My states QIO is an organization the spawned from a Healthcare Group in Colorado that is run by the same organization of Doctors that runs the facility that I'm making a complaint about. I've found out that, because of a unique condition I have, ACE Inhibitors given to me after a surgery I stroked out on 7 years ago caused an Acute Kidney failure. Unfortunately they quickly recognized this, but switched me to another to another drug in the same class for the next month. This became a month long Acute Kidney Failure. At the end of the month it was no longer acute. It was complete atrophy of the left kidney and three quarters of the right (now Chronic Kidney Disease). I has gone to End Stage. Only a recent look int my records did I notice it. I had started the complaint at the end of last year, and they were going to look into it as soon as I signed and returned an authorization form, but I put it off when I realized the QIO connection to my provider.
There is another post in this forum about the largest Medicare Fraud ever exposed in Texas. The same company who discovered that, Health Integrity, LLC, had contacted me a month ago about my complaint, and after speaking with them, they looked into it and they contacted the local CMS. Then they sent me a letter telling me to contact my caseworker at CMS. This caseworker said she had been speaking to a manager at my QIO, which is called HSAG, about my complaint. The caseworker urged me to contact this manager. When I did, that manager said that due to new CMS rules, they can no longer investigate complaints that were about care that happened over three years ago. I just find it odd that this was not a restriction when I filed my original complaint. Along with the fact that what i told Health Integrity is takes my original complaint and expands it into what would be a devastating revelation that would be tremendously embarrassing for the provider. I have read all 900 plus pages of the recent changes just published by medicare and can find nothing in the QIO sections relating to a new restriction on time limitations. Has anyone else heard of this or does any know of a better authority on the subject. I had contacted my local SHIP who called me back saying they were not aware but would look into it. That was over three weeks ago and I haven't heard back from them. Any thoughts would be most appreciated.
ShirleyP
I should also add that I do follow rules and am not just trying to get anyone in trouble. I was very ill, confused, weak and had stopped eating,losing about 25 pounds while being sedentary at the time. A grievance was filed with the HMO by my son (whose durable power of attorney-medical they have on file) at the time that also included a report of patient records mixup during an ER visit where i was misdiagnosed and treated for pneumonia and UTI. The only nutrients i was getting at the time was from fluids administered during the ER visits. My son was contacted by a senior investigator for the HMO. After giving all the details, my sons only focus was about getting someone to come out every 3 days to give me fluids. The investigator said the records mixup was very serious, but she would initiate process to have a nurse visit the home. That night someone went into my online health records and change the ranges on some of my Lab Results (my son had been screen capturing them ever since I became ill). We never heard back from the investigator or anyone about home care. After a week my son went through my medication and found a change in phosphorous binders around the time I stopped eating. Once he withheld the medication, I started eating like a horse. This was mentioned to the HMO's Patient Advocte about 2 months later. Three days after that I received a letter from that Senior Investigator stating that my son had made a complaint but they had closed it due to the fact my son had not submitted their authorization form with my authorization for them to discus my medical conditions with them. It also said he had three days to submit this form and they would open the case back up. He took the form with my signature to the medical secretaries where the faxed and stamped it, dated it and signed it as being submitted. We never heard back. This has nothing to do with expanded complaint I refer to in my previous post.
ShirleyP
There is another post in this forum about the largest Medicare Fraud ever exposed in Texas. The same company who discovered that, Health Integrity, LLC, had contacted me a month ago about my complaint, and after speaking with them, they looked into it and they contacted the local CMS. Then they sent me a letter telling me to contact my caseworker at CMS. This caseworker said she had been speaking to a manager at my QIO, which is called HSAG, about my complaint. The caseworker urged me to contact this manager. When I did, that manager said that due to new CMS rules, they can no longer investigate complaints that were about care that happened over three years ago. I just find it odd that this was not a restriction when I filed my original complaint. Along with the fact that what i told Health Integrity is takes my original complaint and expands it into what would be a devastating revelation that would be tremendously embarrassing for the provider. I have read all 900 plus pages of the recent changes just published by medicare and can find nothing in the QIO sections relating to a new restriction on time limitations. Has anyone else heard of this or does any know of a better authority on the subject. I had contacted my local SHIP who called me back saying they were not aware but would look into it. That was over three weeks ago and I haven't heard back from them. Any thoughts would be most appreciated.
ShirleyP
I should also add that I do follow rules and am not just trying to get anyone in trouble. I was very ill, confused, weak and had stopped eating,losing about 25 pounds while being sedentary at the time. A grievance was filed with the HMO by my son (whose durable power of attorney-medical they have on file) at the time that also included a report of patient records mixup during an ER visit where i was misdiagnosed and treated for pneumonia and UTI. The only nutrients i was getting at the time was from fluids administered during the ER visits. My son was contacted by a senior investigator for the HMO. After giving all the details, my sons only focus was about getting someone to come out every 3 days to give me fluids. The investigator said the records mixup was very serious, but she would initiate process to have a nurse visit the home. That night someone went into my online health records and change the ranges on some of my Lab Results (my son had been screen capturing them ever since I became ill). We never heard back from the investigator or anyone about home care. After a week my son went through my medication and found a change in phosphorous binders around the time I stopped eating. Once he withheld the medication, I started eating like a horse. This was mentioned to the HMO's Patient Advocte about 2 months later. Three days after that I received a letter from that Senior Investigator stating that my son had made a complaint but they had closed it due to the fact my son had not submitted their authorization form with my authorization for them to discus my medical conditions with them. It also said he had three days to submit this form and they would open the case back up. He took the form with my signature to the medical secretaries where the faxed and stamped it, dated it and signed it as being submitted. We never heard back. This has nothing to do with expanded complaint I refer to in my previous post.
ShirleyP