A CLOSE BRUSH WITH THE FEDERAL GOVERNMENT

SLICE OF LIFE, MEDICAL RECORDS FILE

BY LUCY WARNER

JANUARY 13, 2020

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DECEMBER 31, 2019

MEDICARE CLAIM

CMS CASE # -- ***** ***** *****

I RECEIVED YESTERDAY (12/30) A LETTER DATED 12/27/19 FROM CMS (CENTERS FOR MEDICARE & MEDICAID SERVICES) QUESTIONING A CLAIM FROM 2014. IT DOES STATE THAT MEDICARE HAS NOT PAID ANYTHING BUT COULD IN THE FUTURE. APPARENTLY, THE WORDING IMPLIES, IF THERE IS AN OVERPAYMENT SITUATION THEY MAY TAKE ACTION REQUIRING ME TO PAY SOMETHING, WHICH I HAVE NOT RECEIVED AND MAY NEVER RECEIVE, BACK TO MCR. THEY INCLUDE A FORM TO BE FILLED OUT AND SENT TO THEM, AND STATE THAT IF A “SETTLEMENT” COMES TO ME, I AM TO RECORD IT ON THE FORM AND SEND THE INFORMATION TO THEM. THEY STATE THAT I COULD, UNDER UNSPECIFIED CIRCUMSTANCES, RECEIVE A “DEMAND LETTER.” THEY ALSO WANT TO KNOW IF I HAVE RETAINED AN ATTORNEY. ALL IN ALL, I WAS A BIT UNNERVED. I SCRUTINIZED EVERY LINE, GOOGLED “CMS” TO SEE IF THE WHOLE THING WAS A SCAM, AND HAD TO WAIT A FEW DAYS BEFORE I FELT READY TO CALL THE TELEPHONE NUMBER GIVEN AND ASK SOME, HOPEFULLY INTELLIGENT, QUESTIONS.

THE LETTER STATES THAT THE DATE OF THE “INCIDENT” WAS APRIL 15, 2014. I HAVE NEITHER RECORDS NOR MEMORY ON THIS. THE PRIOR LETTER WAS ALSO IN MY MAIL, AND IS DATED 12/23/2019. IT GIVES CONTACT INFORMATION, WHICH WAS NOT REPEATED IN THE SECOND LETTER FOR SOME REASON, AND STATES THAT THE SECOND LETTER IS COMING WITHIN 65 DAYS. IT ARRIVED IN LESS THAN A WEEK. IT INCLUDES A FORM WHICH IS CLEARLY MEANT TO RECORD INFORMATION THAT CAN BE USED FOR A “RECOVERY” BY MCR.

I NEED:

THE NATURE OF THIS CMS ACTION AND WHY IT IS HAPPENING. WAS THERE SUSPICION OF MCR FRAUD? THAT COULD BE VERY SERIOUS. WAS A LAW OR RULE BELIEVED TO HAVE BEEN BROKEN, AND IF SO WHAT? SPECIFICS ON THE “INCIDENT,” IMPLICATIONS OF THIS ACTION (NON-ACTION) BY MCR, WHY THE NEED FOR “RECOVERY” ACTION IF ANY, AND HOW TO PROCEED IF ACTION ON MY PART IS REQUIRED.

WWW.CMS.GOV

CONTACT -- BENEFITS COORDINATION & RECOVERY CENTER (BCRC)

BY PHONE -- 855 798 2627 / FAX 405 869 3309

BY MAIL -- NGHP, PO BOX 138832, OKLAHOMA CITY, OK, 73113

Non-Group Health Plans (NGHP)

Mandatory Insurer Reporting for Non-Group Health Plans (NGHP) Sep 7, 2018

Mandatory Insurer Reporting (NGHP) | CMS

https://www.cms.gov  › Coordination-of-Benefits-and-Recovery › Overview

ACTION:

NOTES ON CALL TO CMS:

JAN 13, 2020

SPOKE TO – EVELYN, AGENT # ****

AT TELEPHONE NUMBER 855-798-2627

NEED EXPLANATIONS FOR THESE LETTERS AND ANY ACTIONS:

EVELYN FIRST OFFERED TO PARAPHRASE THE LETTERS FOR ME, WHICH SHE DID BEAUTIFULLY. SHE DESERVES TO BE MADE EMPLOYEE OF THE YEAR. MCR DID NOT RECEIVE ANY CLAIMS FROM GEICO ON THE ACCIDENT OF APRIL 15, 2014, EVELYN SAID, THOUGH GEICO, IT APPEARS, REPORTED AN ACCIDENT IN WHICH I OR SOMEONE ELSE WAS INJURED AND TREATED. EVELYN SUGGESTS I CALL GEICO ABOUT IT. GEICO SETTLED THE CASE ON MARCH 15, 2018, SHE SAID, PRESUMABLY WITHOUT ANY NEED FOR ME TO PAY OUT OR RECEIVE ANY SETTLEMENT MONEY; BUT THAT IF I DO RECEIVE A SETTLEMENT, MCR REQUESTS THAT I FILL OUT A REPORTING FORM ABOUT HAVING RECEIVED IT. I DON’T BELIEVE I WAS IN AN INJURY ACCIDENT IN 2014 AT ALL, IN MY CAR OR IN ANYONE ELSE’S. IT’S THE KIND OF THING YOU TEND TO REMEMBER.

OFFICIAL GOVERNMENT LETTERS ARE A MIRACLE OF MIRTH, ONCE THE WORDING IS DECIPHERED AND BOILED DOWN TO A FEW FACTS. NO, I DON’T HAVE TO PAY ANY MONEY, AND THE WHOLE SITUATION WAS PRECAUTIONARY. IF AND ONLY IF I WANT TO FIND OUT MORE ABOUT IT, I CAN CALL GEICO. I DON’T THINK I WANT TO. NO SENSE TAKING A STICK AND POKING IT INTO A HORNET’S NEST. IT’S IN THE SAME CATEGORY AS WHAT MY BROTHER-IN-LAW SAID ABOUT BEING IN THE ARMY. “NEVER VOLUNTEER.” ON THE OTHER HAND, GEICO THINKS I’VE BEEN INVOLVED IN SOMETHING OR THEY WOULDN’T HAVE NOTIFIED MCR ABOUT IT; SO, I GUESS I’LL HAVE TO CALL THEM TO RESTORE MY PRIOR PEACE OF MIND, SUCH AS IT WAS.

I HOPE BERNIE SANDERS WILL DO SOMETHING ABOUT REPLACING THOSE GOVERNMENT LETTERS WITH SOMETHING SIMPLER AND CLEARER SO THAT THEY ARE, AT LEAST, EASIER TO UNDERSTAND. I USED TO WORK FOR THE NATIONAL BANK OF WASHINGTON, AND THEY MADE A NEWS ANNOUNCEMENT SOME YEARS AFTER I LEFT THAT THEY WERE GOING TO STOP SENDING SPECIALIZED LEGALESE LETTERS OUT TO THE PUBLIC, REPLACING THEM INSTEAD WITH “PLAIN ENGLISH.” NO MORE INSCRUTABLE FINE PRINT: NOW THAT IS A CHANGE THAT, I FEEL CERTAIN, WILL HELP.