Blue Cross And Blue Shield Of Texas Blue Cross Deny 96% of Claims on Elderly Patients, Force Doctor to Close Practice Richardson Texas
In August 1997, I was one of 39 of the top billing doctors to Medicare placed under a 100% prepayment review that resulted in denying 96% of my claims.
My practice was 90% elderly patients. I provided free transportation and made home visits. In 1996, I was featured in USA Today newpaper as one of the few doctors doing home visits on Medicare patients.
Most of the claims were denied as not medically necessary. I sent patients to get xrays or lab or consult with specialists, they were paid.
I met with BC. We reviewed 11 claims that had previously been denied to find out why. Answer: "Progress notes not signed". I was told to sign and resubmit them. I did. They denied them again as not being medically necessary and/or no documentation received.
We applied for group number and got it. I was not on the initial application. We billed without me on the new group and they paid 98% of the claims. I was added to the group, billed claims, and 100% were denied.
I closed my practice in 2001 and filed a civil suit in 2003. Three trial dates have been cancelled because BC Motion for Summary Judgments. We are now in the appeals courts
Dr. d.g.
Dallas, Texas
U.S.A.
2 Updates & Rebuttals
Dr. d.g. edwards
Dallas,Texas,
U.S.A.
Blue Cross Legal Counsel Gives Judge $5,000 on Same Day of Motion For Summary Judgment
#3Author of original report
Fri, February 01, 2008
Blue Cross legal counsel gives the Judge who would here their Motion for Summary Judgment his largest campaign contribution of $5,000 on the same day before hearing the case. The Judge ruled in Big Blue's favor.
The Judge is Carlos Cortez, 44th civil district court, Dallas, County Texas.
Dr. d.g. edwards
Dallas,Texas,
U.S.A.
Blue Cross Reports Doctor To State Board and FBI, No Allegations Found
#3Author of original report
Fri, February 01, 2008
Blue Cross and Blue Shield of Texas turned me into the Texas State Board of Medical Examiners in 1995 and 1997. Both investigations were for "fraudulent recruitment of patients for home care". All turn out to be false.
I was investigated by the FBI in April 1997. There was a 1232 page file. I never have been charged with any crimes or Medicare fraud.