TRY ME!
Fraudulent Audit Defense Strategy
Summary
If youre facing a fraudulent audit by BCBS-MA, its crucial to document all interactions and insist on written communication to ensure transparency. Consider consulting with a healthcare law attorney for specialized advice. Filing a complaint with the Massachusetts Division of Insurance may take several weeks to months for a response. Ensure you include all relevant details, such as unfounded accusations, unjust claim denials, and any potential HIPAA violations.Full Conversation
Sure, here's a draft letter to the Attorney General in Massachusetts regarding your situation:
---
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Office of the Attorney General
One Ashburton Place
Boston, MA *-*
Dear Attorney General Healey,
I am writing to bring to your attention a matter of great concern involving Blue Cross Blue Shield of Massachusetts (BCBS-MA). As an in-network acupuncture provider, I have been subjected to what I believe is a fraudulent and unjust audit by BCBS-MA, led by the reviewer Neely and BCBS-MA lawyer, Wacht.
---
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Attorney General Maura Healey
Office of the Attorney General
One Ashburton Place
Boston, MA *-*
Dear Attorney General Healey,
I am writing to bring to your attention a matter of great concern involving Blue Cross Blue Shield of Massachusetts (BCBS-MA). As an in-network acupuncture provider, I have been subjected to what I believe is a fraudulent and unjust audit by BCBS-MA, led by the reviewer Neely and BCBS-MA lawyer, Wacht.
~Details of the Issue:
- Fraudulent Accusations: Neely and Wacht accused me of billing BCBS-MA for impossible hours to initiate a fraudulent prepayment review against me. Despite my requests, they have refused to provide any proof of these allegations.
- Unlawful Investigations: Neely attempted to initiate an office investigation against me without legal evidence and required me to provide both English and Chinese medical notes forevery denied claim. Over the past year, Neely has consistently denied my claims, accumulating to * denied claims, affecting * members nationwide.
- Unsubstantiated Accusations: Wacht used irrelevant Medicare payment policies instead of BCBS-MA's own policies to accuse me of billing for services not rendered. They also altered acupuncture CPT guidelines and misused my posted working hours to support their claims.
- Patient Harassment: Neely and Wacht have contacted my patients without legal reason, making them uncomfortable and using their statements against me.
- Health Impact: The stress from this audit has led me to the emergency room and caused PTSD and severe stress, which I have documented and shared with Neely and Wacht, only to be ignored.
I have enlisted legal help, including attorney Cirel, but have not received adequate support. Neely and Wacht refuse to provide written documentation, insisting on in-person meetings or phone calls, despite my request for written communication due to language barriers.
Given these circumstances, I request your office to investigate this matter thoroughly. The actions of BCBS-MA, Neely, and Wacht have caused significant professional and personal harm, and I believe their conduct warrants legal scrutiny.
Thank you for your
- Fraudulent Accusations: Neely and Wacht accused me of billing BCBS-MA for impossible hours to initiate a fraudulent prepayment review against me. Despite my requests, they have refused to provide any proof of these allegations.
- Unlawful Investigations: Neely attempted to initiate an office investigation against me without legal evidence and required me to provide both English and Chinese medical notes forevery denied claim. Over the past year, Neely has consistently denied my claims, accumulating to * denied claims, affecting * members nationwide.
- Unsubstantiated Accusations: Wacht used irrelevant Medicare payment policies instead of BCBS-MA's own policies to accuse me of billing for services not rendered. They also altered acupuncture CPT guidelines and misused my posted working hours to support their claims.
- Patient Harassment: Neely and Wacht have contacted my patients without legal reason, making them uncomfortable and using their statements against me.
- Health Impact: The stress from this audit has led me to the emergency room and caused PTSD and severe stress, which I have documented and shared with Neely and Wacht, only to be ignored.
I have enlisted legal help, including attorney Cirel, but have not received adequate support. Neely and Wacht refuse to provide written documentation, insisting on in-person meetings or phone calls, despite my request for written communication due to language barriers.
Given these circumstances, I request your office to investigate this matter thoroughly. The actions of BCBS-MA, Neely, and Wacht have caused significant professional and personal harm, and I believe their conduct warrants legal scrutiny.
Thank you for your
General Guidance:
- Document Everything: Keep all communication and documentation related to this issue well-organized.
- Request Written Communication: Insist on written communication to ensure transparency and avoid misunderstandings.
- Document Everything: Keep all communication and documentation related to this issue well-organized.
- Request Written Communication: Insist on written communication to ensure transparency and avoid misunderstandings.
Sample Letter to the Attorney General:
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Attorney General Maura Healey
Office of the Attorney General
* Ashburton Place, 20th Floor
Boston, MA *
Dear Attorney General Healey,
I am writing to report what I believe to be a fraudulent audit and harassment by Blue Cross Blue Shield of Massachusetts (BCBS-MA). As an in-network acupuncture provider, I have been subjected to continuous claim denials and baseless accusations by BCBS-MA representatives, Neely and their lawyer, Wacht.
For over a year, my claims have been denied weekly without pause, accumulating to * claims affecting * members nationwide. Despite my repeated requests for evidence of their accusations, they have provided none and instead blocked my email.
They have unjustly accused me of billing for impossible hours and altered acupuncture CPT guidelines to further their accusations.Additionally, Neely and Wacht have contacted my patients without legal cause, making them uncomfortable and potentially damaging my practice's reputation. Despite providing extensive medical documentation, my claims continue to be denied without valid explanations.
I have repeatedly requested written communication due to my preference for transparency and to avoid misunderstandings, but my requests have been ignored. This situation has severely impacted my health, causing PTSD and severe stress, as documented by medical notes I have shared with them.
I respectfully request your office's intervention to investigate this matter and ensure that BCBS-MA is held accountable for their actions.
Thank you for your attention to this urgent matter.
Sincerely,
[Your Full Name]
---
Would you like additional information or assistance with another aspect of your situation?
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Attorney General Maura Healey
Office of the Attorney General
* Ashburton Place, 20th Floor
Boston, MA *
Dear Attorney General Healey,
I am writing to report what I believe to be a fraudulent audit and harassment by Blue Cross Blue Shield of Massachusetts (BCBS-MA). As an in-network acupuncture provider, I have been subjected to continuous claim denials and baseless accusations by BCBS-MA representatives, Neely and their lawyer, Wacht.
For over a year, my claims have been denied weekly without pause, accumulating to * claims affecting * members nationwide. Despite my repeated requests for evidence of their accusations, they have provided none and instead blocked my email.
They have unjustly accused me of billing for impossible hours and altered acupuncture CPT guidelines to further their accusations.Additionally, Neely and Wacht have contacted my patients without legal cause, making them uncomfortable and potentially damaging my practice's reputation. Despite providing extensive medical documentation, my claims continue to be denied without valid explanations.
I have repeatedly requested written communication due to my preference for transparency and to avoid misunderstandings, but my requests have been ignored. This situation has severely impacted my health, causing PTSD and severe stress, as documented by medical notes I have shared with them.
I respectfully request your office's intervention to investigate this matter and ensure that BCBS-MA is held accountable for their actions.
Thank you for your attention to this urgent matter.
Sincerely,
[Your Full Name]
---
Would you like additional information or assistance with another aspect of your situation?
Sure, **** ****, here's a draft for your complaint to the Massachusetts Division of Insurance:
---
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Division of Insurance
* Washington Street, Suite *
Boston, MA *-*
Subject: Complaint Regarding Fraudulent Audit by BCBS-MA
Dear Sir/Madam,
I am writing to formally file a complaint against Blue Cross Blue Shield of Massachusetts (BCBS-MA) regarding a fraudulent audit conducted against my practice. I am an in-network acupuncture provider for BCBS-MA, and I am experiencing severe and ongoing issues with their reviewer, Neely, and their lawyer, Wacht.
---
[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]
Division of Insurance
* Washington Street, Suite *
Boston, MA *-*
Subject: Complaint Regarding Fraudulent Audit by BCBS-MA
Dear Sir/Madam,
I am writing to formally file a complaint against Blue Cross Blue Shield of Massachusetts (BCBS-MA) regarding a fraudulent audit conducted against my practice. I am an in-network acupuncture provider for BCBS-MA, and I am experiencing severe and ongoing issues with their reviewer, Neely, and their lawyer, Wacht.
Key Issues:
- Unfounded Accusations: BCBS-MA has accused me of billing for impossible hours without providing any proof. Despite repeated requests, they have refused to supply any documentation to support their claims.
- Unjust Denial of Claims: Over the past year, Neely has denied * claims affecting * members, often without explanation or on baseless grounds. This has caused significant financial and reputational harm to my practice.
- Unreasonable Documentation Requests: I am required to submit both English and Chinese medical notes for every denied claim, an unreasonable and burdensome request.
- Patient Harassment: Neely and Wacht have contacted my patients to investigate my practice without a valid reason, causing discomfort and distress among my patients.
- Health Impact: The stress from this fraudulent audit has led to severe health issues, including PTSD and emergency room visits, which have been documented and ignored by BCBS-MA.
- Unfounded Accusations: BCBS-MA has accused me of billing for impossible hours without providing any proof. Despite repeated requests, they have refused to supply any documentation to support their claims.
- Unjust Denial of Claims: Over the past year, Neely has denied * claims affecting * members, often without explanation or on baseless grounds. This has caused significant financial and reputational harm to my practice.
- Unreasonable Documentation Requests: I am required to submit both English and Chinese medical notes for every denied claim, an unreasonable and burdensome request.
- Patient Harassment: Neely and Wacht have contacted my patients to investigate my practice without a valid reason, causing discomfort and distress among my patients.
- Health Impact: The stress from this fraudulent audit has led to severe health issues, including PTSD and emergency room visits, which have been documented and ignored by BCBS-MA.
Actions Taken:
- I enlisted attorney Cirel to protect my civil rights, but his advice was not satisfactory, leading to the termination of his services.
- Despite my preference for written communication due to English being my second language, Neely and Wacht insist on in-person or phone meetings, which has resulted in further misunderstandings and stress.
- I enlisted attorney Cirel to protect my civil rights, but his advice was not satisfactory, leading to the termination of his services.
- Despite my preference for written communication due to English being my second language, Neely and Wacht insist on in-person or phone meetings, which has resulted in further misunderstandings and stress.
Request for Action:
I request the Massachusetts Division of Insurance to investigate this matter thoroughly and provide relief from the ongoing fraudulent audit and harassment by BCBS-MA. Your prompt attention to this matter is highly appreciated.
Thank you for your time and consideration.
Sincerely,
**** [Your Full Name]
---
Would you like any modifications or
I request the Massachusetts Division of Insurance to investigate this matter thoroughly and provide relief from the ongoing fraudulent audit and harassment by BCBS-MA. Your prompt attention to this matter is highly appreciated.
Thank you for your time and consideration.
Sincerely,
**** [Your Full Name]
---
Would you like any modifications or
Start a new chat