Below is a copy of a letter sent to Oxford's Special Investigations Unit.
Special Investigations Unit
Monroe, CT 06468
Sir or Madam:
[The below definition is taken from Oxford's web site]
What is healthcare fraud?
Healthcare fraud is the intentional deception or misrepresentation of healthcare transactions by a provider, employer group, or member for the sake of receiving an unauthorized benefit or financial gain. Individuals convicted of this crime face imprisonment and substantial fines.
You left one entity out of your definition: The Healthcare organization itself. Following is a summary of the bait and switch tactics used by Oxford's unscrupulous leadership.
In the spring and early summer of 2005, Oxford saw an opportunity in Orange County, New York to swoop down and prey upon a vast sea of potential Medicare recipients that have been denied any form of zero dollar premium supplemental medical insurance. The only thing available to these elderly retirees and disabled people, who were not privy to the special arrangements offered by Medicare to Health Care Insurance companies for those who lived in New York City, was Medicare alone, which with its high co-payments, and lack of sufficient coverage, was designed to eliminate as many of them as possible from the rolls of Social Security.
Medicare alone slowly drains what little resources they have until in desperation they are forced to forego any needed medical attention in favor of basic survival. Nevertheless, fear not, for to the rescue comes Oxford's Medicare Advantage program, I wonder whose advantage Oxford was thinking of, to save the day. Let us see:
1) $10.00 PCP copay
2) $20.00 Specialist copay
3) $80.00 per day not to exceed $800.00 per hospital stay
4) $100.00 Ambulatory facility copay
5) $0.00 copay for X-Ray, CAT scan, and MRI Services
6) $0.00 copay for Ambulance Services
7) $20.00 copay for urgently needed care
1) $15.00 PCP copay
2) $25.00 Specialist copay
3) $125.00 per day not to exceed $1500.00 per hospital stay
plus a $250.00 in-patient physician copay
4) $300.00 Ambulatory facility copay plus a $200.00 outpatient
5) 20% copay for X-Ray, CAT scan, and MRI Services
(Original Medicare copayment)
6) 20% copay for Ambulance Services
(Original Medicare copayment)
7) $25.00 copay for urgently needed care
Therefore, as you can see, for these people on a fixed income, the difference between some of the benefits in 2005 as compared to the same benefits in 2006 is overwhelming!
An $800.00 hospital stay in 2005 has now morphed into a $1750.00 expense in 2006!
Likewise, a $100.00 outpatient facility copayment has now escalated to a whopping $500.00!
Oxford now leaves the payment of all X-Rays, MRIs, CAT scans, and Ambulance services to Medicare with the policyholder now being charged 20%, the original Medicare copayment. One might well ask, what the hell does Oxford pay!
Oxford sent their bait and switch representative Gary Summers, who like a good little employee, denied Oxford's past bad reputation, into Orange county, New York. His mission was to sucker the unsuspecting and the needy into Oxford's Medicare Advantage plan. It turns out Oxford's true intent was to enlist as many people as it could into their fold and then upon the new year, fleece them!
I realize that Oxford designs its policies to act as algorithmic programs to solve it's never-ending problem: How to screw as many people as possible while claiming to help them in their time of need and at the same time take in as much money as possible while paying out as little as it can.
One way in which Oxford solves this dilemma is to make its co-payments so high that the majority of those covered cannot afford to pay them thereby limiting the disposition of their claims to the most meager of payouts.
In other words, all Oxford, or any other Insurance company for that matter, wants is free money!
Those, like the leadership of Oxford, who are in control, and having no conscience, play their deadly games of greed and power while exploiting and manipulating those in need like Medicare beneficiaries without any misgivings or regard for morality are the truly fraudulent!
I call for the Special Investigation of Oxford itself!
no comment, New York