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Re: No Medical Care For Cebu Retirees


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What I would like to know is what the Philippine dept if health is or is going to do about fraud in their hospitals and medical offices. The US position is a direct slam to the entire Philippine medical system. I would think that there would be some mention, or some action plan to address the problem. Or is the Philippines health system so warm and cozy in their corruption that they don't care? Maybe I already know the answer.

The majority of doctors and hospitals are not involved in fraud. Because ISOS and DHA do not understand local industry standards and expect the world to comply with how they do things such as hiring college degreed coders to bundle and unbundle, as appropriate, local procedures so they match the US system. When they fail to do that, DHA screams fraud. When ISOS certified businessmen as physician groups and physicians as hospitals, for a fee, and taught them how to defraud, ISOS was not blamed. Instead they said local providers were defrauding them and beneficiaries were defrauding them by using these fake but certified providers. Don't believe most of what you hear from ISOS or DHA as they haven't a clue. Most of the fraud occurred in and around Angeles and Subic and some that were well known by local retirees as being heavy into the fraud were the first ones that ISOS brought on board witht he Demo with promises of huge profits.

 

Jim

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With the decertification of the last remaining tertiary hospital in Cebu military retirees in Cebu are effectively left with 0 availability of medical care.  Only Mactan Doctors, Velez, Sacred Heart a

Jim, is it possible for you to just give the facts rather than being insulting in the process? If somebody posts misinformation, it is OK to show why it is misinformation and give the correct informat

May we all learn from this thread - both about medical reporting and how to better react to others.  We are all wrong at times so the old saying "to err is human - to forgive divine" seems to be fitti

Majorsco

The majority of doctors and hospitals are not involved in fraud. Because ISOS and DHA do not understand local industry standards and expect the world to comply with how they do things such as hiring college degreed coders to bundle and unbundle, as appropriate, local procedures so they match the US system. When they fail to do that, DHA screams fraud. When ISOS certified businessmen as physician groups and physicians as hospitals, for a fee, and taught them how to defraud, ISOS was not blamed. Instead they said local providers were defrauding them and beneficiaries were defrauding them by using these fake but certified providers. Don't believe most of what you hear from ISOS or DHA as they haven't a clue. Most of the fraud occurred in and around Angeles and Subic and some that were well known by local retirees as being heavy into the fraud were the first ones that ISOS brought on board witht he Demo with promises of huge profits.

 

Jim

But because of that the entire country has a problem. The question are they fixing it or do they even want to fix it? In other countries it's not a problem.

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But because of that the entire country has a problem. The question are they fixing it or do they even want to fix it? In other countries it's not a problem.

The cause of much of the fraud involving Tricare is due to Tricare's contractor. Eliminate Tricare and the problem goes away, maybe that is what the Philippine government should do? The DODIG doesn't agree with you and thinks DHA needs to look at many other countries where they feel hospitals and doctors are defrauding Tricare. But the biggest defrauders of Tricare are found in the states, day in and day out. I had a long conversation with the lead DCIS investigator for Tricare fraud in the Philippines about Tricare fraud here and he said it was really no different that anywhere else, about 10% of the population is involved. The original fraud, HVC, was owned and operated by an American who taught the local providers how fraud is supposed to work.

 

Jim

 

Jim

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Majorsco

There is something definitely different here vs other countries because there isn't a problem elsewhere. If what you say from the people you talk to is true, the the Philippines us being treated very different. The reason is why.

 

You cannot eliminate Tricare in the Philippines, because Tricare us not a company. It is a program. Maybe the Tricare contractor needs to be replaced, maybe so. Every 5 years, it is up for bid again, so it can change. However if there is no other viable bidder it won't change. I used to do federal DOD contracting and it's important for a contractors track record go be documented in its past performance file. Otherwise it's not referenced in the selection process.

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SkyMan

 

 

Well I must reply to Skyman on how easy Tricare claim filing is. It is obvious he is out of touch with reality and is speaking about something he knows nothing about. I had to file a claim on St. Lukes for a very complex procedure that cost , php 167000 hospital charges, php 240000 doctors fees or a total of php 407000. Well it took 12 pages of documentation, over 3 months to obtain relevant information and numerous phone calls to St Lukes before I obtained the required medical abstracts, medical records, doctors notes, records of doctors rounds etc to support the claim. Also was assisted by members of a retiree group who provided me with the expertise needed to process the claim. Simple medicine claims and office visits are easily filled out but the major claim is an entirely different story. Pro Fees are the big issue for inpatient claims and unless you can break them down into individual events you will not be paid by Tricare period.
Sorry you and your team of experts found such a simple thing so difficult.  Perhaps your problem lies in St Luke's?  I went to Chong Hua about 10AM and requested the detailed bill and records.  After lunch I picked up the certified copies and I never needed to bother them again.  Perhaps St Luke's has shoddy bookkeeping and therefore I'd wonder about the quality of care there.  Maybe they're trying to be sneaky with their books so Tricare may well have been wise to scrutinize your claim.  That and the excessive claim amount would set off bells for me.

 

My claim was about 30 pages and took a few days to put together without a team unless I am teamed with my PC I guess.  There were of course, horrendous problems with it.  After about a month I received notice they couldn't read one of the receipts so I resent a copy.  Later, when the claim was paid, 2 lab tests had been denied amounting to about $10.  I called and inquired why the tests were denied and after a bit of explanation on both sides I was told, 'for a while, sir.'  And 2 weeks later those were paid as well. Terribly difficult.

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lopburi3

I am not under TriCare so not sure what additional documents are needed but for my Blue Cross only the Cash Register receipt and the detailed receipt are normally needed (although they could ask for various medical certificates to justify procedures if they wanted).  But the key in Thailand is asking for "detailed receipt" which they can print out anytime and normally do at same time as you pay cash receipt if you request it.  For inpatient hospital operation this will run a few pages  But asking for the normal itemized receipt or insurance receipt only results in blank stares at most hospitals here (although the detailed receipt is the same thing).

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There is something definitely different here vs other countries because there isn't a problem elsewhere. If what you say from the people you talk to is true, the the Philippines us being treated very different. The reason is why.

 

You cannot eliminate Tricare in the Philippines, because Tricare us not a company. It is a program. Maybe the Tricare contractor needs to be replaced, maybe so. Every 5 years, it is up for bid again, so it can change. However if there is no other viable bidder it won't change. I used to do federal DOD contracting and it's important for a contractors track record go be documented in its past performance file. Otherwise it's not referenced in the selection process.

DHA has a bone to pick with Tricare beneficiaries in the Philippines because they tried to use them as their escape goat when they got hit hard by congress for ignoring fraud for ten years. An American came here and opened a company under the name of Health Visions and for ten years extracted millions from DHA. Beneficiaries reported the fraud the first year it occurred but nothing happened. DHA claimed it wasn’t their problem until the DODIG and DCIS went to congress who mandated that DHA do something; that was ten years into the fraud by this American who taught Filipinos how to defraud TRICARE. When they finally came around they placed the blame on beneficiaries saying we should have known better than to use this defrauder. A company that treated them well, filed claims for ten times what it cost for the care and were paid without question even after beneficiaries reported it as fraud. Since DHA paid all claims without question and said nothing when Health Visions claimed they were DHA’s official TRICARE provider for the Philippines many beneficiaries figured they must be okay in the mind of DHA. To this day they still claim 3 out of 4 beneficiaries are trying to defraud them. That means in a family of four, the husband, wife and one of the children are defrauding TRICARE is you believe the hype they put out. I was involved with a case where the contractor ISOS was certifying businessmen as provider groups, for a fee, and taught them how to defraud TRICARE for millions. I had the proof and reported the fraud and then heard nothing back. When I inquired I was told it was an isolated incident and the single employee was fired and to never speak of it again. I knew that wasn’t true as these fake groups were all over the Philippines. Later the director of the ISOS program approached me and wanted to know what I knew of the fraud. I refused to discuss it with him. I have evidence that they were filing fake claims for Prime Remote as well. I also identified multiple physicians that were certified as hospitals and would bill as a hospital at ten times the actual cost of care. I reported all of this to DHA yet years later nothing happened. I do know that DCIS investigated much of this and it stopped overnight but the investigation was done in secret and nothing was made public and it appears ISOS got off the hook.

 

Once when I asked why those in Washington that make policy decisions on us never come to see for themselves the consequences of their poorly thought out actions I was told they are not allowed to enter the Philippines because the Philippine government has barred TRICARE employees; a lie but they have no problem lying to us.

 

Jim

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But the key in Thailand is asking for "detailed receipt" which they can print out anytime and normally do at same time as you pay cash receipt if you request it.

 

Unless that detailed receipt includes the specific medical terminology used in the U.S. along with the exact charges for each procedure or group of procedures depending on the U.S. standard and costed against the TRICARE CMAC which requires the associated medical codes it will not be paid. The Philippine standards do not require such receipt nor do providers have a clue how to convert their standard to the U.S. standards.

 

Jim

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Majorsco

Unless that detailed receipt includes the specific medical terminology used in the U.S. along with the exact charges for each procedure or group of procedures depending on the U.S. standard and costed against the TRICARE CMAC which requires the associated medical codes it will not be paid. The Philippine standards do not require such receipt nor do providers have a clue how to convert their standard to the U.S. standards.

 

Jim

Good luck with the codes going forward since Obamacare not only changed many codes, but significantly expanded the list of codes. The US doctors are having a tough time with them. Imagine the problems here with many times more codes to deal with.

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Good luck with the codes going forward since Obamacare not only changed many codes, but significantly expanded the list of codes. The US doctors are having a tough time with them. Imagine the problems here with many times more codes to deal with.

You might want to get your facts straight. The expanded code set has been in the works for many years and before the ACA was ever passed into law. There is nothing in the law that even addresses medical coding and claims processing; go look for yourself. The drivers behind this are the medical insurance industry and Medicare. Tricare has opted to retain the old coding system for overseas; not that it really makes much difference since no other country in the world uses the US coding and billing system used in the states.

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Majorsco

Ok, it is merely coincidental that this massive code change happens at the same time as Obamacare's destruction of the American medical system.  However, the  zeal of the implementation is impressive and I've heard interviews of medical professionals at the cost of the conversion and the confusion it will cause.  As to whether Tricare will or will not adopt it, I found no reference.  However, I don't believe that Tricare overseas will be exempt as, it appears to be an international set of codes and it may only be a temporary reprieve.

 

As I said with my prior post, good luck with the codes and the Philippines when it does happen.

 

 

 http://beforeitsnews.com/new-world-order/2013/11/bombshell-international-medical-coding-and-legal-execution-by-beheading-brought-to-usa-under-obamacareis-this-why-the-government-need-guillotines-596.html\
 

(by Lorri Anderson, FREEDOM OUTPOST) – A faithful reader sent me a code and asked me to investigate how it ties into the larger scale of things. The specific code sent to me will make any American’s hair stand up on the back of their neck. The code is ICD 9 E 978. After reading this code I decided that it was my duty to investigate further and get to the bottom of why we have a medical code in the United States for “Legal Execution.” Below are my results.

According to reports, more than 68,105 new medical codes are being added due to the Obamacare monstrosity. Doctors all across the nation have been complaining due to the overwhelming burden it places upon them. Just the time consumption alone, making sure these codes are accurate, will inevitably take time away from the doctor/patient relationship creating a barrier of paperwork while destroying the personal experience with your doctor. While these doctors are correct to state it will be even more of a burden, they are not correct to state this has come out of Obamacare itself. Let me explain.

ICD 9 E 978 “Legal Execution

All executions performed at the behest of the judiciary or ruling authority [whether permanent or temporary] as:

  • asphyxiation by gas
  • beheading, decapitation (by guillotine)
  • capital punishment
  • electrocution
  • hanging
  • poisoning
  • shooting
  • other specified means
  • INJURY UNDETERMINED WHETHER ACCIDENTALLY OR PURPOSELY
  • INFLICTED

These codes were not created by Obamacare, however Obamacare is trying to implement every American citizen under international codes to link us to the “international” system. These codes were actually created by the WHO (World Health Organization) . The WHO is a specialized agency of the United Nations.

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Ok, it is merely coincidental that this massive code change happens at the same time as Obamacare's destruction of the American medical system.  However, the  zeal of the implementation is impressive and I've heard interviews of medical professionals at the cost of the conversion and the confusion it will cause.  As to whether Tricare will or will not adopt it, I found no reference.  However, I don't believe that Tricare overseas will be exempt as, it appears to be an international set of codes and it may only be a temporary reprieve.

 

As I said with my prior post, good luck with the codes and the Philippines when it does happen.

 

 

 http://beforeitsnews.com/new-world-order/2013/11/bombshell-international-medical-coding-and-legal-execution-by-beheading-brought-to-usa-under-obamacareis-this-why-the-government-need-guillotines-596.html\
 

(by Lorri Anderson, FREEDOM OUTPOST) – A faithful reader sent me a code and asked me to investigate how it ties into the larger scale of things. The specific code sent to me will make any American’s hair stand up on the back of their neck. The code is ICD 9 E 978. After reading this code I decided that it was my duty to investigate further and get to the bottom of why we have a medical code in the United States for “Legal Execution.” Below are my results.

According to reports, more than 68,105 new medical codes are being added due to the Obamacare monstrosity. Doctors all across the nation have been complaining due to the overwhelming burden it places upon them. Just the time consumption alone, making sure these codes are accurate, will inevitably take time away from the doctor/patient relationship creating a barrier of paperwork while destroying the personal experience with your doctor. While these doctors are correct to state it will be even more of a burden, they are not correct to state this has come out of Obamacare itself. Let me explain.

ICD 9 E 978 “Legal Execution

All executions performed at the behest of the judiciary or ruling authority [whether permanent or temporary] as:

  • asphyxiation by gas
  • beheading, decapitation (by guillotine)
  • capital punishment
  • electrocution
  • hanging
  • poisoning
  • shooting
  • other specified means
  • INJURY UNDETERMINED WHETHER ACCIDENTALLY OR PURPOSELY
  • INFLICTED

These codes were not created by Obamacare, however Obamacare is trying to implement every American citizen under international codes to link us to the “international” system. These codes were actually created by the WHO (World Health Organization) . The WHO is a specialized agency of the United Nations.

 

It is not international and you are talking apples and oranges and appear to have no real idea what you are talking about. Medical coding of procedures uses CPT codes. You are talking about ICD 9 codes which are diagnosis codes and have not changed. The wingnut who wrote this manufactured story is mixing apples and oranges and also hasn't a clue. Best you take a few months and take some online courses on CPT codes, which are owned by the American Medical Association and has nothing to do with WHO! This is a perfect example of how people believe anything they read on the internet and end up making a fool of themselves. I spent 41 years in Health Care Administration, what are your qualifications on medical coding?

 

Jim

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USMC-Retired

Just to add to what is said above, this was passed around on social media. Here is the fact check on it. Easier reading with an understanding to further Jim's correct statement.

http://www.politifact.com/truth-o-meter/statements/2014/jan/02/blog-posting/bloggers-say-obamacare-coding-system-could-usher-b/

 

Sent from my GT-P6200 using Tapatalk

 

Edited by USMC-Retired
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Just to add to what is said above, this was passed around on social media. Here is the fact check on it. Easier reading with an understanding to further Jim's correct statement. http://www.politifact.com/truth-o-meter/statements/2014/jan/02/blog-posting/bloggers-say-obamacare-coding-system-could-usher-b/ Sent from my GT-P6200 using Tapatalk

Thanks for the reference. To further clarify the referenced article, ICD codes are diagnosis codes or codes that describe what happened. CPT codes (Current Procedural Terminology) are used to describe what the provider does to address the condition or what happened to the individual; surgical procedures, inserting a cathater, setting a broken arm, etc. These codes, not ICD codes, are the ones that insurance companies in the US use to pay for care. The ICD code is used as a reference to help determine the validity of the claimed procedure. For example if the ICD code said "broken right arm" and the doctor billed a CPT code for abdominal surgery it would be questioned. Based on an ever changing playing field some CPT codes are alwasy grouped together when billing, what is called bundling in the industry, while others are not. These rules apply only in the states. When a Philippine physician tries to file a claim using these procedures and fails to know the latest rulings and lists them seperately rather than as a group Tricare claims he is committing fraud when all that is happening is he doesn't have the 4 year degree that coders in the states have to do this. See http://en.wikipedia.org/wiki/Current_Procedural_Terminology for a detailed explaination of CPT codes.

 

Jim

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It is not international and you are talking apples and oranges and appear to have no real idea what you are talking about. Medical coding of procedures uses CPT codes. You are talking about ICD 9 codes which are diagnosis codes and have not changed. The wingnut who wrote this manufactured story is mixing apples and oranges and also hasn't a clue. Best you take a few months and take some online courses on CPT codes, which are owned by the American Medical Association and has nothing to do with WHO! This is a perfect example of how people believe anything they read on the internet and end up making a fool of themselves. I spent 41 years in Health Care Administration, what are your qualifications on medical coding?

 

Jim

 

Jim, is it possible for you to just give the facts rather than being insulting in the process? If somebody posts misinformation, it is OK to show why it is misinformation and give the correct information...but it is NOT OK to insult another member in the process. Many of us know your qualifications, but using them to tell another member, "I'm right because I'm more qualified than you" just isn't necessary. This is LinC Forums...and not your newsletter, so please be courteous here.

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