Topic: Washington state (249)

Grand Theft - Medicare

Privatization of Medicare has moved into the state of Washington. Beware of the Dirty Dozen.

Privatization of Medicare has moved into the state of Washington. Beware of the Dirty Dozen.

As the graphic above indicates, Washington state is home to at least a dozen Direct Contracting Entities that scoop up unaware Traditional/Original Medicare recipients so these entities can “legally” filch funds that otherwise would be destined for actual Medicare patient care. Like Medicare Advantage, these companies are often run by hedge funds or other Wall Street poltroons, poseurs, and mountebanks. Although they will tell you that their mission is to improve the quality of care under Medicare, their primary purpose is making money by denying or limiting service to you, your loved ones, and your friends. We have our very own “WANTED” entity right here in Whatcom County that I wrote about a while back - “The Blob” or Peace Health’s Latest Expansion Gambit. It gets worse.

Eleven more of these entities have already been established in our state, among the 100+ established nationwide. Just take a look at the spreadsheet, (see ATTACHED FILES below) and pay special attention to the items highlighted in yellow indicating their presence in Washington. As you read this, your name may already have been placed on the rolls of one of these organizations. Whether or not you have been snarfed up without your knowledge depends upon who your primary care provider is. So phone your provider right away to determine if he or she falls under one of these contracting entities. You may have to dig, as some primary care providers might not even know they are now controlled by a contracting entity such as… we'll pick one at random…let's say PraxisCare! Their list of practices includes Northwest Medical Associates, headquartered in Vancouver, WA. Are you under Northwest Medical Associates?  If so, you need to find out if you were moved from your original Traditional Medicare into the DCE that is PraxisCare, and by extension Northwest Medical Associates. 

If you go to the PraxisCare website, this will greet you:

“PraxisCare is honored to be one of the few organizations chosen by the Centers for Medicare and Medicaid Services (CMS) to be part of a new program called Direct Contracting. This new program builds on years of innovative program design to bring the best model of care for patients. PraxisCare is partnering with providers and practices across the United States to provide Medicare members with better care focused on quality and the patient experience through our combined group called a Direct Contracting Entity.”

You can watch this video to get a sense of what these Direct Contracting Entities do. (Senator Warren's Exchange Three at Hearing on Protecting and Expanding Medicare Coverage) I encourage you to view the entire video - it's only nine minutes of your time. After that, you can do your own research to find out if your primary care provider is part of this pendunculated Medicare program designed to cheat some of the most vulnerable in our country out of their full measure of health care, which is what these Direct Contracting Entities do (now also called ACO Reach). Risibly, as PraxiCare says, they are “honored” to have been chosen to participate in this skimming exercise. Say what? They are proud of this bunkum. Shame on them and the other 11 Direct Contracting Entities in our state.

This current round of privatization of Medicare began under Trump, as Warren says on the video, and continues now under Biden who is doing squat to terminate this very, very bad concept for running Medicare. 

Bizarro World has come to the U.S. 

Unfortunately, only YOU are able to determine if you have been victimized by this predatory program. As I mentioned above, call your primary care doctor and ask if his practice is under one of the DCEs highlighted in yellow on the spreadsheet located under ATTACHED FILES below. You can also register a complaint, if necessary, by contacting your representative or senator in Washington, DC. Call the White House and tell them you DO NOT want the privatization of Medicare. I don't have Uncle Joe's direct number but this will get the job done: Click Here

Attached Files

About Dick Conoboy

Citizen Journalist and Editor • Member since Jan 26, 2008

Comments by Readers

Leslie Shankman

Aug 21, 2022

Thank you for reporting on this and providing action steps. More on this area of morass, a little tangential but not really, was discussed by Russell Brand 3 days ago : https://www.youtube.com/watch?v=Ub8BgowUE2M

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Dianne Foster

Aug 21, 2022

Dick,

Thanks once again.   Unfortunately, I don’t have a representative;   I have Rick Larsen who  is funded by Big Pharma,  weapons manufacturers, and big banks.   Those donor-owners smashed Bernie Sanders and Jason Call, so I have no one to write to….  even if I find out I’m in a DCE, I don’t know how to remedy the situation.   I donated thousands of hours and dollars to the Call campaign, and haven’t met anyone who voted for Rick   I will do what I can however.

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Ellen Baker-Glacier

Aug 21, 2022

I’m no conspracy theorist, but I’ve always expected that this sort of thing is precisely the direction that “single payer” would take:  single = monopoly (“the exclusive possession or control of the supply of or trade in a commodity or service”).

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Dick Conoboy

Aug 22, 2022

 Ellen,

I want to make sure that I understand.  You are against single-payer and afraid it would become a “monopoly”?

Dick

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Dick Conoboy

Aug 22, 2022

 Leslie,

Thanks for the Russell Brand video.  But I would say hardly tangential!!

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Dick Conoboy

Aug 22, 2022

Dianne,

You crack me up!  “Unfortunately, I don’t have a representative;   I have Rick Larsen…”

You can get out from under a DCE or ACO Reach if you find a primary care physician who is not a participating provider under that DCE or ACO Reach.  Just make sure the new one, if you can find a new doctor under Medicare, is not also in some sort of grand theft operation.

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Ellen Baker-Glacier

Aug 22, 2022

My point was simply that single source [anything] is - in fact, by definition - monopoly.  I don’t know that I’d say I’m “afraid” of them as much as I understand the downsides of putting anything [x,y,z - commodities, services] in the complete control of a few.

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Maggie Carrigan

Aug 22, 2022

I asked my doctor about this the last time I was in and he said he didn’t get involved in any of the administrative goings on.  The next day I got a letter in the mail from Peace-Health Direct Contracting dba Cascadia Community Care Alliance.  I’m sorry he wasn’t upfront with me.  However, doctors are scarce.  Where would I go?  

Since I first noticed this happening, I have tried to tell my friends and neighbors about it, but they just stare at me like I’m some kind of crazy.  They do the same thing when I tell them about our Social Security being taken over.  Why isn’t CNN or MSNBC shouting out about it?  I have written them letters, I have actually written or called everyone, but they don’t seem to be interested.  It needs to be on the news and talk shows.  I don’t want to believe that people just don’t care.

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Michael Riordan

Aug 22, 2022

This DCE phenomenon may (or may not) be related to my experience with “upcoding” at Peace Health/St. Joe’s, which charged Medicare $346.00 for a 15-minute follow-up January visit to my cardiologist. Just do the math, and you get a rate of $1,384/hr for his services. In their detailed records, it was claimed to be a 30-39 minute visit. Now as a former business owner, I know there are substantial overheads to be covered, but this is absolutely ridiculous. And I hear there are many executives in the Peace Health system with multi-six-figure salaries that need to be accomodated, plus perhaps the need to show healthy profits if a DCE is involved.

Has anyone else had such upcoding or excessive billing experiences at St. Joe’s?

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Maggie Carrigan

Aug 22, 2022

It’s very hard to tell what they are doing, e.g., I had surgery.  The doctor billed me $95.000.00, Medicare-approved $27,226.09, and paid $21,682.56.  My insurance paid $5,543.53.  Why did the doctor have to charge $95,000.00 in the first place?  Every bill is like this.  A large charge, then a small payment.  I would be very happy to go back to just having a patient, a doctor, and an insurance company.  That worked very well before HMOs arose from Hell and put us where we are today.  I believe the six-figure salaries have been around long before any DCE.

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Dick Conoboy

Aug 22, 2022

 Maggie,

Thanks for the comment.  I can’t say that you are the only one with a complaint about doctors not knowing much about under whom they are working. 

CNN and MSNBC are essentially coporate shills.  I just do not watch them for any information of any worth except for an unfolding incident like a shooting or some such.  It is getting worse as the new management at CNN is cleaning house, not that the house was worth cleaning much to begin with. 

“Brian Stelter rebukes CNN on final show: ‘It’s not partisan to stand up to demagogues’ Host says, ‘It is not partisan to stand up for decency and democracy and dialogue,’ after CNN cancels media show Reliable Sources”.

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