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:4/29/2016)... Los Angeles, CA (PRWEB) , ... April 29, 2016 , ... ... Sarah Mirmelli, a mother and divorcee, shares her enthusiasm for Botox and lip injections, ... of the world famous youth oriented Coachella Valley Music and Arts Festival. The article ...
(Date:4/29/2016)... ... April 29, 2016 , ... Our bodies are bombarded daily by ... and deal with these stressors is to adopt a more healthful diet, but too ... Risa Groux, a certified Holistic Nutritionist and the creator of the Newport Beach Cleanse ...
(Date:4/29/2016)... (PRWEB) , ... April 29, 2016 , ... ... student loans more flexibility in repaying their loans, more information about their loan ... time when total outstanding student loan debt, including federal and private loans, has ...
(Date:4/29/2016)... , ... April 29, 2016 , ... Spine Team Texas, ... is proud to announce one of their physicians has been invited to be a ... (Texas ACOFP) Family Practice Review conference on April 30, 2016. , Dr. R. ...
(Date:4/29/2016)... , ... April 29, 2016 , ... ... Canadian Celiac Association (CCA), is pleased to announce the launch of the ... nutritional articles, recipes, and more. The purpose of the GFCP Scoop ...
Breaking Medicine News(10 mins):
(Date:4/28/2016)... TapImmune,Inc. (TPIV), a clinical-stage ... gene-based immunotherapeutics and vaccines for the treatment of cancer & ... 3rd Annual Growth Capital Expo to be held ... Caesars Palace in Las Vegas, Nevada.  The Company presentation ... th by Dr. John N. Bonfiglio a ...
(Date:4/27/2016)... 27, 2016 ... in Zürich gab Strekin AG den Start ... zur Erhaltung des Resthörvermögens von Patienten, denen ... die umfassende Phase-II-Doppelblindstudie mit Placebo-Kontrollgruppe werden momentan ... wird während der Operation direkt ins Mittelohr ...
(Date:4/27/2016)... TURIN, Italy , April 27, 2016 ... MR-guided linear accelerator (MR-linac) platform will be the focal ... annual meeting of the European Society for Radiotherapy & ... Elekta,s MR-linac integrates a state-of-the-art radiotherapy system and ... a physician to clearly see the patient,s anatomy in ...
Breaking Medicine Technology: