Navigation Links
Texas Doctor Files Case Pro Se in U.S. Supreme Court Against Insurance Giant on Integrity and Unethical Practices
Date:9/24/2009

DALLAS, Sept. 24 /PRNewswire/ -- Dr. Dralves Edwards, a board-certified family physician in Dallas, today filed a civil case in the U.S. Supreme Court against Blue Cross Blue Shield of Texas, the contractor for Medicare.

For the past 13 years, Edwards has challenged the integrity and unethical practices of Blue Cross Blue Shield (BCBS) and is confident that the U.S. Supreme Court will rule in a responsible way that every Medicare provider and patient benefits.

In 2003, the original suit was filed in Dallas district court alleging that BCBS engaged in fraud, gross negligence, and criminal acts that, according to Edwards, forced him to close his doors. Today, he works as a hospital emergency room physician.

BCBS responded to the suit by removing it to federal court, but the case was remanded back to district court. BCBS then filed a "No Evidence" Motion for Summary Judgment that was granted sovereign immunity by the lower courts.

Edwards acknowledges that lower court decisions have historically disagreed with well established U.S. Supreme Court cases (i.e., Ardary vs. Aetna; Heckler vs. Ringer; and Kelly vs. Advantage Health, Rochester vs. Travelers).

In 1997, Edwards says BCBS caused irreparable harm to his thriving practice and marred his professional name when he was placed on a 100 percent prepayment review. For three consecutive years, 96 percent of his claims were denied; his practice was 90 percent Medicare.

"I provided free transportation and made house calls that saved Medicare millions of dollars," reports Edwards. "These were patients who probably would have ended up in the emergency room."

In October 1996, Edwards was featured in USA Today as "One of the few doctors in America making house calls."

BCBS denied most of Edwards' claims as "non-covered services and not reasonable and medically necessary."

Medical conditions like breast cancer, diabetes, and decubitus ulcers were denied. However, after the course of five years, claims were appealed through Medicare's administrative process and paid.

"Something was terribly wrong," Edwards says. "Other doctors were being paid by BCBS for these same medical conditions, but payment continued to be denied to me."

Edwards alleges that "BCBS was tested for profiling and got caught."

He explains what happened. One doctor employed by him applied for a new Medicare group number. Dr. Edwards' name was deliberately left off of the original application. The group number was granted, 300 claims were submitted, and BCBS paid 98 percent of them. A month later, Edwards' name was added, 300 claims were submitted and all were denied.

BCBS told Edwards he had a documentation problem. However, after meeting with a Medicare representative to review the denied claims, no problems were discovered. It was recommended that he sign his progress notes and resubmit the claims for payment. He did and they were still denied as "non-covered services and not reasonable and medically necessary."

Edwards then obtained the list of 100 doctors on the prepayment review list for 1997 through 1998. He contacted most all of these doctors and discovered that they knew nothing about a "prepayment review."

"This evidence was highlighted in the suit, but ignored by the courts," says Edwards.

It was becoming apparent that some unethical practices were in play.

To date, this 13-year ordeal has led to thousands of dollars spent; countless hours; a five-year administrative process; five summary-judgment hearings; numerous investigations; nine attorneys; 19 judges; a 100 percent prepayment review; and protectionism from the lower courts.

"Justice for the innocent has not been served," Edwards says. "The guilty remain in business. Right now, it rests in the hands of the U.S. Supreme Court."

To view the video: D. G. Edwards vs. Blue Cross and Blue Shield of Texas, visit: http://www.youtube.com/sevlard or follow at http://twitter.com/sevlard.

This release was issued on behalf of the above organization by Send2Press(R), a unit of Neotrope(R).http://www.Send2Press.com

    Dr. D. G. Edwards
    +1-214-215-4425
    Dralves51@msn.com


'/>"/>
SOURCE Dr. Dralves Edwards
Copyright©2009 PR Newswire.
All rights reserved

Related medicine news :

1. Drenchers(TM) Increases Distribution in Texas
2. Modern Healthcare Selects Texas Health Harris Methodist Hospital Southlake as One of the Best Places to Work in Healthcare
3. TBGH Report on Status of Diabetes in Texas Indicates Growing Severity of Problem and Higher Cost of Care Than National Average
4. Texas Cardiac Arrhythmia Institute at St. Davids Medical Center Orders 4 Odyssey Systems
5. Texas Kidney Community Expresses Hope DC Health Care Reform Debate Can Help Drive Continued Progress in Texas Opening Needed Dialysis Facilities
6. Texas Dental Association Offers Premier Accounts Receivable Management Services from TekCollect via TDA Perks Program
7. Austin Texas Cosmetic Dentist Celebrates 30 Years in Practice
8. Texas Hold'em Tournament to Benefit Autism Speaks
9. New Study of House Health Care Reform Bill: Texas Faces Over $2.7 Billion in Medicare-Funded Nursing Home Cuts Over Ten Years
10. Texas Health Hospitals to Receive Financial Awards for Quality
11. Dr. Jack P. Gunter Offers 3D Imaging for Dallas, Texas Plastic Surgery Patients
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:7/22/2017)... Edmonton, AB (PRWEB) , ... July 21, 2017 , ... ... a life insurance brokerage firm servicing Albertans,” says owner and licensed broker Nerissa McNaughton. ... health insurance can be difficult, but it is a very necessary conversation. I make ...
(Date:7/21/2017)... ... , ... "As a doctor of lung medicine managing chest diseases for more ... said an inventor from Center Valley, Pa. "My idea is to improve the device ... the patent-pending PLEURAL SAFE-t-STAT CATHETER KIT to offer an efficient means of draining pleural ...
(Date:7/21/2017)... Augusta, GA (PRWEB) , ... July 21, 2017 , ... ... is teaming up with the Epilepsy Foundation in a community wide charity event with ... region. , Delaney Sunde, a young local woman who lives with epilepsy, recently launched ...
(Date:7/21/2017)... Minnesota (PRWEB) , ... July 21, 2017 , ... ... BWBR recently were selected to renovate and improve the Ramsey County Medical Examiners ... adjacent to Regions Hospital, the $2.5 million project is scheduled to start in ...
(Date:7/21/2017)... ... July 21, 2017 , ... Hospital M&A activity slowed in the second quarter ... hospital acquisitions rose to 23 in the second quarter, up 15% from the 20 ... 20 announced deals in the year-ago second quarter. Only four of the transactions disclosed ...
Breaking Medicine News(10 mins):
(Date:7/5/2017)... Wash. , July 5, 2017   BioLife ... leading developer, manufacturer and marketer of proprietary clinical grade ... cryopreservation freeze media ("BioLife"), today announced that it ... its debt holder and largest shareholder, to modify its ... Pursuant to the modification, WAVI agreed to exchange ...
(Date:6/30/2017)... SAN DIEGO , June 30, 2017  AVACEN Medical (AVACEN) ... Access Journal. The research describes the use of its AVACEN ... by those suffering from fibromyalgia. ... AVACEN Medical ... Fibromyalgia is characterized by chronic widespread pain. It affects approximately 200 to ...
(Date:6/27/2017)... 27, 2017   NuEyes (NuEyes Technologies Inc.) today ... fuel its growth in helping the legally blind live more ... Group), the leading developer of augmented, virtual and mixed reality ... The undisclosed funding amount was provided by strategic partners ... with offices in Abu Dhabi , ...
Breaking Medicine Technology: