60 My Battle to Make the Health Insurers Obey the Law Part 13: 16 October 2024

I was extremely concerned by learning that the official HCF on-line member claims’ history did not contain information about claims for treatments provided by Lift Cancer Care Services.  Even if claims had been rejected, the law required some minimal information to be shown in the claims’ history.

·       When the claim was lodged, but not accepted or rejected, the fact of lodgment had to be shown;

·       If a claim was accepted, the acceptance of the claim had to be shown;

·       If a claim was rejected, the rejection had to be shown.

On Monday 8 March, I logged into our HCF on-line member claims' history.  I discovered that the official on-line claims history was fabricated.  It contained very few references to the cancer treatments given to Margaret by Lift Cancer Care Services.  According to the official HCF record, most of these claims did not exist and were never submitted to HCF for payment.  Even where a few of the claims had been paid, they usually did not appear in the official record.  These claims had not been rejected, but according to the official HCF record, they had never been submitted to HCF.  I was now clear to me that HCF was not merely ignoring the law; it was taking active steps to hide its actions.  I had no doubt that HCF had engaged in criminal conduct.

I printed the details of every claim that was recorded in the claims’ history.  If in the future, HCF altered the record by including claims that officially did not exist on 8 March 2022, I would still be able to prove that the claims’ history record had been false that day.  As further backup, on 9 March 2022, I asked HCF for a printed version of its official record of all claims lodged from the beginning of January 2021.  Margaret had her first treatment at Lift in January 2021.  This official HCF document confirmed the falsity of the official HCF claims’ history.

That day in March, I established two separate types of unlawful behaviour by HCF.

·       HCF refused to pay claims that the law required it to pay; and

·       HCF tried to disguise its contempt for the law by deleting from its official record, any mention of the claims that the law said it had to pay, but refused to pay.

This conduct took advantage of two separate factors.

Lift had been reluctant to burden its grievously ill patients with detailed information about the refusal of the health insurers to obey the law – so patient knowledge of the unlawful behaviour of their health insurers was minimal.

Adding to the patient ignorance, privacy requirements apply to health records.  Although patients had access to their own HCF claims’ history records, Lift had no knowledge of what the official health insurance records contained.  Privacy requirements prevented Lift from being aware that the health insurers maintained false records.  By falsifying the patient history records, HCF could pretend to regulators that it was obeying the law – although I believe the regulators were well aware that the conduct was unlawful and were actively helping the health insurers to break the law.

This is a tabulation of our claims’ history records in January, February and March 2021; Margaret had her first treatment at Lift in January 2021 while she was undergoing chemotherapy.  The tabulation contrasts what was actually in the claims’ history with what should have been there but was in fact deleted from the record.  The only significant omissions from our official HCF claims’ history were the claims for Margaret’s exercise medicine treatments at Lift Cancer Care Services. 

Information for January and February 2021 is based on the written HCF document sent to me when I asked for it.  Information for March 2021 is based on the printed copies of the claims’ history that I downloaded and printed on 8 March 2021 from our online HCF official member claims’ history record.

****

This is a summary of the official HCF claims’ history record for January 2021 with the addition of the treatments Margaret received from Lift Cancer Care Services.

Treatment Date	Treatment Type	Recipient of Treatment	Paid or Not Paid	On Official Record?	Missing From Official Record?
11 January	Exercise medicine at Lift	Margaret	Paid	Not paid	Missing
13 January	Chiropractic	Margaret	Paid	Yes	Present
13 January	Exercise medicine at Lift	Margaret	Paid	Not paid	Missing
14 January	Exercise medicine at Lift	Margaret	Paid	Not paid	Missing
18 January*	Exercise medicine at Lift	Margaret	Paid	Not paid	Missing
20 January	Medical	Margaret	Paid	Yes	Present
21 January*	Exercise medicine at Lift	Margaret	Not paid	Not paid	Missing
28 January*	Exercise medicine at Lift	Margaret	Not paid	Not paid	Missing

 

Of the six exercise medicine treatments Margaret received in January 2021, although HCF paid four, none of the six treatments appear on the official HCF claims’ history record – either as paid or as rejected.

****

This is a summary of the official HCF claims’ history record for February 2021, with the addition of the treatments Margaret received from Lift Cancer Care Services.

Treatment Date	Treatment Type	Recipient of Treatment	Paid or Not Paid	On Official Record?	Missing From Official Record?
3 February*	Exercise medicine at Lift	Margaret	Not paid	Not paid	Missing
10 February	Dental	John	Paid	Yes	Present
10 February	Chiropractic	Margaret	Paid	Yes	Present
10 February	Chiropractic	John	Paid	Yes	Present
11 February*	Exercise medicine at Lift	Margaret	Not paid	Not paid	Missing
25 February*	Exercise medicine at Lift	Margaret	Not paid	Not paid	Missing

 

Of the three exercise medicine treatments Margaret received in February 2021, none were paid and none appear on the official HCF claims’ history record – even as rejected claims.

****

This is a summary of the official HCF claims’ history record for March 2021 with the addition of the treatments Margaret received from Lift Cancer Care Services.

Treatment Date	Treatment Type	Recipient of Treatment	Paid or Not Paid	On Official Record?	Missing From Official Record?
3 March*	Exercise medicine at Lift	Margaret	Not paid	No	Missing
10 March	Hospital accommodation	Margaret	Paid	Yes	Present
10 March	Surgical	Margaret	Paid	Yes	Present
10 March	Medical	Margaret	Paid	Yes	Present
10 March	Pathology and medical	Margaret	Paid	Yes	Present
16 March	Dental	Margaret	Paid	Yes	Present
17 March	Chiropractic	Margaret	Paid	Yes	Present
17 March	Chiropractic	John	Paid	Yes	Present
18 March	Podiatry	Margaret	Paid	Yes	Present
19 March*	Exercise medicine at Lift	Margaret	Not paid	Not	Missing
24 March*	Exercise medicine at Lift	Margaret	Not paid	No	Missing
24 March	Chiropractic	John	Paid	Yes	Present
30 March	Medical	Margaret	Paid	Yes	Present
31 March*	Exercise medicine at Lift	Margaret	Not paid	No	Missing
31 March	Chiropractic	John	Paid	Yes	Present

 

Of the four exercise medicine treatments Margaret received in March 2021, none were paid and none appear on the official HCF claims’ history record – even as rejected claims.

I have done similar tabulations for every month that Margaret received treatments from Lift Cancer Care Services.  Every tabulation tells the same story of the criminal conduct by HCF.