The Raven

The Raven

Thursday, August 26, 2010

Richman vs Kootman and AARP Medicare Complete

Medical billing fraud is committed when a medical facility or office intentionally bills procedures that may not have happened or misrepresents procedures that did happen in order to increase the amount processed, thereby deceiving insurances and patients into paying more for services. Medical billing fraud costs insurances, providers and patients millions of dollars each year.

UnitedHealth Group

Attn: Appeals and Grievances
P.O. Box 6106
Cypress, CA 90630
Mail Stop: CY124-0157

Subject: Grievances against Dr. Jefrrey Kootman and AARP/Medicare Complete

On April 23rd I saw Dr. Jeffrey Kootman, an oral surgeon, to look at a lesion in my mouth before I was to have a crown put on a back tooth that was near this painful lesion. Even though there were several other oral surgeons nearer to where I live, I was told by an AARP phone representaive, that I had to see Dr. Kootman, but I was given an explanation for why it had to be Dr. Kootman that I still do not understand. When I saw his name on page 30 of the 2010 AARP Physician Provider list that had been sent to me in February, naturally I assumed that AARP Medicare would cover my visit, since he was listed along with several other oral surgeons on AARP’s Physician Provider’s List.

His receptionist photocopied my AARP/Medicare Complete card, (0235765-01) and assured me that their sevices are included in your plan. When I offered her my co-pay she said that would not be necessary because, to quote her, “They pay for everything.” I then asked if she would like to see my referral and she said that would not be necessary because she would call my primary care physician.

A month later, in May, I got a notice from my previous insurance company, Evercare, which I had left for AARP eight months ago. The letter stated they were not going to pay a $295 bill from Dr. Kootman because I was no longer with them.

I called the doctor's office about this mistake and the receptionist said they knew they had sent it to the wrong company by mistake and that 3 days before my call the claim had been sent to AARP.

A month later, in June, I got another refusal to pay the $295 claim from Evercare. I again called Dr. Kootman’s office and the same receptionist took my AARP insurance number and said she would take care of it.

On July 24th, I received my FIRST bill from Dr. Kootman saying I had to pay $295 by August 15.

In checking up Dr. Kootman’s record on the internet I have noticed many complaints against him made by other patients who have had similar billing difficulties from his office. There are also recordings of complaints to the Arizona Dental Board from many other patients. His physican’s record appears to be blemished by numerous complaints to the Dental Board on more than just billing problems.

After receiving this first bill from Kootman’s office I immediately called AARP. The phone representative said that Dr. Kootman is on their list but there is no record of his ever filing a claim with them for the $295 he now was billing me.

Just today, August 25, I have received a second bill for $295 from Kootman warning me that he is going to put finance charges on my bill and that he has sent it to collections.

The lesion had disappeared just before my visit to him. All he did was look at it and said that it was gone and that I should continue with the Ibprufen which I had started myself just before it disappeared. The whole visit took about three minutes, so that means Kootman is charging $100 a minute!

I would like to make it clear that I hold AARP responsible for the Kootman pickle that I am in for having demanded that I see him and even having him listed in their directory. I have been informed about a week ago, again, from another AARP phone representative, that he is no longer listed as a provider with AARP.

One lawyer I spoke to about my problen, suggested that your company send me the reinbursement for his services. I could use your check to either send to him or pay him his bill but get paid by you for the liability that I have incurred merely by doing ALL the “right things” such as having insurance and obeying your command to see Kootman in the first place.

Kootman never seems to ever contact your claims department but keeps harassing me along with other victims of his weird confabulations which he has worked out along with his collaborator, Jean Windsor. I sent him an e-mail telling him that his operation reminded me of an earlier melodrama called “The Demon Barber of Fleet Street.”

In the Dental Association to which he belongs, he boasts about the discounts in anesthesia he gets from his supplier and the credit collection company he uses to keep his patients in line. IT is the name of his collection company and it has just about the blackest record in the business for harsh strong-arm methods, rude and abusive language and violation of FTC standards of proper policies credit collection companies ought to use for the sake of fair trade and the barest semblance of ethical and humane values that are supposed to be the treasured inheritance of American society.

What do you think?

Jordan Richman

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