Gastrointestinal Associates PA and Endoscopy Center

I was referred by my physician to GI associates to perform an age-related screening colonoscopy (*** *** *** *** *** ***) in December but witnessed that GI Associates, in connivance with at least some insurance companies to whose networks they belong, are engaged in what I believe is healthcare fraudHere is how this fraud works:
The Affordable Care Act (ACC) mandates all insurance plans to provide free preventive colonoscopy for adults over A patient gets a written referral from his regular physician for an age-related preventive procedure, which should be free under ACC GI Associates performs the procedure and then submits a reimbursement claim to the patient's insurance company and codes the procedure as diagnostic because they were instructed by the insurance company to disregard the referring physician's preventive referral and to ALWAYS code such procedures as diagnosticThe insurance company is now only willing to pay for the procedure under the regular 80% plan and only after the patient pays the full value of his high deductibleSuch an arrangement, between unscrupulous insurance companies such as *** *** and equally unscrupulous in-network providers such as GI Associates, allows the insurance company to circumvent the preventive provisions of the Affordable Care Act and to increase their profit margin by shifting a part of the preventive care cost to the consumer Now, the insurance company has extra profit created by such unscrupulous in-network provider and they can share it in the form of higher payout rates, more referrals, etcI find myself if this situation now after my December 22, colonoscopyI have contacted both the insurance company and GI Associates on multiple occasionsThe insurance company refuses to pay in full as required by ACC because their in-network provider GI Associates coded the procedure as diagnostic and the GI Associates refuses to code the procedure as preventive because they were told by my insurance company to always code such procedures as diagnosticUnless you want to join me as another victim of this fraud, I recommend you stay away from GI Associates or the *** *** *** to which they belong

My first conversation with Mr*** was on 8/15/2016. I advised that on the charges he was referring to, that one was for an initial consult and the other was for a hospital follvisit. I advised that I will refer to Dr*** for reviewI received a response from Dr
*** on 8/15/to write off the two charges. I informed our billing manager and she did write off these charges. I attempted to call Mr*** and received his voicemail. I left him a message to call me back.On 8/16/I attempted to call Mr*** again and was unable to leave a voicemail. On Friday afternoon, August 19, I received the complaint from the Revdex.com. I called Mrs*** on his home phone and did reach himBelow is my documentation from that point onFriday, August 19, I just talked to Mr*** and informed him that I had left him messages on his cell to call me. He stated that he dropped his cell phone in water this week and it no longer works.
I told him that I have been trying to reach him to let him know that Dr*** has written off his charges. He stated, “Oh well you didn’t have to do that.” I advised that we had already discussed with Dr***
and advised us to write of his charges He thanked me and stated, “Well okay.” I asked him if he was satisfied with the outcome and he stated that he was
I informed him that we received a complaint from the Revdex.com today (see attached) that was filed on 8/8/2016, one week prior to my first conversation with him. He stated, “Oh, I forgot about that. I’m so sorry. I did that when I was upset and could not get any answers from anyone.”
I informed him that I was going to have to respond to the complaint and wanted to make sure that he was happy with how we had handled this issue and if he was willing to rescind his complaint with the Revdex.com. He stated that he was completely
satisfied and asked me for the name and number of the person at the Revdex.com that the letter came from. He stated, “I am going to contact her and tell her that this issue is resolved.” I advised that I will also call and make sure that this complaint is
closed out as resolved. I asked that he contact me directly if he has any further issues. I called and left a message for Linda Clopton, Director of Dispute Resolution, late this afternoon to call me back
Monday, August 22,
I just received a phone call from MsClopton this AM. She stated that Mr*** called her on Friday and told her that he would like to withdraw his complaintShe asked him to send her an email stating this. She asked for my name and title and is documenting in her files that this issue is resolved and will close out the file
*** ***

My first conversation with Mr. [redacted] was on 8/15/2016.  I advised that on the charges he was referring to, that one was for an initial consult and the other was for a hospital follow-up visit.  I advised that I will refer to Dr. [redacted] for review.I received a response from Dr. [redacted] on...

8/15/2016 to write off the two charges.  I informed our billing manager and she did write off these charges.  I attempted to call Mr. [redacted] and received his voicemail.  I left him a message to call me back.On 8/16/2016 I attempted to call Mr. [redacted] again and was unable to leave a voicemail.  On Friday afternoon, August 19,  I received the complaint from the Revdex.com.  I called Mrs. [redacted] on his home phone and did reach him.Below is my documentation from that point on.Friday, August 19, 2016I just talked to Mr. [redacted] and informed him that I had left him messages on his cell to call me.  He stated that he dropped his  cell phone in water this week and it no longer works.  I told him that I have been trying to reach him to let him know that Dr. [redacted] has written off his charges.  He stated, “Oh well you didn’t have to do that.”  I advised that we had already discussed with Dr. [redacted]and advised us to write of his charges  He thanked me and stated, “Well okay.”  I asked him if he was satisfied with the outcome and he stated that he was. I informed him that we received a complaint from the Revdex.com today (see attached) that was filed on 8/8/2016, one week prior to my first conversation with him.  He stated, “Oh, I forgot about that.  I’m so sorry.  I did that when I was upset and could not get any answers from anyone.”I informed him that I was going to have to respond to the complaint and wanted to make sure that he was happy with how we had handled this issue and if he was willing to rescind his complaint with the Revdex.com.  He stated that he was completely satisfied and asked me for the name and number of the person at the Revdex.com that the letter came from.  He stated, “I am going to contact her and tell her that this issue is resolved.”  I advised that I will also call and make sure that this complaint is closed out as resolved.  I asked that he contact me directly if he has any further issues.  I called and left a message for Linda Clopton, Director of Dispute Resolution, late this afternoon to call me back.  Monday, August 22, 2016 I just received a phone call from Ms. Clopton this AM.  She stated that Mr. [redacted] called her on Friday and told her that he would like to withdraw his complaint.She asked him to send her an email stating this.  She asked for my name and title and is documenting in her files that this issue is resolved and will close out the file.  [redacted]