Friday, March 3, 2023

Blue Cross Pays Up to Advanced Infusion Services

 An FBI raid always gets attention and Wednesday's raid on Advanced Infusion Systems facitilies in Ridgeland and Chunky were no exception.  The Fibbies are as tight-lipped as usual so it will probably be awhile before more is known about the raids.  However, two federal court cases might - repeat, might - provide some clues. 

Randy Denning sued AIS in Louisiana.  The company filled his prescription for medication administered through a pain pump.  She discovered in 2021 that "AIS was billing her insurer at a rate of $120 per day for allegedly unauthorized services."  

The court fight wound up at the Fifth Circuit Court of Appeals.  The Court ruled the unauthorized billings were indeed a breach of contract but Denning lacked standing to sue AIS as she was not the injured party.   Case closed.  

Blue Cross/Blue Shield and AIS went to war in federal court in Mississippi.  AIS sued the insurer for failure to pay claims.  Blue Cross counterclaimed, accusing AIS of committing insurance fraud by allegedly including per diem charges for each day medication is administered through a pain pump.  However, AIS argued the practice is an industry standard.  The two sides skirmished for a while before settling the case and issuing a joint statement: 

Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company ("BCBSMS") and the Blue Cross Blue Shield Association ("BCBSA") have evaluated the billings by Bond Pharmacy dba AIS Healthcare ("AIS") that included per diems, and have now concluded, after further evaluation that all of AIS' bills to BCBSMS, including without limitation AIS' bills using HCPCS Code S9328 for per diems, did not constitute fraud, and made no finding of waste or abuse.

AIS, BCBSMS, BCBSA, and Advanced Health Systems, Inc. ("AHS") have settled all disputes arising out of, relating to, or concerning the claims and issues asserted by the parties to the legal proceedings in the lawsuit known as Bond Pharmacy d/b/a Advanced Infusion Solutions v. Advanced Health Systems, Inc. and Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company, United States District Court for the Southern District of Mississippi, Civil Action No. 3:21-cv-123-KHJ-MTP. The settlement includes an arm's length negotiated resolution on mutually acceptable terms by which a confidential amount will be paid to AIS for past services.

There will be a new participation agreement going forward between AIS and BCBSMS that will allow enrollees of the Federal Employee Health Benefits Plan ("FEP") co-administered by BCBSA and its licensee Blue Cross and Blue Shield companies to receive services from AIS as a participating provider for FEP. The settlement does not require an admission of wrongdoing by anyone. The rest of the terms of the settlement are confidential except that (a) AIS can provide this Written Settlement Statement to anyone, and (b) BCBSMS, BCBSA and AHS will and hereby do confirm the authenticity and accuracy of this Settlement Statement. The parties to the confidential settlement agreement have approved this Settlement Statement.

Agreed on October 14, 2022 between Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company, the Blue Cross Blue Shield Association, and Bond Pharmacy dba AIS Healthcare.

U.S. District Judge Kristi Johnson dismissed the case in November.   


Anonymous said...

Mess with the cross and you’ll get the shield

Anonymous said...

Where there is smoke there is fire-

Bill Dees said...

BC/BS Mississippi knows how to fight long and hard. (e.g. UMMC) They settled this case and apologized because they knew they were wrong. There has to be more to the FBI's involvement than the allegations in this federal lawsuit.

Anonymous said...

Reminder that the same people who will tell you that cannabis isn’t medicine are always silent about their preferred vices! The don’t mind the “medicines” that Perdue Pharma knew would get America hooked and earn them trillions!

Anonymous said...

Ahhh…..a “pain clinic patient” is upset

But bam the weed, y’all

Anonymous said...

I wish the FBI would raid BCBS! They deserve it!

Anonymous said...

@5:10 pm.
the medical offices filing fraudulent claims should be reported to AG office under anonymous reported.
There are many!
I could give you a few names ..... but I will wait.

Anonymous said...

Please clarify your proof that BCBS "knew they were wrong and apologized" or concede you're making things up. UMMC was on the ropes if you recall, and still is after losing the burn center.

Bill Dees said...

@7:08 AM The circumstantial evidence is overwhelming. (see e.g. Alex Murtaugh) BC/BS does not give up like this unless they know they're wrong. An apology? Seriously? The apology, in this context, means "We are REALLY GLAD we didn't get popped for punitive damages."

Anonymous said...

Bill Dees...

The Alex Murtaugh case? Are you serious? There was a whole lot more than circumstantial evidence in that situation. Terrible example Bill.

UMMC cried uncle first because they were hemorrhaging money, and BCBS just let them up so they could get back to business, on BCBS's terms. If they had pursued their litigation of UMMC afterwards, they would have looked like the bad guy you think they are.

Frustrated Consumer said...

As one who uses AIS compounding pharmacy services for the medication in my intrathecal pump. Their charges are absurd! I mean absolutely mind blowingly , astronomical and that’s before BCBS pays a huge portion. Which leaves me over a barrel with a huge payment due because I have no choice in the matter!

Anonymous said...

AIS has been fraudulently billing insurances for years! Several years ago, I switched to a Humana Medicare plan. AIS and my pain physician had an agreement that intrathecal pump patients receiving their compounded medications from AIS and who had Medicare only,would pay AIS $45 for roughly, a 3 month supply. Medicare does not cover the intrathecal pump meds. But when I switched to Humana, all of a sudden,I started receiving bills for exorbitant amounts i.e.$400+ for the same amount of medications. When I questioned AIS and looked at their billing practices and procedure codes, I realized they were using the code for a home healthcare nurse to come to my home, and administer the medication(s). I was getting my pump refilled in my physician's office and not at home! I complained to Humana, Medicare, Attorney General, etc. because this was insurance fraud, plain and simple! Did I mention I was a retired nurse with 25 yrs of insurance experience?! My complaints fell on deaf ears! Long story short, they billed Humana tens of thousands of dollars and Humana paid! Even after I had spoken with supervisors, managers, etc.! I even filed a complaint with their fraud dept.! Nothing worked! No one listened! To this day, I refuse a Medicare advantage plan because AIS said they will continue to bill in this fashion. They did write off all the monies (my 20%) that they said I owed them! Wonder why? I'd love to have one of those plans again because of the vision and dental benefits and I can't. I can't watch AIS continue to use fraudulent billing practices! I hope the FBI shuts these crooks down! I'll get my pump meds some way, some how. Hopefully from a company nothing like AIS!

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Trollfest '09

Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).

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Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.

In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

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This is definitely a Beaver production.

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Trollfest '07

Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

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