- 0.1 I’m republishing this article to share these TRICARE problems across a wider audience. Major thanks to Jim Houtsma, who has worked tirelessly for many years now to bring these out and out abuses to public attention.
- 0.2 Lying as a Way of Life in the Military and by Their Contractors
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Bottom line is, if you are dependent upon TRICARE as a major for of medical/health care insurance, better be very careful before you make the decision to live in the Philippines … because things aren’t always what they seem to be and you can’t depend upon your own government and your own military leadership to tell you the truth. Dad, indeed.
For years we’ve watched as the former TRICARE Management Activity (TMA), now the Defense Health Agency (DHA) and International SOS (ISOS) have lied to each other and to the beneficiaries living in the Philippines. Although we have no direct proof that they lied to all the other beneficiaries around the world it seems clear that is a very distinct possibility with very little doubt.
We have many examples of these lies from over the years from all three entities and have in the past posted some, but not all of them, on this blog and in the Newsletter. We were criticized by some for doing this claiming that most of the lies are simple mistakes or inadvertent misstatements by these entities and should be overlooked. We believe the article below has vindicated us.
Today the truth has come out in an Army Times article, Report: Army officers admit to (and defend) their lying. It doesn’t take a great leap of faith to conclude that this same philosophy of lying and defending the lies as being for the “greater good” is also a rampant philosophy among the officers and senior NCOs in all services today. Nor does it take a great leap of faith to also conclude this is accepted as the norm by the contractors that extract billions of defense dollars from the taxpayer also for the “greater good”.
What the “greater good” means to these officers, NCOs and senior staff of the services and contractors is anyone’s guess. But I suspect when they speak of “greater good” they are talking about the “greater good” they are doing for their own career or the bottom line and not the nation or those that suffer due to these lies for the “greater good”.
We can only hope that this nationally published article and the underlying study result in national outrage that puts a stop to this and punishes those that are involved.
This goes a very long way in explaining all the out and out lies that we see spewed at us by DHA and ISOS.
Some examples of lies we have been told by DHA and ISOS in the recent past.
- In January 2014 Lt. Gen Robb, Director of DHA appeared before a subcommittee of the House Armed Services Committee. He was presented with some questions about the Limited Philippine TRICARE program and submitted a written response. The response was fraught with lies, innuendos and begging the question and apparently deliberately done to hide the truth from Congress and beneficiaries. He lied about how the promised local employee came to pass and then lied about why it was dumped. While he knew full well that he already told the DODIG that the Philippine Demonstration was faltering and causing a lack of access to care and increased costs to beneficiaries he implied to Congress that this program was doing what they proposed it would to further justify their removal of the promised position. Further he made false statements about certification of providers in an attempt to make his organization and ISOS look good at the expense of beneficiaries. He also chose to ignore one of the questions entirely in favor of expounding on what he hoped would convince Congress what a good job he was doing. See the second article in the Tricare Philippines Newsletter 14006.
- This culture of lying apparently has been ongoing for many years. In 2011 RADM C. S. Hunter, the Deputy Director of TMA in response to a congressional inquiry from a Senator she claimed that the need to reduce access to care in the Philippines was due to “rampant fraud” and to make her point she said; “These fraudulent activities in the Philippines have presented the greatest challenge for our Program Integrity (PI) office. TRICARE Management Activity PI placed 64 percent of all Philippine providers’ and 77 percent of all Philippine beneficiaries’ claims on pre-payment review”. The clear and obvious conclusion the Senator was to draw from this was that 6 out of 10 providers and 8 out of 10 beneficiaries were suspected of fraud in the Philippines which was her justification for reduced access to care. It was further intended to cause the Senator to dismiss any future complaints from the Philippines where almost 80% of TRICARE beneficiaries were considered as likely to be involved in defrauding the U.S. taxpayer. And in this case her lies were fully successful in accomplishing just that. What is of note and which clearly shows that this senior officer deliberately misstated the truth is a slide presentation put out by her own PI office in mid 2010, six months before she passed on the lies above. On slide 8 her PI office says that 35% of providers are on pre-payment review and a whopping 22% of beneficiaries are on pre-payment review. The slide further explains that “many [beneficiaries are on prepayment review] as a ID theft protective measure”. Not only did she grossly exaggerate the percentages she deliberately let the Senator think the primary reason for pre-payment review of beneficiary claims was for suspected fraud on their part. We wonder if she justified these lies by claiming they were for the “greater good” and what that “greater good” was.
- ISOS started the Philippine Demonstration experiment in January 2013 with lies to beneficiaries and to the TRICARE Overseas Program office. See Continuing Issue of Denial of Care at AUFMC and apparent Lies from ISOS to TMA. The Demo got off to a very rocky start with huge price increases instigated by ISOS, very poor training of providers and extremely limited access to care for beneficiaries that were being forced to use the limited number of providers. From day one we discovered as did many other beneficiaries that the single hospital that the largest single population of beneficiaries in the Philippines was forced to use only accepted Demo patients Monday through Friday from 8 to 5. After those hours and on weekends and holidays beneficiaries were advised to return the next working day or pay for their own care in direct violation of the stated policy under the Demo. Reporting these failures to ISOS and the front Global 24 garnered constant denials that this was true. When it was reported to the TRICARE Overseas Program office they informed us that ISOS told them this was absolutely not true and that apparently we and other beneficiaries couldn’t figure out who to see at the hospital creating the problem. In other words taking the lies from ISOS over beneficiary reported issues. We have recordings of a conversation made in public where the hospital staff clearly tell us they do not see Demo patients outside Monday through Friday from 8 to 5 and to come back tomorrow. When this same issue was addressed to Frewen, an official from ISOS, at a meeting with a number of beneficiaries in Angles City he responded that we should be “grateful” for what we had and not what we didn’t have. Obviously a poor attempt at avoiding the question as he knew he would have been booed out of the room if he made the same false claims to us as he or his organization made to TRICARE.
- A lot of lies were passed around by ISOS, TMA and the DODIG early on with regard to huge price increases implemented by ISOS with the Demo. ISOS lied to TMA claiming that people that had told beneficiaries that the price increases were directed by ISOS told them that they had not spoken to beneficiaries about the price increases and further would not have said that ISOS was involved. TMA then claimed that all providers worldwide increase their prices when dealing with insurance which is not true and been proven not true by multiple studies in the Philippines and other areas. Two of us returned and spoke to the individual that ISOS claimed we lied about because they said the individual said they never spoke to us or discussed price increases. We recorded the conversation as it was in a public location and also executed a signed and notarized statement indicating the individual again restated that ISOS was behind the huge price increases and also acknowledged her previous conversation that ISOS claimed never took place. We later provided this and many more signed and notarized statements regarding the price increases to the DODIG for inclusion with their pending investigation entitled, DoD Did Not Negotiate Rates With Overseas Health Care Providers and Generally Paid Claims as Billed. This audit found the DHA and ISOS extremely lacking in negotiating lower rates for health care provided TRICARE beneficiaries. In the documentation we provided we showed, in the case of the Philippines, that not only were lower rates not negotiated but that ISOS offered participating providers rate increases of between two to four times their normal rates for both cash and local insurance carriers. The DODIG rejected our information claiming it did not involve what they were investigating and claimed they sent it to the DHAIG for appropriate action. What we eventually found was that there was no such thing as a DHAIG and the document was sent to an individual that said he was not authorized to do anything but file the documents away and forget them. It appears we cannot even trust the DODIG to tell the truth and suspect that addressing these negotiated price increases by ISOS did not fit their agenda so were ignored. See Tricare Philippines Newsletter 14004, DODIG: Contractor Driven Price Increases in the Philippines are Not Worthy of Review.
- Another lie we caught ISOS in was with regard to replacement lenses due to cataract surgery. See, Secret Lens Purchase Agreement about half way down in Tricare Philippines Newsletter 14003. In August 2013 a retiree was told by a Demo approved provider that he was told by Global 24, the ISOS front used for the Demo, that the lenses used during cataract surgery were not a TRICARE benefit and beneficiaries were required to pay for them in full and up front. Obviously this was incorrect. An attempt to get this resolved with ISOS via email resulted in being ignored. Contact with DHA resulted in the beneficiary being told that ISOS claimed the provider was lying as ISOS would never tell them that. The beneficiary contracted several other Ophthalmologists that were Demo approved and was told the same story that ISOS told them it was not a covered benefit. In the end DHA directed ISOS to retrain all the Ophthalmologists and shortly after that DHA said ISOS claimed the retraining was completed. To the utter surprise of the beneficiary, when he returned in early 2014 to have a second cataract removed he was told the same story. The provider said nobody from ISOS or Global 24 had contacted him. When he was told that ISOS said he was lying about the lenses he became very upset. Again the beneficiary was stuck with paying for a lens that, under published Demo rules, should have been covered and a claim filed by the provider. Again DHA was contacted and eventually the beneficiary was informed that now ISOS admitted they had a secret agreement with these providers that allowed them to tell beneficiaries lenses were not a benefit. So they lied to beneficiaries and to DHA. Maybe there is a brotherhood among these liars because it didn’t seem to bother DHA that they had been lied to originally and now they were defended the lie as essential to insure the Demo succeeded, apparently at all cost. When it was suggested they should advertise this obvious exception to published policy they claimed it was not necessary as patients would find out when they saw the doctors. So here we have lies and liars protected and defended and an attempt to hide the lie from those effected.
- The faked Philippine Demonstration survey is another example of the lies put out by DHA in 2014. See Tricare Philippines Newsletter 14007. After a number of mistakes and miss-starts an official notice came out. In it they said;“If you received care during under the Philippines Demo during 2013, we want to hear from you!” and then they further said, “The Defense Health Agency is partnering with Zogby Analytics to conduct an official satisfaction survey. The survey will ask your opinions about the care you’ve received in the Philippines. Zogby Analytics will contact you if you lived in or received care in Manila, Angeles City, Pampanga, Olongapo City or Zambales any time during 2013.”
This turned out to be almost a total lie. In fact living in or receiving care in the Demo areas was not considered as criteria and almost nobody was contacted. Here is what we found was the truth after months of inquiries and rejection after rejection by multiple beneficiaries who attempted to join the survey as promised by DHA.
- If you were seen but the provider failed to file a claim, very common for those that paid in full due to their deductible, you were not considered as having received care under the Demo.
- If you chose to annotate the claim form asking that your EOB and checks be sent to your FPO address, a process that was approved by DHA, you were not considered as having received care under the Demo.
- If you tried to avoid the massive fee increases directed by International SOS (ISOS) by paying cash at the customary local rates and submitted your own claim, you were not considered as having received care under the Demo.
- If you received care in the Demo areas but have since changed status such as moving back to the states, you were not considered as having received care under the Demo.
- If when your claim was processed and the claims processor failed to include Reason Code 292 on your EOB, you were not considered as having received care under the Demo.We would like to elaborate on the use of Reason Code 292. Reason Code 292 states, “Services provided by an Approved Demonstration Provider.” This code did not come into existence until almost half way through 2013, thereby automatically eliminating all care received to that point as being consider under the Demo. Further we have evidence that the majority of claims during the rest of 2013 and even those in 2014 do not contain this magic reason code. One thing we discovered is the claims processor’s automated system does not allow more than one reason code per line so if any other reason code is assigned by the claim processor reason code 292 will automatically be removed.
- We have documented proof of multiple providers listed on the “Fake Provider List” we are forced to use. These have resulted in delays in claims payments of months and probably denials of claims as well. In a conversation with customer support at Wisconsin Physician’s Service (WPS) we were told these fake providers listed on the “Fake Provider List” is common and they see them all the time. But they said they have no control over the “Fake Provider List” we are forced to use and use the “Official List of Providers” we are not allowed to see. We contacted DHA on this asking for an explanation on what would be done to eliminate the fake providers listed on the “Fake Provider List” and why we cannot, like all other beneficiaries around the world, access the real list. We also asked why claims were not paid when the provider used was listed as certified even if they were not because the error was not the beneficiaries fault. After weeks and multiple inquiries we were told that ISOS claimed the two specific examples we provided were a minor glitch and nothing to worry about and DHA seemed to agree that it was not anything to worry about; what are a few more denied claims when the greater good is considered. As usual they ignored the other two questions. It appears that either ISOS lied to DHA again or that WPS lied to us when they said they see these uncertified providers listed on the “Fake Provider List” all the time. Either way someone lied.
We could go on but we think you get the idea and probably have a number of your own personal examples. If so please feel free to add them as comments.
If you want to find out the real story behind DHA’s and ISOS’s focused attack on TRICARE beneficiaries in the Philippines instead of their spin and propaganda, read TRICARE: Betrayal in the Philippines, Is This the Future of TRICARE Overseas? It is available at the link and most online book sales outlets such as iBooks, Barnes & Noble, Amazon and others.
Never forget the Defense Health Agency and International SOS always have your back when it comes to high quality and easy access to care; just ask them!