Complaint: Healthfirst started auditing our records in november 2016 for prior years 2012 to 2016 . General Dynamics is the auditing firm. They asked for a number of patients records, including proof of delivery, clinical documents, writtin orders from Physician, etc— we sent everything we had on file . Same Documents we sent to Health First Medical Management Dept in those years to get authorization. We have all authorizations on file from this department, only then we dispensed products because they gave us the green light. Now General Dynamics is auditing records and kicks everything back saying we dont have sufficient documentation. We were presented with a huge bill for overpayments. Approximately 168K . We appealed, how can it be right ? something is wrong . Maybe they did not receive all the pages ? We sent everything again. In the meantime in August of 2017 Health First send us a letter saying we are on prepay hold. So for us to get paid we had to send all supporting documents, this takes them 60 days to review and then we would get paid . They continued using us to supply products to their members and giving us authorizations. Till this date Healthfirst still owes us approximately 90K , they only paid around 30K from the total, even claims that GDIT approved still remains unpaid . From all the records we sent to GDIT multiple times, almost all of them still shows on HF portal as GDIT DOCS NEEDED!. We filed a complaint with the State – Dept of Financial Services, They told us we had to try to work it out with Health First. It took us a month to get a meeting with the investigations unit at HF and GDIT members – Nothing happened here, nothing was resolved, we were told we have not submitted documentation, we are dispensing products, (which they authorized) and we should not. We were told that HF Authorizations are Hypothetical. Everything we dispense we have authorization from HF medical team. They review the docs before they give an Auth. and when you dont dispense the product after they issued an AUTH , you are tagged as refusing service. Member services starts calling, members demand service because they have an authorization. But yet, The Auhtorization doesnt guarantee payment. I asked the investigation team why they were giving out authorizations anyway if it is Hypothetical and it really means nothing . They said they did not want to talk about that. If they are following medicare guidelines, they should not give auhtorizations, since medicare doesn’t . THen it is up to the provider to provide the service or not. Not too long ago we received a letter of termination at no fault and we were encouraged to Join Integra Partners since they are the Preferred DME Vendor We have still not gotten paid and now we received a letter being accused of Fraud, Waste and Abuse and an overpayment bill- So not only did they not pay us for services we provided upon their approval but they also want money back from 2012 -2016 last time I checked the dictionary this type of Business Strategy is called legal extortion. This must stop ! This type of Business Practise is not acceptable .
Tags: Employee/ Business Violation, Extortion Artist, Fraud Phoney, Fraudulent Money Activity, Health Insurance Fraud, Ripoff- Misc
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