Fraudulent Audit Allegations

Summary

BCBS-MA has initiated a prepayment review against you, alleging fraudulent billing practices. You have faced communication barriers and potential HIPAA violations. Consider filing a formal complaint with the Massachusetts Division of Insurance or consulting a lawyer to address these issues. Additionally, you have concerns about misleading accusations and civil rights violations. Document all communications and seek legal counsel to protect your rights and privacy.

Full Conversation

"Fraudulent Audit: on */*/*, BCBS Patrica Neely sent me a mail that BCBS-MA is going to initiate a prepayment review against me (File *). The reason she accused me of "Billing for impossible hours per day" is fraudulent. I have asked her so many times, she never replies and block my email. (File *, File *)"
Hi Yun-Pu Munroe, it sounds like you're dealing with a complex issue. Fraudulent billing accusations can have serious consequences. Have you considered filing a formal complaint with the Massachusetts Division of Insurance or seeking legal advice to address this situation effectively?
rephrase "Fraudulent Audit: on */*/*, BCBS Patrica Neely sent me a mail that BCBS-MA is going to initiate a prepayment review against me (File *). The reason she accused me of "Billing for impossible hours per day" is fraudulent. I have asked her so many times, she never replies and block my email. (File *, File *)"
Fraudulent Audit: On */*/*, BCBS's Patricia Neely notified me that BCBS-MA would initiate a prepayment review against me (File *). She accused me of "Billing for impossible hours per day," which is fraudulent. Despite numerous attempts to contact her, she never replies and has blocked my email (File *, File *).
Have you already considered filing a formal complaint with the Massachusetts Division of Insurance or consulting a lawyer to address this issue?
rephrase "Violate HIPAA: under this fraudulent audit, Neely request me NOT to complay with HIPAA( File *). Neely keeps deny the claim and asks for medical notes in both English and Chinese. As of today */*/*, * claims have been denied and affected more than * innocent patients. I have already sent over * medical notes, but none have been paid, and the reasons given have been vague or absent. Shows that the medical note requesation is not only based on fraudulent audit and also not for legal payment review purposes but for denying only. Neely and Wacht(BCBS-MA's in house lawyer) initiated patient investigation under no legal reason only to find out any wrongdoing of me and used the patient's word to accuse me. Violate both patients' and my privacy. (File *)"
HIPAA Violation: During this fraudulent audit, Neely requested me to disregard HIPAA (File *). She consistently denies claims and demands medical notes in both English and Chinese. As of today, */*/*, * claims have been denied, impacting over * patients. I have sent over * medical notes, none of which have been paid, with vague or absent reasons. This indicates that the request for medical notes is not for legal payment review, but solely for denial purposes. Neely and Wacht (BCBS-MA's in-house lawyer) conducted patient investigations without legal grounds, violating both patient and my privacy (File *).
Have you documented all communications and instances of non-compliance for potential legal action?
rephrase "Misleading and Misrepresenting: Wacht uses irrelevant medical payment policy to accused me for billing BCBS-MA of service not rendered (File71). In File * Wacht accuse me of */*/* my working hours for * claims is either * hours or * hours, but she also wrote that one patient's treatment hours is one hour(Page *). That means that Wacht clearly knows that * claims's working time is * hours only on */*/*. But Wacht choose * hours to accuse me of insurance fraud. */*/* is the date before this fraudulent audit(*/*/*). It should not be counted as the "finding" of the prepayment plan. Wacht alter CPT guideline from one-on-one to Face-to-Face"
Misleading and Misrepresenting: Wacht used an irrelevant medical payment policy to accuse me of billing BCBS-MA for services not rendered (File *). They claimed my working hours on */*/* for * claims were either * or * hours, despite knowing it was * hours. Wacht chose * hours to allege insurance fraud. This date should not be part of the prepayment audit findings. Additionally, Wacht altered CPT guidelines from one-on-one to Face-to-Face.
Have you considered gathering all your documentation and consulting a lawyer to address these serious allegations?
rephrase "There are some more, like violate my civil right, corecin with my ex-laywer to ask me to bill my patient out of pocket, iniate me of FIP will take further action and initiate post payment plan against me. "
There are other issues, such as violations of my civil rights, coercion by my ex-lawyer to bill patients out-of-pocket, threats of further action by FIP, and the initiation of a post-payment plan against me.
Have you considered consulting a lawyer to address these multiple serious allegations?
rephrase "I believe BCBS-MA is conducting a fraudulent audit against me.(File *) There are strong evidence shows on they refuse to provide the documentation to accuse me of billing service not rendered but only want to phone call to me and meet me in person. (File *-*) Insurance company has been required to commicate with transparency and good faith. BCBS-MA insist on commuicate in talking, or meeting is lack of transparency. BCBS-MA is exploding my vulnerability.""
I believe BCBS-MA is conducting a fraudulent audit against me (File *). There is strong evidence showing they refuse to provide documentation to accuse me of billing for services not rendered and only want phone calls or in-person meetings (File *-*). Insurance companies are required to communicate with transparency and good faith. BCBS-MA's insistence on verbal communication lacks transparency and exploits my vulnerability.
Have you considered consulting a lawyer to address these serious allegations?
rephrase "Since I have noticed that BCBS-MA is requesting my patient's medical notes base on fraudulent audit, I can not send them any more medical notes. It is my my obligation to protect my patient's privacy. "
Since I've identified that BCBS-MA is requesting my patient's medical notes based on a fraudulent audit, I can no longer provide them with any more notes. It is my duty to protect my patient's privacy.
rephrase "I will be very happy to meet or talk to Cari to give her some ideas to help her to expedite our case faster."
I'd be delighted to meet or talk with Cari to provide her with some ideas to help expedite our case.
rephrase "If BCBS-MA will use the excuse of investigation is private or some kind of shit to refuse to provide the policy they are using to accuse me of insurance fraud. "
If BCBS-MA claims the investigation is private or uses any other excuse to avoid providing the policy they are using to accuse me of insurance fraud.