-
Alexander posted an update in the group
COURT WATCHERS NEEDED 1 year, 8 months ago A call‡
to Medicare Appeals Council
to decide appeal M-23-386, filed on 28 October 2022
and still pending as of Friday, 20 October 2023;Inline image
(dab = Departmental Appeals Board of Medicare, tel. (202)565-0100;
alj appeal = appeal from the administrative law judge decision)and
a call
to people who have been denied their rights by Medicare and related entities,
to class action law firms, and to investigative journalists,
to join forces to expose the abuse of power and cover-up
affecting so many people who assert their rights
as single party to their stand-alone case and
even do so without a lawyer (pro se), and
as a result, have barely any chance against coordinated
hospitals, medical practitioners,
equipment and laboratory services providers,
health insurance companies and health management organizations (HMOs)
and their networks of services and equipment providers,
medical decisions reviewers, administrative law judges,
Medicare, Medicaid, and the Medicare Appeals Council,
all with their lawyers and working together to further their common interest in
enlarging their networks of services and equipment providers;
denying claims of people to save money; and/or
billing them for the balance of bills in excess of
what the tables of medical costs allow by law and contract, which
constitutes balance billing and has been illegal since 1997♦(OL3:1611§A)
because it defeats the purpose of medical costs limited by health insurance,
thus prompting the recent adoption by Congress of the No Surprise Bill Act.
‡ http://Judicial-Discipline-Reform.org/ALJ/23-8-28DrRCordero_class_action_v_Medicare.pdfBy
Dr. Richard Cordero, Esq.
Ph.D., University of Cambridge, England
M.B.A., University of Michigan Business School
D.E.A., La Sorbonne, Paris
Judicial Discipline Reform
New York City
http://www.Judicial-Discipline-Reform.org
[email protected], [email protected], [email protected]A. To lawyers, journalists, schools, patients, and Advocates of Honest Judiciaries
1. The above-named entities have engaged in coordination consisting in harmonious conduct in support of common interests, described below. Thereby they have reached implicitly or explicitly reciprocal exoneration agreements providing that ‘I help and protect you today and you help and protect me tomorrow’. They function as a collective entity ‘too powerful to be held accountable’. As a result of their unaccountability, they have been able to form and operate a racketeering enterprise. Cf. Racketeer Influenced and Corrupt Organizations Act (RICO); 18 U.S.C. §§1961 to 1968; and Enterprise Corruption; NY Consolidated Laws, Penal Law-PEN §460. There is a lot of money to be grabbed through racketeering.
a. “The Medicare Program [has] 65.0 million beneficiaries and total expenditures of $905 billion in 2022”. It works with hundreds of health insurance and management organizations (HMOs), and medical services and equipment providers. All of them have common interests: pay the fewest claims and attract to, and maintain in their, networks the largest number of providers. To advance their interests they deny and uphold the denial of as many of their insureds’ claims as possible; disregard their legal duty to accept as total payment the amounts stated in Medicare’s and HMOs’ schedules of fees for services and equipment; and condone the billing of insureds for the unpaid balance, which constitutes the illegal practice of ‘balance billing’.
1) Section 1902(n)(3)(B) of the Social Security Act, found in Title 42 of the U.S. Code of federal laws, as modified by Section 4714 of the Balanced Budget Act of 1997, P.L. 105-33, prohibits services and equipment providers from balance billing Medicaid QMBs (Qualified Medicare Beneficiaries) for Medicare cost-sharing. The provider is duty-bound statutorily and contractually to submit its bill to Medi-caid and accept as full payment what Medicaid pays, as set forth in its fee schedules. See also Overview of Medicaid Provisions in the Balanced Budget Act.
2) Knowledge of the prohibition on balance billing insureds is imputed to the provider because by law and contract it was informed of it: There is no need to prove that it had actual knowledge. The provider has ‘superior knowledge’ relative to the knowledge that insureds can reasonably be expected to have. The provider and the insureds do not deal at arm’s length. When the provider takes advantage of this knowledge differential to balance bill an insured, it abuses its power.
b. Most insureds who appeal claim denials and balance billing appear pro se, unable to afford lawyers. Due to their ignorance of the law, they easily fall prey to abusive providers. More-over, precisely because of their health problems, few have the substantial resources of emotional energy, let alone money, needed to struggle through four levels of appeal until reaching the Medicare Appeals Council, tel. (202)565-0100, whose decision is appealable to a U.S. district court.
2. The exposure of the providers’ abuse of power can be set off by holding unprecedented citizens hearings. They are to be held by journalists, media outlets, IT experts, and journalism, law, and IT students and professors. Their venue will be media stations, school auditoriums, and via the Internet so that wherever abusees are, they can tell their story of the abuse that they have suffered or witnessed by providers and the other entities. At the citizens hearings, the abusees will shout self-assertively the rallying cry:
Enough is enough!
We won’t take any abuse by anybody anymore.3. Abusees can so inform and outrage the national public as to cause it to challenge the abusers’ unaccountability through the electoral process and a class action. To that end, we can join forces to turn the above-named entities’ coordinated abuse of power into a key issue of the presidential debates, the primaries, and the general election. This issue can attract the attention of the national public and politicians, whether principled or opportunistic, because “The Medicare Program is the second-largest social insurance program in the U.S.”, after Social Security.
4. Together we can pioneer a multidisciplinary academic and journalistic business venture; and launch of a civic, MeToo!-like movement arising from an informed and outraged national public ready to wield its strongest powers: electoral donating, volunteering, and voting. The venture and the movement can implement a concrete, reasonable, and feasible plan of action offering rewards:
a. The plan includes a class action, for it can accomplish what abusees cannot proceeding individually. A class action win can force transformative change in the way health entities coordinate their abuse of patients, in particular, and of the national public, in general. Lawyers can win huge rewards: treble damages, attorney’s fees, and national recognition that increases their number of clients; cf. the suits against tobacco, guns, and opioids entities.
b. Journalists who investigate(OL:194§E) this story and join in holding the unprecedented citizens hearings can reasonably expect to be considered for a Pulitzer prize.
c. Students can be nationally recognized as the youth of the Montana climate case have been. They can parlay the experience gained by creating a niche law and investigative practice.
d. The media and the schools, suffering from low public esteem and income, can increase their appeal and profitability by becoming an engine of transformative socio-political change to be reckoned with. The schools can emerge as the fifth power for public accountability.
5. I offer to make via video conference or, if in NY City, in person, a presentation on the citizens hearings and the plan of action. See my contact information below. Consequently, this email and its link‡ can be shared and posted widely to announce my offered presentation.
6. The presentation is supported by my professional law research and writing, and strategic thinking. They are the skills that have already produced my three-volume study*†♣ of judges and their judiciaries, titled and downloadable thus:
Exposing Judges’ Unaccountability and
Consequent Riskless Abuse of Power:
Pioneering the news and publishing field of
judicial unaccountability reporting*†♣7. The study discusses evidence supporting the axiom ‘Unaccountability breeds abuse’. Its corollary is ‘What judges allow themselves to do -exposed by The Wall Street Journal and Thomson Reuters-, others copy and exceed’.
a. How many of the above-named entities and judges have found comfort and encouragement in the unethical and illegal practices that justices of the U.S. Supreme Court and the ‘Friends of the Justices’ have engaged in for decades, as revealed by ProPublica; and that a former President has engaged in for years, as stated by NY State Judge Arthur Engoron in his decision on Trump and his business of Tuesday, 26 September 2023?
8. Some of my articles on unaccountability and abuse of power are posted to my website Judicial-Discipline-Reform.org. They have attracted so many webvisitors and impressed them so positively that as of 2 November 2023, the number of visitors that had become subscribers was 49,095.
a. These subscribers not only read what is in front of them, but also welcome more. They can reasonably be expected to be educated, influential, and capable of understanding how they are harmed by coordinated health entities and willing to support a class action against them.
B. Thousands of emails to top Medicare and related officers and entities have met the silence of a coordinated cover-up
9. Thousands of emails have been sent to dozens of top officers of Medicare and health insurer EmblemHealth for more than a year, who have left them unanswered. Their same conduct cannot reasonably be said to be merely coincidental. Their failure to answer constitutes the circumstantial evidence from which a reasonable inference can be drawn: It betrays the silence of a coordinated cover-up. So does their failure to provide discovery, disclosure, even a responsive brief to answer my complaint of 21 May 2022, and to enter default judgment as a consequence thereof.
10. Likewise, their failure to decide the appeal M-23-386, filed with the Medicare Appeals Council, tel. (202)565-0100, almost a year ago on 28 October 2022, betrays self-interested dereliction of duty and obstruction of justice. A sample of the email headers and text has been collected below. They were sent:
To: [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected] [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected],
C. A similar case of coordinated abuse of power and cover-up
involving prosecutors, police officers, and judges11. In the same vein are the thousands of emails and letters sent, and phone calls made, to the dozens of prosecutors, police officers, and judges in the below bloc of email addresses since 7 June 2022, with no response, on the subject of:
Fabricated indictments♦
based on false and insufficient evidence
presented to grand juries by prosecutors, police officers, and judges who
abuse the jurors’ ignorance of the law and untrained and uncritical judgment.
They reciprocally cover up leveraging fabricated indictments
to coerce defendants into unfavorable plea bargains.
That leads to higher conviction rates,
greater chances of reelection and promotion, and
collection of IOUs to be cashed in when needed.
Thereby they gain a benefit
by inflicting injury in fact on defendants,
deprive them and the public of honest services, and
obstruct justice.
They thus commit fraud, racketeering, and enterprise corruption.The proposal to expose the fabricators and their abuse of power through
unprecedented citizens hearings (¶2↑) and
a story that can earn investigative journalists and media outlets a Pulitzer Prize.12. The many officers listed next have failed to respond though duty-bound to deal effectively with their constituents’ grievances, especially those brought to their attention so repeatedly and for such a long time.
a. Their conduct is non-coincidental.
b. It is motivated by interests that can foreseeably be advanced by obstructing justice through an implicitly or explicitly coordinated cover-up. Any alleged willful ignorance and blindness is particularly inexcusable because of their duty of due diligence to know.
c. Those officers have engaged in dereliction of duty and abuse of power.
13. The abusees can tell their stories at the proposed unprecedented citizens hearings. The analysis of their stories will enable the detection of patterns of circumstances where the fabricators fester and their modus operandi.
To: [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected] [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected],
I look forward to hearing from you.
Dare shout “I accuse!”…You may trigger history and enter it.
Sincerely,
Dr. Richard Cordero, Esq.
2165 Bruckner Blvd.
Bronx, New York City, USA 10472-6506
Judicial Discipline Reform
tel. 1(718)827-9521
[email protected] , [email protected] , [email protected]
https://www.linkedin.com/in/dr-richard-cordero-esq-0508ba4b
*******************D. Sample of the emails to top Medicare and related officers and entities going back to 30 September 2022, which are collected in the file here.
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