DC Consultant (Ret)
11-27-2012, 01:20 PM
It appears my previous Post may have been deleted. But, this is a follow up to that Post. It has been a 6 month effort to return over $6000 in possible fraudulent Doctors billing to State Group Health Insurance paid by United Health Care. At very least this should be a learning lesson to the D.I.F. Doctors Billing Codes do not and will not be disclosed if you are a participant in the Group Health Insurance. My D.I.F. referal number is T12-11241. I thank Lt. M.F. for his Professionalism but the information assumed by D.I.F. is incorrect when it comes to the Fl. Group Health Insurance Program. I have a pending Dept. of Health complaint 2012-13434 in which they were actively pursueing because they also believed U.H.C. had to disclose Billing Code Information. I am waiting for their letter "Knocking Their Socks Off" also. The Post below can be viewed at http://www.floridaprobationofficer.com .
Added 11/27/12: In an effort to prove INSURANCE FRAUD by the Doctors a key element is, What Services the Doctor billed as compared to the actual services provided. United Health Care has dealt a major blow to this argument. What in the end is probably more significant is UHC has stated State of Florida Group Health Participants are Second Class Citizens. Complaint #1-754808940 filed with the Dept. of Financial Services, Consumer Services on or about 09/17/12 has finally resulted in a response from UHC. A letter dated 11/26/12 from DFS states UHC claims that they are protected from releasing any Doctor Billing Information because the State of Florida Self-Insured Group Health Insurance is not governed by ERISA and therefore UHC does not have to cooperate. Clearly, the letter from DFS puts all Group Health Insurance participants at risk because UHC refuses to cooperate with all REASONABLE requests for billing information. Now, Lt. M.F. DFS, Fraud Division, on 09/12/12 I met personally with the Lt. at the Fort Myers office. He saided that I was entiltled to those Billing Codes and when I got them to make an appointment with him and he would go over the codes. I can only assume this was known in D.I.F. but just not shared with Field Staff.
ps: All Posts Are Copied for Legal Verification
Added 11/27/12: In an effort to prove INSURANCE FRAUD by the Doctors a key element is, What Services the Doctor billed as compared to the actual services provided. United Health Care has dealt a major blow to this argument. What in the end is probably more significant is UHC has stated State of Florida Group Health Participants are Second Class Citizens. Complaint #1-754808940 filed with the Dept. of Financial Services, Consumer Services on or about 09/17/12 has finally resulted in a response from UHC. A letter dated 11/26/12 from DFS states UHC claims that they are protected from releasing any Doctor Billing Information because the State of Florida Self-Insured Group Health Insurance is not governed by ERISA and therefore UHC does not have to cooperate. Clearly, the letter from DFS puts all Group Health Insurance participants at risk because UHC refuses to cooperate with all REASONABLE requests for billing information. Now, Lt. M.F. DFS, Fraud Division, on 09/12/12 I met personally with the Lt. at the Fort Myers office. He saided that I was entiltled to those Billing Codes and when I got them to make an appointment with him and he would go over the codes. I can only assume this was known in D.I.F. but just not shared with Field Staff.
ps: All Posts Are Copied for Legal Verification