. Bruce Albion Bailey, was forced into giving up his license. That is a good beginning... ... to be continued. Jupirena Stein Jupirena Stein may be reached at: j_u_stein@yahoo.com |
