This has to be illegal?

[ShowMeTheCredit]

Trying to help out my pops, he's 93.  I manage his affairs now, recently signed him up with the VA for first time in his life, for future reference.  Anyway hospital stay late 2021.  Handed his Medicare card to hospital going in the door, multiple providers billed for multiple services during the stay.  All denied initially with a stated reason of... no coverage at time of service.  They all sent the bills to the wrong address.  Most providers figured it out on their own, while some called and I helped them find the correct address.  Eventually, all providers got paid after resubmitting to correct address.  All but one, that is.  That provider did get paid on 3 of 4 bills submitted.  One relatively small bill was never submitted to the correct address however.  Medical provider ultimately turned it over to collections and as soon as I saw it, I got the medical provider and the insurer on a 3 way call.

Insurer confirmed and informed medical provider during this call that

1. Member number medical provider had used for patient was correct.
2. Patient was covered at time of service, but provider never received a claim on that bill.  Provider  just kept resubmitting to incorrect address.

3. Insurer also noted provider did send some bills from the same hospital stay to the correct address, and did get paid on those bills, just not this one.  Insurer could see all of the bills that had been submitted to incorrect address and denied, and none received at correct address. 
4. Insurer informed provider that the window for submitting claims on that bill had since passed.  ie, provider was informed they were never going to get paid.

Provider then promised to remove collection from my pops credit report and get back to him.  Obviously, nothing ever happened.

I recently took this up again.  I have had at least two other recent contacts with the provider's billing department, where I was told the same thing, they would fix it, and nothing ever happened.  

Well, one thing did happen I should definitely make note of.  My pops very recently received a new bill from provider, for same services provided in 2021, where the last line item says the provider resubmitted the bill again to the insurer last month and the insurer denied the claim for the stated reason of that particular service was not a covered service.

This led to another 3 way call with insurer and medical provider, where I luckily managed to get a very experienced and  informed supervisor from insurer who just happened to be taking calls that day, and that guy really let the provider have it.  First he noted there has been no claim activity on this bill in 2 years, and they have never denied any claims for the reason stated on the new bill.   He also noted the provider would have received statements (explanation of benefits) along with the denial letters that clearly indicated the patient had zero responsibility for the bill.  Like, in bed bold red letters!  He made it abundantly clear on that call as well, that particular service was a zero cost service to the patient, under all circumstances.  It wouldn't matter, where, when, how or who, the patient was not to be billed for that service.  period.    He questioned why the provider would have ever billed my pops for anything for that service. He also questioned the professionalism of the provider's representatives, scolding the rep and the provider's company for not knowing these things.

Provider once again promised to remove from credit report, and insurer was quick to note they do record all calls.  That was awesome!  

When provider hung up, I stayed on with insurer.  We talked for a bit.  very helpful.  I asked if the bill the provider most recently sent my pops could be considered medicare fraud.  He said absolutely.  He is sending me the statements and explanation of benefits the provider would have received.

So anyway, I waited over a week, still on credit report.  Now I contact the collection agency, and this is where things really went south.  The collection agency informed me they have had no contact from provider on this acct for almost 2 years.  In other words, provider has made no requests whatsoever to have the collection removed.  I should also note, the collection was disputed long ago, I think via Credit Karma, and was verified.  After trying to explain the activities to date to the initial collection agency agent, I was getting nowhere, just more runaround and so I asked to have this escalated to someone higher up.  She was trying to push it back to provider, and I was having none of it.  As I was explaining the details to the higher up, the collection agency stooge suddenly cut me off, then got really mouthy and insulting and hostile.  So much so that I just hung up.

That really made me angry.  This whole thing has made me pretty angry.  That's when I remembered, there are penalties for this kind of thing.  Normally, I'd be happy to just get this resolved, and move on.  But the stooge from the collection agency changed that.  Now I feel like I need to make an example of both sides of this disaster.  I feel like I could be holding a document that effectively represents Medicare fraud in the latest bill from provider.  I also feel like collection agency has some responsibility in this as well.  But that's why I am here.  This is where the answers are.

What do I do fellers? I know I can get it removed from my pops credit report easy enough, but can I make it sting for provider and collection agency in the process?

[greendeh]

Paging

 

@Why Chat

@legaleagle2012

@Flyingifr

@shifter

@hdporter

@hegemony

 

[Flyingifr]

There are more moving parts to this than a Swiss watch, but here is my two cents, but first, some clarifying questions:

 

1: What is dad's mental health? Is he capable of doing this himself at his age? I ask because unless you have a Power of Attorney or a Court appointment as Representative/Conservator, this is a fight you can only do from the sidelines.

 

2:  I don't see any Cause of Action under FDCPA against the Collection Agency.  FDCPA SOL is 1 year, in this case it has been at least 2. Other than being a jerk, I really am having difficulty finding anything the CA has done wrong within the FDCPA Statute.

 

3: The OC, however, is another story. The verified TL on dad's CRA file is a FCRA violation. By accepting Medicare as a payor, the OC accepted Medicare's billing requirements, one of which is to submit a proper bill within a certain time limit. The OC failed to do that, and their contract with Medicare stipulates that they lose the right to payment if they violate the rules. Another part of these rules is that if they violate them and lose the right to payment they cannot turn to the patient for payment. They violated, they lose, not the patient. By reporting the claim to a CRA and then verifying its accuracy, they violated FCRA.

 

You don't say how much the claim is for, but I am certain that all of this is a good defense against any OC suit against dad, and is certainly good evidence of a FCRA suit by dad against the OC.

[Why Chat]

I think that you should take the advice of Flyingifr and make sure you are legally allowed to be your father's representative.

 

Then you should get PAPER reports from each of the CRA's for your father:

https://whychat.me/GUIDEBOOK.html

 

carefully check all reports for ANY discrepancies and get those resolved. Opting out will help prevent his credit data from being sold to credit miners.

 

You can submit a complaint to the proper authorities

https://whychat.me/hipaaleg.html#complaint

https://whychat.me/hipaaftccomp.html

[SeekerOfWisdom]

11 hours ago, Flyingifr said:

2:  I don't see any Cause of Action under FDCPA against the Collection Agency.  FDCPA SOL is 1 year, in this case it has been at least 2. Other than being a jerk, I really am having difficulty finding anything the CA has done wrong within the FDCPA Statute.

 

Every time a debt collector updates a false report to the credit bureau, it restarts the statute for that purpose--so you'd want to check the "balance updated" or "status updated" date on the report.  If that's within the last year,  SOL shouldn't be a problem.

 

If there's no update within the last year, then a dispute letter to the bureau ("the amount being charged is false...") should trigger either a deletion or an update by teh dirtbag collector, creating a new event for SOL purposes.

[Why Chat]

I think that you should take the advice of Flyingifr and make sure you are legally allowed to be your father's representative.

 

Then you should get PAPER reports from each of the CRA's for your father:

https://whychat.me/GUIDEBOOK.html

 

carefully check all reports for ANY discrepancies and get those resolved. Opting out will help prevent his credit data from being sold to credit miners.

 

You can submit a complaint to the proper authorities

https://whychat.me/hipaaleg.html#complaint

https://whychat.me/hipaaftccomp.html

 

You can file a complaint against the OC and CA even if the account is not reporting. IMO "Seeker's" advice for disputing is invalid. If you need to dispute the steps to take are within my guidebook link . https://whychat.me/GUIDE HIPAA PROGRAM.html

Edited May 26, 2024 by Why Chat

[SeekerOfWisdom]

2 hours ago, Why Chat said:

You can file a complaint against the OC and CA even if the account is not reporting. IMO "Seeker's" advice for disputing is invalid.

 

 

I correctly stated that new updates to a credit report is a new violation for SOL purposes under the FDCPA, and that any response to a dispute from a debt collector is exactly such a new update.  If you disagree with that, I'm curious what you're basing that on.

 

 

 

 

 

 

 

 

[Why Chat]

I am  disagreeing with your method of disputing a CRA entry of a medical debt. IMO disputes to CRAs that do not reference a HIPAA violation are doomed to failure.

In all other cases a SOL dispute MAY work, but a HIPAA dispute has been proven successful.

[SeekerOfWisdom]

15 hours ago, Why Chat said:

I am  disagreeing with your method of disputing a CRA entry of a medical debt. IMO disputes to CRAs that do not reference a HIPAA violation are doomed to failure.

In all other cases a SOL dispute MAY work, but a HIPAA dispute has been proven successful.

 

I was addressing the issue of the FDCPA claim being out of SOL—if it's "doomed" that means they've re-reported, and since the FDCPA issue is that the amount is false (because it's not owed) that would give him a new basis to sue.

And if he has a valid basis to sue, that's not "failure." 

 

Just my two cents.