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Fraudulent Medicare ABN

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alracd

Junior Member
What is the name of your state?Texas
My doctor ordered a series of blood tests for me. My blood was drawn at his office and then sent to Quest Labs. No one at the doctor's office advised me or presented me with an ABN showing that certain blood tests might not be covered by Medicare where I had the option to decline those certain blood tests (which I would have). Payment for those blood tests was later declined by Medicare and I was billed over $350 by Quest. Quest was contacted and stated I had an ABN on file for those tests and I had checked and signed Option 1 on the ABN form and signed it. I asked Quest for a copy of the ABN form that they claim I signed, Upon receiving a copy, it's very clear that this is not my signature on the form and so this form must have been drawn up and signed by someone else at a later date because I had never seen it. The "Identifier" on the ABN form is listed as Quest (not my doctor's office). Does that mean that Quest is the one that drew up the form? Quest is refusing to do anything about the $350 charges (are also charging me the full rate and not the amount they would have received from Medicare) even though I have notified them that I was never given an ABN and never signed one saying I would be responsible for the charges if Medicare declined payment - even though I have submitted a letter and a copy of my real signature (on another legal document). What are my rights? Am I responsible for this charge that is based on a fraudulent ABN?
 


adjusterjack

Senior Member
Pay it. They don't care. The whole system is corrupt. They'll just send it to collections and trash your credit while the amount keeps rising with interest, fees and costs,

After you pay it, you can sue your doctor in small claims court for the $350. You may have better luck.
 

Bali Hai Again

Active Member
Pay it. They don't care. The whole system is corrupt. They'll just send it to collections and trash your credit while the amount keeps rising with interest, fees and costs,

After you pay it, you can sue your doctor in small claims court for the $350. You may have better luck.
Unfortunately I have realized this just recently.
 

LdiJ

Senior Member
Pay it. They don't care. The whole system is corrupt. They'll just send it to collections and trash your credit while the amount keeps rising with interest, fees and costs,

After you pay it, you can sue your doctor in small claims court for the $350. You may have better luck.
Once in a while I have had a doctor's office or other medical provider accept responsibility for something billed wrong or done wrong. However, I agree that otherwise they will just send it to collections and trash your credit. It is not just medical providers either. I had two different collection agencies admit that they could not validate a debt (that wasn't mine) and declined to proceed with collections. However, instead of it ending there, they just sold it on to a lower tier collection agency and the whole process started over. In one case the lower tier included a sleezy attorney who sued me without serving me, got a judgment, and then found loopholes so that I couldn't challenge the judgment.
 

quincy

Senior Member
What is the name of your state?Texas
My doctor ordered a series of blood tests for me. My blood was drawn at his office and then sent to Quest Labs. No one at the doctor's office advised me or presented me with an ABN showing that certain blood tests might not be covered by Medicare where I had the option to decline those certain blood tests (which I would have). Payment for those blood tests was later declined by Medicare and I was billed over $350 by Quest. Quest was contacted and stated I had an ABN on file for those tests and I had checked and signed Option 1 on the ABN form and signed it. I asked Quest for a copy of the ABN form that they claim I signed, Upon receiving a copy, it's very clear that this is not my signature on the form and so this form must have been drawn up and signed by someone else at a later date because I had never seen it. The "Identifier" on the ABN form is listed as Quest (not my doctor's office). Does that mean that Quest is the one that drew up the form? Quest is refusing to do anything about the $350 charges (are also charging me the full rate and not the amount they would have received from Medicare) even though I have notified them that I was never given an ABN and never signed one saying I would be responsible for the charges if Medicare declined payment - even though I have submitted a letter and a copy of my real signature (on another legal document). What are my rights? Am I responsible for this charge that is based on a fraudulent ABN?
You signed nothing at your doctor’s office prior to your blood being drawn? Did your doctor go over with you what blood tests were being requested from Quest and for what reasons? After you received the bill from Quest, did you ask your doctor’s office about their failure to provide you with an ABN?

If the lab did the tests requested by your doctor, then the lab obviously deserves to be paid. And I agree with the others that if you don’t pay the lab, a collection action is likely. But you might be able to negotiate a lower cost if you address the issue with your doctor’s office.

Here is a link to what is required on an ABN form:
https://www.cms.gov/medicare/medicare-general-information/bni/downloads/abn-form-instructions.pdf
 

alracd

Junior Member
You signed nothing at your doctor’s office prior to your blood being drawn? Did your doctor go over with you what blood tests were being requested from Quest and for what reasons? After you received the bill from Quest, did you ask your doctor’s office about their failure to provide you with an ABN?

If the lab did the tests requested by your doctor, then the lab obviously deserves to be paid. And I agree with the others that if you don’t pay the lab, a collection action is likely. But you might be able to negotiate a lower cost if you address the issue with your doctor’s office.

Here is a link to what is required on an ABN form:
https://www.cms.gov/medicare/medicare-general-information/bni/downloads/abn-form-instructions.pdf
 

alracd

Junior Member
Thank you for your reply. I signed nothing at the doctor's office prior to the blood being drawn. I had seen the doctor the previous day and he suggested that I needed to come into the office the next morning to have some blood drawn. He did not go over what blood tests were being requested and I was not presented an ABN form. I went in the following morning, had the blood drawn by Quest, which took about 5 minutes, and left. Again, no one advised me as to what blood tests were being ordered and no ABN was presented to me at the time by Quest, and I signed nothing. A couple of months later, I received a bill from Quest for $350 after three of the tests were declined by Medicare as "not medically necessary". I went back to the doctor's office and asked why I had not been advised that certain tests would not be paid by Medicare. They told me that the wrong codes were probably submitted and they would resubmit it with the proper codes. The second submission was also declined by Medicare and Quest sent me a $350 bill again and noted on the bill that I had signed an ABN and stated I would be responsible for any costs that Medicare did not cover. I asked for a copy of this ABN that Quest said I had signed and they sent it to me, all filled out with the proper blood tests that were ordered, and the ones that would probably not be paid for, with the box checked saying I would take responsibility for payment if Medicare didn't pay, and someone had signed my name to it. This was the first time I had ever seen the ABN and the signature was not my handwriting. This ABN was obviously filled out and signed by someone at Quest after the blood was drawn or tested and is totally fraudulent.

Based on the link you sent (I had already looked that up but thank you anyway for including it), Medicare REQUIRES that an ABN be presented to the patient if there is a possibility that Medicare may not pay for the service, so that the patient can decide whether they want to go ahead and have the service and take financial responsibility or whether they choose "I don't want the test and am not responsible for payment". It's very clear on the ABN form. Since this is a fraudulent document that was not presented to or signed by me, it should render it null and void.

We have contacted Quest, told them the ABN is fraudulent and that we never saw or signed it, and I have even submitted copies of my actual signature on other documents (that looks nothing like the signature on the ABN) and they have done nothing about it - just sent an email telling us we need to appeal to Medicare about the charges that weren't paid or submit the proper codes.
 

quincy

Senior Member
Thank you for your reply. I signed nothing at the doctor's office prior to the blood being drawn. I had seen the doctor the previous day and he suggested that I needed to come into the office the next morning to have some blood drawn. He did not go over what blood tests were being requested and I was not presented an ABN form. I went in the following morning, had the blood drawn by Quest, which took about 5 minutes, and left. Again, no one advised me as to what blood tests were being ordered and no ABN was presented to me at the time by Quest, and I signed nothing. A couple of months later, I received a bill from Quest for $350 after three of the tests were declined by Medicare as "not medically necessary". I went back to the doctor's office and asked why I had not been advised that certain tests would not be paid by Medicare. They told me that the wrong codes were probably submitted and they would resubmit it with the proper codes. The second submission was also declined by Medicare and Quest sent me a $350 bill again and noted on the bill that I had signed an ABN and stated I would be responsible for any costs that Medicare did not cover. I asked for a copy of this ABN that Quest said I had signed and they sent it to me, all filled out with the proper blood tests that were ordered, and the ones that would probably not be paid for, with the box checked saying I would take responsibility for payment if Medicare didn't pay, and someone had signed my name to it. This was the first time I had ever seen the ABN and the signature was not my handwriting. This ABN was obviously filled out and signed by someone at Quest after the blood was drawn or tested and is totally fraudulent.

Based on the link you sent (I had already looked that up but thank you anyway for including it), Medicare REQUIRES that an ABN be presented to the patient if there is a possibility that Medicare may not pay for the service, so that the patient can decide whether they want to go ahead and have the service and take financial responsibility or whether they choose "I don't want the test and am not responsible for payment". It's very clear on the ABN form. Since this is a fraudulent document that was not presented to or signed by me, it should render it null and void.

We have contacted Quest, told them the ABN is fraudulent and that we never saw or signed it, and I have even submitted copies of my actual signature on other documents (that looks nothing like the signature on the ABN) and they have done nothing about it - just sent an email telling us we need to appeal to Medicare about the charges that weren't paid or submit the proper codes.
Thanks for the additional information. Here is a link to appealing the denial:

https://appeals.lmi.org/dapmailbox

I don’t know whether to suggest you pay the $350 first or not. Paying first should help you avoid a debt collection action but it could also mean you never see your $350 again.
 

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