You are SO right about ACO REACH scams.  I was one of the PeaceHealth Original Medicare beneficieries who was SECRETLY enrolled in the PH scam.  I am furious a year ago when I found out, and a year later, I am still furious.

Thanks, Dick, I will write the new PH head-of-state…

Lorna Gober, MD
CMO, PeaceHealth
1115 SE 164th Avenue
Vancouver, WA 98683

Dear Dr. Gober:

Subject: ACO-REACH Scam at PeaceHealth, Washington State

On May 27, 2022, I received a “Notification Letter: No Action Needed” letter from PeaceHealth informing me of my status within their DCE-REACH program Cascadia Community Care Alliance. This was when I first learned that my PERSONAL medical file had been shared with a for-profit entity without my knowledge or consent. Yes, I had been involuntarily and surreptitiously enrolled in this dangerous, privatized Medicare scam, along with 2.1 Million Original Medicare recipients. Recently, the federal government has indicated that there will be no new corporate ACO-REACH program start-ups. This announcement is certainly welcome news; yet as one of the trapped 2.1 million Original Medicare recipients, I must respectfully insist that my medical file be returned to the Original Medicare management system at PeaceHealth and removed from your third-party for-profit ACO-REACH entity.

Sadly, my doctor’s previous patient-centered approach at PeaceHealth is being directed by a for-profit entity regarding what Medicare services I will—and will not—receive in future. This is a complete betrayal of my trust. Simply put, my doctor is For-Profit, not For-Me, as (I assume) a condition of his employment. I wish to be notified in writing that PeaceHealth has removed my file from this for-profit REACH scam and returned to its Original Medicare recipient folder.

Please consider this letter to PeaceHealth as my “Notification Letter: Action Needed.”

Respectfully,

Lynda Hanscome, Ed.D.
Educator (Retired)
cc:
President Joe Biden
President of the United States

Congressman Rick Larsen
Washington 2nd District

Senator Patty Murray
Washington State

Senator Maria Cantwell
Washington State

Lynda,

Thank you for informing us of your well-put letter.  I encourage others to follow suit.  It would be nice if Dr. Gober finds here new desk covered with similar letters. 

Thank you, Dick.  I sent the letter via postal service and the copies to the others as well.  We’ll see what happens; the entire mess makes me furious.

Is this the program you’re referring to?
The link should take you to a filtered view of the data where location contains “WA” and one of the name columns contains “Family.”



ACO Organizations Filtered

Randy, I will look at the link.  But in the meantime, PH’s ACO-REACH is called Cascadia Community Care Alliance.  They did not grab all patient files when they set this scam up.  They only ‘aligned’ the patients from whom they could make the most money from via Medicare.  My file was stolen; my husband’s was not.  I  am well; he is not as well.  The process of up-coding and ultimately reducing and delaying treatments for any condition/illness is part of this scam.  The healthier the patient, the more they scam.  They aim not to get caught (audited) by the Federal government.  Cascadia Community Care Alliance sniffs out every opportunity to make money—that is their ONLY goal.  Lynda Hanscome

This comment is submitted on behalf of Scott Foster, MD, Chief Medical Executive, PeaceHealth Medical Group:

I’m responding on behalf of Dick Conoby’s article in the March 12, 2023 issue regarding CMS’s ACO Reach program, specifically PeaceHealth’s model.

One of the most important points in the discussion is that not all Accountable Care Organizations (ACOs) operate in the same way, and the differences between them matter. Some organizations may design ACOs to maximize revenue, possibly at the expense of appropriate patient care, since Medicare doesn’t fully cover the cost of care and has an arm length’s relationship with beneficiaries and their service providers. As a nonprofit organization—re-investing any revenues over expenses in improved care and services to the community—PeaceHealth has designed its ACO to improve access to care and patient outcomes while reducing the cost of care for patients and for Medicare (including the taxpayers who fund it).

From the onset, PeaceHealth has embraced the program’s guiding principle: Anyone participating in our ACO would have all of the benefits and rights of Medicare patients not participating. Freedom of choice prevails. In fact, CMS deternmines which of PeaceHealth’s Medicare beneficiaries will be a part of its ACO, not PeaceHealth. And per CMS guidelines, patients can opt-out of participating in PeaceHealth’s (or any providers’s) ACO while remaining a PeaceHealth patient.

Patients who do choose to participate in PeaceHealth’s ACO also have access to enhanced benefits as a result of reduced barriers granted to ACOs by CMS. For example, PeaceHealth’s ACO waives: 1) copays for care management programs and services to better manage wellness and chronic diseases. We’ve added staff to provide more of these important services that keep people well; 2) Medicare requirements for patients to be designated as “home-bound” before they can have access to home health services. We’re piloting a program to offer at-home visits by nurses and nurse practiotioners; and 3) requirements for patients to stay in the hospital for three days before becoming eligible for skilled nursing care at participating facilities.

In addition, PeaceHealth has added staff to primary care offices to assist with behavioral health concerns patients may have, and to provide additional care navigation/management for patients requiring home health or skilled nursing care.

These enhanced benefits are paid for by PeaceHealth. In making these investments, we assume that the things we are doing will keep people healthier and out of the hospital and the ED, where the most expensive care occurs, and we’re using that “paid forward” savings to support new services.

Our experience over time will tell us if we are successful in achieving better care for our patients. If we are successful, the savings will help to support these enhanced benefits in the future. If we’re not successful, we will endure the losses.

As noted above, PeaceHealth embraces the freedom of patients’ choice. All patients, participating or not in the ACO, can freely choose their primary care provider (and specialists) and can notify Medicare of these choices by calling 1-800-Medicare. Doing so will not change patients’ fundamental benefits as a Medicare benficiary.

The bottom line for Medicare benficiaries: Ask more questions of the ACO you are thinking about, learn who the sponsoring organization is, and compare the benfits and restrictions. For more information about PeaceHealth’s ACO, called the Cascadia Community Care Alliance, call 833-838-6307.

It seems pretty clear that PeaceHealth has tried to pull yet another fast one. 

Dick, as you note in your excellent article, PeaceHealth (PH) is scheming to take over the primary physician market in Bellingham. A number of physicians have left PH because they simply could not be part of such a blatant Privatized Medicare scam known as ACO-REACH. Those of us whose medical files were stolen to be “enrolled” in this scam have an absolute right to be furious and to fight hard, which I have been doing for over a year. I urge readers to understand that there is NOTHING in PH’s ACO-Care Alliance scam that is patient centered. That is nonsense. An ACO is a profit centered business entity with its own business/state license. ACOs are laser focused on PROFITS not PATIENTS.  PH tries to cover itself in glory with phony assurances that they are patient-centered when, in fact, money they are “saving” is money drained from Medicare as business profit (up to 40%!!)

ACOs defraud Original Medicare by “up coding” diagnoses on the front end and thereafter by delaying, denying or minimizing medical care. Simply put, PH is syphoning Medicare funds by exaggerating (up coding) diagnoses to migrate patient files into higher (more profitable) risk groups. You might remember our parents telling us: “Figures lie, and liars figure.”

Below is my personal, documented, experience of how PH up codes a diagnosis. Here’s how it works: PH made a sleazy attempt to “up code” my occasional high blood pressure to a “Chronic Disease.” Mayo Clinic classifies HBP as a “Common Condition.” Despite PH’s spirited denial, this is a perfect example of up coding. After all, a “chronic disease” sounds much more serious than a “common condition,” right? PHs self-righteous denial would have been laughable if it wasn’t a black mark on my decades of hard work to maintain my good health only to find myself shifted to a more profitable “Chronic Disease” category.

And one can only imagine what PH would have Medicare believe after trying desperately to save my life through a one-on-one counseling session with a nurse practitioner. Yes, that was the written PH plan for me. Think about that: Up coding the diagnosis for a “disease” that never existed and then minimizing treatments for the “disease.” (Never mind that there are excellent prescription meds for this “common condition.”) PH is not interested in patient-centered options; just PH ACO-REACH profits. PH would keep those Medicare funds coming on behalf of Dr. Hanscome’s new “Chronic Disease” status to enrich the for-profit ACO Care Alliance scam. Another example of using my good name to defraud Medicare.

And say, what? Mr. Scott Foster from PH is too busy (squeezing Medicare’s money pouch perhaps?) to compose his own responses? I watched one of his videos and, as one of your readers noted, every time he rolled his eyes, he was lying. Not to worry, Beverly Mayhew is sitting firmly on the ACO gravy train. She must have led her class in creative writing… Speaking of Loyal Beverly: She told many lies in her response for Mr. Foster. For example, she says (spelling errors included): “Freedom of choice prevails. In fact, CMS deternmines which of PeaceHealth’s Medicare beneficiaries will be a part of its ACO, not PeaceHealth. “

This is a gerrymandered statement at best or simply an outright lie.  Your choice.  According to the PH/ACO agreement—not readily available to the public—selections are based on risk types; so the secret invaders (alien or otherwise) pawed through the PH files (with NO knowledge or approval from patients) to create the top-secret patient list. Only after my file had been stolen and put into the ACO-REACH scam was I told—by PH, NOT CMS—that I was in it. Wouldn’t one think that a religious organization in fellowship with a for-profit business would fight to keep patient files away from prying eyes? The answer is pretty simple: profits, profits, profits. You might remember what our parents told us in our youth: “Figures lie, and liars figure.” And whatever happened to ethics? lol

Loyal Beverly continues: “And per CMS guidelines, patients can opt-out of participating in PeaceHealth’s (or any providers’s) ACO while remaining a PeaceHealth patient.”

This is false. I have sent emails and letters to PH (copied to our State Representatives, President of the United States, and other officials) for over a year to opt-out of PH’s ACO scam. The responses to date from PH have simply been goo-goo talk (also known as gibberish). I have yet to hear a response to my March 13, 2023, letter to CMO Ms. Lorna Gober asking/demanding that I be opted-out of this fraudulent program. Why would it take PH more than 6 weeks to transfer my patient file from the “ACO-REACH” scam to “Original Medicare with Tri-Care-for-Life? Remember, Loyal Beverly’s goo-goo words: “Freedom of Choice prevails..” (Belly laugh…)

Until 2022, I had wonderful experiences with both Original Medicare and Tri-Care-for-Life until I got caught in this disgusting web of lies from PH. I am just one of 2.1 million Original Medicare recipients trapped in this scandalous for-profit, privatized Medicare scam. My plea to readers: If you are one of the ‘stolen patients’, please do not sit by quietly. Speak up: contact Joe Biden, your representatives and PH to demand that PH (or the thieving aliens) remove your stolen record from the ACO scam. And above all, do not believe the dribble that PH will tell you with a straight face and a pious countenance.

Lynda Hanscome, Ed.D.
Educator (Retired)

Lynda,

Thanks for your personal account. 

One question that is not answered is once everyone eventually comes under ACO Reach (the goal), where will one go to opt out?  All will be privatized.

A note to clarify:  The posting from Mayhew was actually a quoted response prepared by Foster who did not even deign to respond personally.   

And I was the one to comment on the “eye roll”:  “Dr. Scott Foster is the Chief Medical Executive of PeaceHealth’s new DCE, which is now open for business as Cascadia Community Care Alliance. Dr. Foster is also a master of the eye roll, which he seems to use to relay that “even I can’t believe I am saying this shit.” (Watch this League of Women Voters video—preferably with a double gin and tonic or some other mind altering drug.)”

Dick:  The second sentence of your first paragraph says it all:  All will be privatized.

You can bet that all of the Disadvantage Medicare scams are already lining up—eager to shed their poor public image—to jump on the bandwagon for (much more profitable) new, wonderful ACO-REACH—PLUS scams…coming to a city near you!

Just my two cents’ worth…Lynda Hanscome