Jump to content

TRICARE Sanctions Chong Hua Hospital as well as Cebu Doctor's


Recommended Posts

The two high quality hospitals in Cebu have been secretly tried and convicted of fraud by TRICARE.

 

Extracted from the TRICARE Overseas Blog, http://wp.me/p2Ka0E-aj

 

Chong Hua Hospital no Longer Certified and Not on the Not Used in > 2 Years List

 

On the Philippine Standard front it appears that DHA has secretly removed and sanctioned Chong Hua Hospital in Cebu sometime between 15 November 2013 and 1 December 2013. Last January they secretly removed and sanctioned Cebu Doctor’s Hospital. That means the two quality hospitals in Cebu are no longer available for use. Since neither hospital ever filed TRICARE claims it boggles the mind how they were found guilty of fraud against TRICARE.

 

When a provider simply disappears from the certified list and is not moved to the Not Used in > 2 Years list it is usually a good indicator that they were secretly tried and convicted of fraud by ISOS and/or DHA.

 

In the states providers that have been convicted of fraud against Medicare or TRICARE are sanctioned by not allowing them to participate or be paid by medical insurance companies. Once they are convicted they are placed on one of two sanctioned lists which are available on the internet. The more extensive of these lists can be found on the U.S. Dept of Health & Human Services. This list contains only the names of those that are currently sanctioned and contains 55,864 names mostly from the states but around 100 from overseas. Of those overseas only one is from the Philippines. The TRICARE Sanctions list appears to contain every provider ever officially sanctioned by them as the sanction has expired on a great number of them. This list contains 110 names. All of them are from the U.S. or the Philippines which has 18 of the 110 listed. Of the 18 only 8 are currently active sanctions.

 

But that’s not the end of the story. We know of many Philippine providers who have been removed from the Certified list and apparently tried and convicted of fraud in absentia. DHA apparently found it more convenient and expedient to bypass legal action in favor of their current process. We became aware of this process many years ago. Initially they posted a list of these providers on the TAO-P webpage but within a few months it disappeared. We asked that it be reactivated but were told that DHA was afraid of possible adverse actions they might encounter if the providers were aware they were sanctioned so refused. So for the last five years the identities of these secretly sanctioned providers have been kept secret from beneficiaries. If a beneficiary is unaware of the sanction and uses one of these providers their claims will be denied out of hand but they will not be told the truth about why it is denied.

 

Some indications you’re being had by the system are when you see the claim denied because the provider is not certified and the denial comes within two or three weeks of receipt by the claims contractor. If you inquire as to the reason the provider was not certified you maybe told the provider “died”, “closed their office” or “retired” on some date before the date(s) of care. Since you saw the provider you would obviously know this it false information. Another indicator is, while anyone that submitted bills and receipts for care from a non-existent provider would be investigated for fraud, they will not pursue fraud charges as they know they would be found out.

 

While many of these providers were involved in fraud, like the physicians that ISOS certified as tertiary hospitals so they could file false inpatient claims, we know of others that did nothing wrong and the basis for the claim of fraud was based on local policy or law which local providers have no control over.

 

There is little you can do about this except report it to the affected provider and complain to your congressman. We feel, in the spirit of openness, you have the right to know what is causing you to lose your benefit so decided to publish this now.

Link to post
Share on other sites
Majorsco

While Obama is busy dismantling the US healthcare system, do you think he or the democratic controlled Senate would do anything about Tricare overseas in general, or Philippines in particular?  If Tricare is dismantling itself here, it fits in with the Obama way of doing things.

Link to post
Share on other sites

I'm not sure how to respond to that statement. It seems to be a self fulling comment but with little relation to reality and the Philippines. The civilians in charge at the Pentagon have been at this distruction of TRICARE for the last 15 years. The real issue is what are you going to do about it?

  • Like 1
Link to post
Share on other sites
Majorsco

Those civilians at the pentagon work for SecDef who works for the president. In a fiscal environment such as today's cost cutting where the victims can't scream with any real power (such as expats), these service issues are expected. Obama, nor any democrat are pro military or pro veteran beyond trying to get votes. Why do you think SecDefs have sometimes been republican in a democratic administration? It wasn't to have a token republican.

Link to post
Share on other sites
  • Administrator
Salty Dog

Guess I better move back to Dumaguete, or is Silliman Medical Center also off their list now as well?

Link to post
Share on other sites

overall not good news for our american comrades ,where do you go now for medical treatment as they 2 are considered the best around cebu if i,m not correct

Link to post
Share on other sites

It really is to bad there is nobody here that is concerned enough to do anything but come up with conspiracy theories. Enjoy your medical care.

Link to post
Share on other sites
SkyMan

It really is to bad there is nobody here that is concerned enough to do anything but come up with conspiracy theories. Enjoy your medical care.

Jim, I've written to Congressmen on a number of occasions and the most I've ever gotten back is a form letter thanking me for my support of their effort to do the exact opposite of what I want them to do. We could send letters about Tricare/ISOS and I hope I'm not the only one that does but TC/ISOS will report their survey results that 90% of us just love them and that will satisfy whatever questions there might be.
Link to post
Share on other sites
Headshot

Face it guys. The US government doesn't want us living in the Philippines. Because of that, they will do whatever they can to make life difficult for us here. Tricare is just one tool they use to discriminate against us. This is really bad. With both Cebu Doc and Chong Hua off the approved list, there really aren't any quality hospitals left for us. The weird thing about this is that neither Cebu Docs or Chong Hua bills Tricare directly, since they are not full participating providers. Members must pay upfront, and then submit the charges to Tricare. So...Tricare is really saying that members are submitting fraudulent claims in the name of these hospitals. Doesn't that just give everybody warm fuzzies?

Link to post
Share on other sites
Majorsco

Jim, I've written to Congressmen on a number of occasions and the most I've ever gotten back is a form letter thanking me for my support of their effort to do the exact opposite of what I want them to do. We could send letters about Tricare/ISOS and I hope I'm not the only one that does but TC/ISOS will report their survey results that 90% of us just love them and that will satisfy whatever questions there might be.

Senators and representatives couldn't care less about expats here or anywhere. We are not a base of voters generally that contribute to their coffers and many aren't registered to vote anyway.

 

They often don't even provide good representation to people actually living in their districts.

 

Expats just are out of luck.

Link to post
Share on other sites

Jim, I've written to Congressmen on a number of occasions and the most I've ever gotten back is a form letter thanking me for my support of their effort to do the exact opposite of what I want them to do. We could send letters about Tricare/ISOS and I hope I'm not the only one that does but TC/ISOS will report their survey results that 90% of us just love them and that will satisfy whatever questions there might be.

Are you registered to vote? Do you vote? When you write a congressman or senator the first thing they do is check to see if you live in their district or state and vote. If you live overseas and are not registered to vote in their district they see no point in responding.

Link to post
Share on other sites

 

 

Members must pay upfront, and then submit the charges to Tricare. So...Tricare is really saying that members are submitting fraudulent claims in the name of these hospitals. Doesn't that just give everybody warm fuzzies?

 

Most beneficiaries do not file claims and we can prove that via our survey. The Defense Health Agency claims there are almost no military retirees living outside 100 miles of Manila and the vast majority of those that do live in Iloilo City. So the 25 or so that do there can't be more than 2 or 3 of you in Cebu. Besides Camacho said that only 50 claims have been filed across a significant portion of the Visayas including Cebu, Iloilo, Tacloban, Roxas, Palawan etc. See Tricare waives some payment rules in Philippines. The waiver they finally granted is nothing more than a slap in the face of every retiree living here, see After Weeks of Debate and Coordination DHA Announces Disaster Relief for Haiyan or Did They.

 

We need to start filing claims even if they don't pay them. Otherwise they claim we do not exist.

Link to post
Share on other sites
USMC-Retired

Philippines and Fraud.  It just goes together like Peanut Butter and Jelly.  Sorry to say that however what do expect when it is rampant in every form of government and private sector.

Link to post
Share on other sites

Senators and representatives couldn't care less about expats here or anywhere. We are not a base of voters generally that contribute to their coffers and many aren't registered to vote anyway.

 

They often don't even provide good representation to people actually living in their districts.

 

Expats just are out of luck.

Good for you. My congressman and that of another have taken an interest. But then we vote and don't just cry. Good luck to you.

Link to post
Share on other sites

Philippines and Fraud.  It just goes together like Peanut Butter and Jelly.  Sorry to say that however what do expect when it is rampant in every form of government and private sector.

Best to leave so you don't get caught up in all the fraud. Maybe you could go to the states where there is only a little fraud like hundreds of millions lost in fraud to military contractors and hundreds of millions more lost to Medicare fraud.

Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...

Important Information

By using this site, you agree to our Terms of Use, Privacy Policy and Guidelines. We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue..

Capture.JPG

I Understand...