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Health Insurance and the 'Racketeer Influenced and Corrupt Organizations Act' {RICO}

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posted on Jun, 12 2016 @ 07:26 AM
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Seriously
Very seriously


Because of pending litigation and/or criminal charges the name of this company [a major health insurance company] will be kept anonymous.

This is based upon ongoing dealings with this company [here to for to be referred to as 'the Company']. by a real person who for the same reasons as previously stated will also remain anonymous.

The Company lies, writes out fraudulent and erroneous statements, issues policies in 'bad faith', and otherwise uses any technique it can to avoid paying a legitimate claim - fraudulently attempting to convince policy holder that he is responsible for a large bill which should clearly be covered by the policy.

The scam has the advantage to the company in two ways: 1. If the policyholder expires while the company maintains the fraudulent responsibility of the policyholder, the company can try to convince the original medical provider that they can't collect as the poicy holder is deceased. 2. If the policyholder survives for any length of time and is mentally incompetent, and the company can maintain the fraudulent claim of responsibility - The company can convince the medical provider to go after the person's assists [if any] - especially advantageous if the Company can dispose of the policy holder's agent. [Would they actually kill someone to avoid paying a sum of money in excess of say 50 thousand dollars? - Maybe]

And your options say you find yourself in such a situation? You can complain to Medicare [under Obamacare other fedeal agencies will take complaints]
But what if the Company continues to lie to you - saying one thing and doing something else? You can find a lawyer - most don't want to get envolved
- In this because there is not enough money involved - Or because they are afraid of the Company with its high priced lawyers - Who know every trick in the book to circumnavigate the law?

And how does this apply to the 'Racketeer Influenced and Corrupt Organizations Act' [RICO] ? - Company has already had to pay millions of dollars in
fines in various states because of policyholder complaints - Apparently it is good business to pay millions in fines while bilking the public out of
billions of dollars with policies that are on the edge of, if not actually, fraudulent.

The following is a brief summation of the RICO act and one case where a Health care provider was prosecuted under it - Think the government would
have the guts to prosecute a major insurance company
- Or are major insurance companies above the law - and a slap on the wrist fine is all they risk



The Racketeer Influenced and Corrupt Organizations Act, commonly referred to as the RICO Act or simply RICO, is a United States federal law that provides for extended criminal penalties and a civil cause of action for acts performed as part of an ongoing criminal organization. The RICO Act focuses specifically on racketeering, and it allows the leaders of a syndicate to be tried for the crimes which they ordered others to do or assisted them in doing, closing a perceived loophole that allowed a person who instructed someone else to, for example, murder, to be exempt from the trial because he did not actually commit the crime personally.[1] RICO was enacted by section 901(a) of the Organized Crime Control Act of 1970 (Pub.L. 91–452 , 84 Stat. 922 , enacted October 15, 1970), and is codified at 18 U.S.C. ch. 96 as 18 U.S.C. §§ 1961 –1968 . G. Robert Blakey, an adviser to the United States Senate Government Operations Committee, drafted the law under the close supervision of the committee's chairman, Senator John Little McClellan. It was enacted as Title IX of the Organized Crime Control Act of 1970, and signed into law by Richard M. Nixon. While its original use in the 1970s was to prosecute the Mafia as well as others who were actively engaged in organized crime, its later application has been more widespread....


"RICO predicate offenses: [excerpt]:

Any act of bribery, counterfeiting, theft, embezzlement, **** fraud*****, dealing in obscene matter, obstruction of justice, slavery, racketeering, gambling, money laundering, commission of murder-for-hire, and many other offenses covered under the Federal criminal code (Title 18);

And one case where they actually prosecuted a health care provider [don't know to what extent, if any, health insurance companies were involved]:"

"AccessHealthSource[edit] Eleven defendants were indicted on RICO charges for allegedly assisting AccessHealthSource, a local health care provider, in obtaining and maintaining lucrative contracts with local and state government entities in the city of El Paso, Texas, “through bribery of and kickbacks to elected officials or himself and others, extortion under color of authority, fraudulent schemes and artifices, false pretenses, promises and representations and deprivation of the right of citizens to the honest services of their elected local officials” (see indictment).[33]"

Quote source:
en.wikipedia.org...

Now how good is your health insurance? - Are you sure?

See:
"How good is your Health Insurance ?"
www.abovetopsecret.com...




posted on Jun, 12 2016 @ 07:59 AM
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a reply to: AlienView


Because of pending litigation and/or criminal charges the name of this company [a major health insurance company] will be kept anonymous.

Smart move, the big unmentionables, the largest corruption scheme going: the protection rackets. "Insurance" costs are a major contributor to dragging down everyones economy.

People pay through the nose to 'protect' their belongings, health and life even though insurance doesn't protect you from disaster . In the case of auto insurance, its required by law, the definition of legal extortion.

We can't prosecute them, they are 'required by law'.

We have this blank spot, used to be called protection rackets back in the day. They would come round your shop and threaten to break something then offer to protect you in the future if you pay a little… or else.

Nowadays that extortion racket is legal. If you drive your car uninsured, they take it.

Haven't done anything 'wrong', just didn't pay the protection money.



posted on Jun, 12 2016 @ 08:55 AM
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Most racketeering cases I can recall only come in when the government is losing out on its cut. Does this company pay much to the Clinton Foundation or other political causes?. What at the tax implications? if the IRS is missing out then there could be some resources to take on any big budget law firm.



posted on Jun, 12 2016 @ 02:35 PM
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WCB is another Insurance based Global Money laundering asset of TPTB....their dereliction is why I am posting today....lol.

ALL insurance companies are arms of the Global CABAL and they convert fiat dollars into tangible dollars for TPTB.

Google the Titanic Insurance fraud....learn about who pulled it off and remember the names.....as we speak many people are tracking the money which was gained from the fraud to learn where it was invested and by whom......IMHO trillions of dollars will soon be repatriated back to Humanity from individuls who have gained their wealth crookedly....lol...the irony is this.....if you made a bundle off of the Titanic fraud and then you invested in say Oil or Electricity or Pharmacuticals or ANYTHING and your bundle turned into a BALE OF MONEY....lol...its ALL COMING BACK....if you left in your will your money to your Family or kids....lol...its all coming back.....no lawsuits no civil litigation which TPTB like to use.....just simple re-appropriation.

Even if you flipped those dollars 1000 times you will be outed .....even if you burned the paper trails the fiscal impacts appear and re-appear and you will be outed.There is NO AMNESTY FORTHCOMING....lol.



posted on Jun, 12 2016 @ 02:43 PM
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a reply to: AlienView

Dont worry.....every one of these Global Money laundering entities is listed and is being researched....as you are seeing there is a need to hit the JUDGES AND LAWYERS FIRST....REMOVE THEM ALL IN ONE FELL SWOOP....and then disenfranchise every law these criminals have PAID TO INSTALL OVER 200 YEARS OR MORE......nope simply talking about it is not enough.... a beginning but not enough.....the legal safety net TPTB use must be removed....then you go after them ALL at once.

Removing the litigation timeline and sympathetic laws they manipulate by removing the Judges and Lawyers who are complicit or are following what was left to them is PARAMOUNT.

Trump is on it.



posted on Jun, 12 2016 @ 03:58 PM
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I worked for BXBS. There is fraud everywhere, even the nice old PC doc down the street. Don't get me started on chiro or PT, they are just straight up fraud machines.

Insurance companies do dumb things, but they are not evil or against you. They don't delay on purpose just to screw you. They have to have a bureaucracy in place to discourage fraud. They don't have clerks making medical judgements. They have MD's or RN's or NP's for that.


Most major carries premium come down to this;

85% goes straight out to pay your claims.
10% goes to overhead, its extremely expensive to process all those claims, market, sell, keep buildings open.
5% is profit.

its not a "racket" but they basically look at the claims for a population and just mark it up. That's cost based pricing. Most companies don't have that luxury, they look at what price they need to be at and work backwards from there, or price based costing.

Its all our fault. When they rolled out HMO's the idea was initially a capitated system where the doc got paid $40 a year per contract, regardless of how many times you saw him/her and the idea was the doc had incentive to keep you healthy !!! Lose wight ! stop smoking ! eat your veggies !

most people who were used to the 80/20 "reasonable and customary" plans saw the $5 copay as a license to eat and smoke and drink !!

As a population we are now overweight, over-medicated and unhealthy.

and that is truly expensive.



posted on Jun, 12 2016 @ 04:51 PM
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a reply to: syrinx high priest

I am curious what the percentages were in 2015... of the people covered by insurance in the US, what % have the 'classic' HMO/PPO with a standard % copay, vs. What % have the 'newfangled' High Deductible plan where the copay provisions kick in only after the deductible is satisfied?

I am thankful that I have insurance in case of catastrophe, don't misunderstand.

I find it oddly coincidental, though, that my family hasn't met the deductible limit even once in the 8 yrs we've had this plan.

So in effect, I am paying premiums that amount to thousands a year, my employer is paying additional thousands in premiums (for which I am thankful!), AND I am paying thousands every year in out of pocket costs.

The sick thing is, I STILL hear people around me who are not as healthy as me and mine say "Well, I met my deductible because of that hospital visit... I might as well get all my other aches and pains taken care of now, otherwise I'll have to pay if I wait 'til the next plan year". As they skip out to buy their ciggies and bottles of booze for the weekend.

Knowing I am insured, my Dr. and pharmacy are required by contract to price out their work to me at the contract rate, rather than at their cost + overhead rate. So the antibiotics to treat my daughter's ear infection cost me 45.00, not 10.00.

It seems to me, once again, those that are the least burdensome on the system are the ones getting less for more cost.

And my choices are now (A) have coverage, or (B) be fined.

Completely a racket. No question in my mind.



posted on Jun, 12 2016 @ 06:19 PM
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The funny thing about the policy this major insurance company gave was that it was too good to be true.

No premiums, comprehensive coverage, and a reasonable maximum 'out of pocket' expense per year on any 'in network' provider.

So last year 'the summary of benefits' statement at the end of the year lists total costs to policyholder as 300 dollars.

Now here is where tha fraud comes in. Apparently all the medical providers that that the company refused to pay re-submitted all the charges and now the company fraudulently [it is not a mistake as they were notified of what at first might have been considered a mistake several times] as from an 'out of network provider'' - While their benefits book clearly lists the charges from an 'in network provider' - Company then lies saying no problem and then issues new summary statement stating over 125,000 dollars is patient responsibilituy to policyholder


You tell me this is not fraud


Tell me a good law firm that likes these type of cases



posted on Jun, 12 2016 @ 06:23 PM
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a reply to: CantStandIt

I got out in 2005. The system is totally out of control. It all started with some school teachers who put money aside every month to cover hospital bills. Now we cover viagra !

The requirement to buy insurance is unconstitutional and outrageous. The basic premise of the law of large numbers is sound, but forcing people to buy it is an awful solution.

your example of Rx is not sound. In a vast majority of cases you pay a lot less. ALWAYS BUY GENERIC Rx. In some cases the generics are made at the same factory as the brand ! research the heck out of your scripts, you can get a "value card" at a lot of pharmacies and pay less. You can get the manufacturer to send you coupons, you can save every third copay by getting mail order etc etc etc

You should be thankful you aren't meeting your deductibles, as we used to say, if you are getting your moneys worth out of health insurance you are having a bad year !!!

The premiums of the healthy are used to pay the claims of the sick. That's the idea behind the whole system.

Obama care is an unmitigated disaster. We desperately need single payer

When he says "you pay more in taxes for healthcare then if were british and in exchange you get no healthcare" you should be very upset.






edit on 12-6-2016 by syrinx high priest because: (no reason given)



posted on Jun, 12 2016 @ 06:25 PM
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#s are placeholders for example only....... WCB collects 1 billion in premiums.....85% of WCBs injury claims are less than 5000.00 in total the remaining 15% are 1-6 million dollar claims on very serious cases.......WCB pays off the 85% for peanuts......screws 14% of the high value claims.....pays out on 1% of claims over 5ooo.00......and pays their employees BONUSES based on dollars the agents prevent from being paid out.......WCB does heavy MSM supported propoganda showing they sucessfully resolve 85% of their claims....COMPLETE FRAUD......the GOVERNMENT IS COMPLICIT THE LEGAL SYSTEM IS COMPLICIT......there is no way to break the cycle........ANONYMOUS NEEDS TO EXPOSE THE WCB.


The same thing happened with the Titanic.....the Insurance Company setteled lots of small claims screwed EVERY BIG CLAIM.....built a warchest ....then JP Morgan CASHED OUT.....he had "financed" the cost of the Ships using FIAT DOLLARS.....the Bank was in his back pocket......then he sank the ship and collected from his Insurance Company TPTB cohorts TANGIBLE DOLLARS thereby laundering a massive volume of "imaginary" fiat dollars coming out of the bank and turned them into REAL DOLLARS paid into the Insurance company as premiums....LOL....lol....lol....the insurance company made JP Morgan their equivilant of WCBs 1%.....lol.

So now who is going to go get the proceeds of that crime which have been ....passed down in the Family and then rolled into a 200 Billion or so dollars today.That PROFIT ...AND...the seed money stolen from the Insurance Company needs to be repatriated to the Country it was stolen from.......all of it no Amnesty....Executive Order.....reclaiming the proceeds of Crimes against Humanity.Then we swing over to Edisons buddies and big Pharma and so on and so on....one by one the spokes of the wheel are removed until the bicycle doesnt roll along anymore.The Families of people who comitted crimes against Humanity have no rights to that money.....none of it....and every dime generated should be taken back.....AND....every instance where a partnership was formed and such investments created even more peripheral monies down the road....well that needs to be taken back to....as far as the partnerships are concerned ignorance is no excuse so their loot goes back to where it belongs.

The Donald has to run off all the Judges..... and the Judges in waiting....anyone in Hock to TPTB must be removed from power.....then you go to town...you RECIND every single screwy law that TPTB have spent billions paying to THEIR OWN LAW FIRMS....LOL...to put in place to benefit themselves....THEN you go after the Quadrillions of dollars in stolen money and repatriate it.....hopefully with the help of other Countries willing to do the same actions for their fair share of the loot.

LOL...imagine if you were one of the conjobs with a 50 billion dollar portfolio and your morning coffee wasnt made because your staffs cheques had bounced....lol...and when you turned on your TV you saw breaking story about a Multi-National Consortium of Lawmakers from China,US,Russia,England,...every major World Power....lol....preventing your cohorts from playing Superpowers against each other and starting a World War so they can hide out for a few decades....this day is on the Horizon.....the proceeds of crime regardless of changed hands are the proceeds of crime and the Profits from the proceeds of crime are equitable to the proceeds of crimes and are inclusive and should be seized.

Lets say 5 Quadrillion is seized.....welcome to a new world....no TPTB.....no more dying population and planet....no more deception...no more knowledge suppression......lol....of course we will never see this ...but it would be fun to be a fly on this imaginary wall....lol.



posted on Jun, 12 2016 @ 06:41 PM
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a reply to: AlienView

do you have the EOB ?



posted on Jun, 12 2016 @ 08:35 PM
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originally posted by: syrinx high priest
a reply to: AlienView

do you have the EOB ?


He has it - called Medicare and mentioned fraud - Company calls him up after being contacted by Medicare and says we will not tolerate fraud and then says it is having trouble contacting the 'medical group' patient was under - he calls medical group and gets them on the phone in five minutes - mecdical group says they are woriking on the problem and he mentions another two thousand dollar bill he got
- medical group says they paid it - two days later he gets a collection notice for the two thousand dollar bill


He believes his policy is not only 'bad faith' but fraudulent - Company pays almost no claims


Research shows Company lost many millions in fines in the past because of customer complaints - Company continues to grow -
Apparently million in fines is a cheap price to pay for billions [if not trillions] in the profits from fraud



edit on 12-6-2016 by AlienView because: (no reason given)



posted on Jun, 12 2016 @ 09:29 PM
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a reply to: AlienView

why would the medical group be paying claims ? Is this private insurance or some sort of buying group ?



posted on Jun, 13 2016 @ 05:36 AM
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When we consider "Health Insurance and the 'Racketeer Influenced and Corrupt Organizations Act' [RICO]" we must realize that the main threat to the United States is not the radical mad men who want to destroy us - threat though they are.

But the main threat, the more serious threat, is corruption from within - When we allow major corporations to act in a fraudulent and underhanded manner - we are allowing a cancer that will destroy the United States more effectively than
any terrorist agenda. - This corruption led to the big financial crash back in 2007-2008. That time the economy survived.

The next crash, which some see happening soon, may be far more devastating - The recovery that took some years last time is liable to be far worse the next time - There may not be a recovery - The United States might fall like Rome, more from the corruption within than the enemies on the outside.

And when greedy and corrupt individuals and groups control major corporations, and especially important corporations
involved in our health and well being - No American is safe - Not your savings, not your life, and certainly not your sense
well being.

Maybe Obama was right about the health care system in America being sick - But to what extent has Obama care fixed it?
Has it weeded out the greedy and corrupt who are still obviously there - Or has it just given them a license to continue


But maybe it has done something - the individual mentioned in the above story told me that supposedly since the enactment of Obama care he has a right to appeal the Company's decision to deny coverage - And to appeal it again through third
party arbitration if the company continues to deny it.

The problem he has now though is that he believes that the Company is so corrupt that even if he files the appeal with a
certified letter the Company will deny ever receiving it, or say there was nothing inside the envelope.

They are forcing him to hire an attorney in order to deal with them


What was that old saying: There ota be a law for this!!! And there is:

the 'Racketeer Influenced and Corrupt Organizations Act' [RICO]

"The Racketeer Influenced and Corrupt Organizations Act, commonly referred to as the RICO Act or simply RICO, is a United States federal law that provides for extended criminal penalties and a civil cause of action for acts performed as part of an ongoing criminal organization."

And how far we have already fallen when a major health insurance carrier can be considered
as an ongoing criminal organization.



posted on Jun, 13 2016 @ 07:38 AM
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a reply to: AlienView

a major carrier is not a "medical group". you mentioned there were no premiums. this sounds like a buying group or discount membership plan

there are only about 5 major carriers left, and none of them are known as "medical groups"



posted on Jun, 13 2016 @ 04:38 PM
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I still know lots of people in the industry, if you can clear up a few things for me I might be able to help



posted on Jun, 13 2016 @ 05:51 PM
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originally posted by: syrinx high priest
a reply to: AlienView

a major carrier is not a "medical group". you mentioned there were no premiums. this sounds like a buying group or discount membership plan

there are only about 5 major carriers left, and none of them are known as "medical groups"


The plan is an HMO - Medicare Advantage plan [issued by a major insurance company]- that actually replaces Medicare even though still under Medicare jurisdiction and rules - Every policyholder must have an assigned primary care physician and that physician must be part of a medical group in the plan.

Plan explicitly states that for all medical services for an 'in network' provider maximum patient responsibility is less than
3000 dollars per year. Company keeps issuing statements through the United States Mail stating patient was treated at an
''out of network'' provider when in fact provider was 'in network' at time of service [mail fraud?] - Agents over phone agree that provider was 'in network' but can't explain why they are saying on statements patient is responsible for costs. And yet they will not correct the mistake in writing



posted on Jun, 13 2016 @ 07:13 PM
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a reply to: AlienView

thank you for that explanation.

That seems like the dreaded coding mistake. It seems like the providers status changed, and the claims are being processed with the old, incorrect information.

I wouldn't go to crazy with RICO and mail fraud angle, what you need is a claims rep to kick this up to a manager. My suggestion would be to gather all the relevant EOB's and bills and ask for an in-person review or appeal hearing.

My experience is you can get much further along in-person.

I know its a hassle but it seems like a correctable issue.



posted on Jun, 14 2016 @ 01:18 AM
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originally posted by: intrptr

We can't prosecute them, they are 'required by law'.

We have this blank spot, used to be called protection rackets back in the day. They would come round your shop and threaten to break something then offer to protect you in the future if you pay a little… or else.

Nowadays that extortion racket is legal. If you drive your car uninsured, they take it.

Haven't done anything 'wrong', just didn't pay the protection money.


Yep. When Obamacare first went through, I was in a daze for months wondering how the hell they could do that. And then I was thinking about old school gangsters and racketeering and protection rackets. Or I was reading about them or something and it just hit me. It was like "Whoa! That's exactly what this is!"



posted on Jun, 14 2016 @ 01:22 AM
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originally posted by: syrinx high priest

your example of Rx is not sound. In a vast majority of cases you pay a lot less. ALWAYS BUY GENERIC Rx. In some cases the generics are made at the same factory as the brand ! research the heck out of your scripts, you can get a "value card" at a lot of pharmacies and pay less. You can get the manufacturer to send you coupons, you can save every third copay by getting mail order etc etc etc


Be careful with that. I have epilepsy and I used to buy the brand name drugs to treat it. Worked very well. Around 2005 I started buying the generic because they told me it was the same thing and I started having seizures again. I can't prove it (obviously) but it doesn't seem like a coincidence to me that the brand name worked almost perfectly for close to 20 years and as soon as I switched to the generic I started having seizures again.

You might be fine with most generics but when it absolutely has to work, be careful.



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