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Association of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto

11/15/99

Ms. Nancy-Ann Min DeParle
Administrator
Health Care Financing Administration
200 Independence Ave S.W.
Washington, DC 20201

Dear Ms. DeParle:

I wish to file a formal complaint against Ms. Marcie Zeccola, Upstate Medicare Program Inquiries Representative (see enclosed letter to Ms. Zeccola dated Nov 15, 1999 which details what she did). This "HCFA contracted carrier" is committing FRAUD on a grand scale in purporting to "review" claims and documentation sent to them on appeal. It is obvious from reading Ms. Zeccola's letter that she didn't even read the information that I sent to Upstate Medicare to be considered for this appeal. Most of what she sent to me was computer-generated boilerplate that didn't even apply to the procedure under appeal. This represents not only gross negligence on her part, but FRAUD, because this carrier is taking government money under false pretenses, saying that they will properly process and review claims and never having any intention of fulfilling that obligation. And, Upstate Medicare supervisory personnel are fully aware that this FRAUD is being perpetrated .

Physicians such as myself spend a great deal of time putting together these "Medicare appeals," and it is outrageous and inexcusable when the "reviewer" at Upstate Medicare doesn't even read the material. These so-called "independent reviewers" seem to just glance at the claim denial, hit a key or two on the computer to reaffirm the denial and generate some nonrelevant nonsense to send back to the physician, all without even looking at the documentation that the physician sends. This goes on all of the time at Upstate Medicare. Moreover, allowing people with only a high school education as their highest level of education, with no medical credentials or training whatsoever to review claims like this containing complex medical issues, is irresponsible beyond belief. Furthermore, it's clearly FRAUDULENT. Upstate Medicare is allowing totally unqualified individuals to review these Medicare appeals. You would think that after the GAO published its findings several years ago detailing this type of FRAUD, that HCFA would have taken some action to stop it (articles enclosed for your review). This is without question one of the biggest FRAUDS being perpetrated on the American public today.

It's high time that HCFA opened it's eyes and dealt with this wholesale FRAUD being committed by it's own contractors.

Sincerely,

L.R. Huntoon, M.D., Ph.D.