Complaint Review: Advanced Reimbursement solutions

Formerly known as Maldonado Medical LLC Pathon Gloval holding based out of Delware PANTHEON GLOBAL HOLDINGS LLC 2801 CENTERVILLE ROAD FIRST FLOOR, WILMINGTON, DE, 19808, USA AZ ADDRESS 19820 N 7TH AVE SUITE 230-P, PHOENIX, AZ, 85027, USA REM NEUROMONITORING LLC 20235 N CAVE CREEK RD STE 104-495 PHOENIX, AZ MATRIX ANESTHESIA LLC 19820 N 7TH AVE STE 230B PHOENIX, AZ 85027 Medical FRAUD Company

Medical Billing Fraud and Tax Fraud. The process in which the company consist of code guiding the medical professional provider, office and facilities. The company does direct kick backs to the doctors and doctors offices and cuts them checks. The company processes all the billing the for the medical providers customers.

At the same time either by percentage or flat rate whichever is agreed upon by the medical provider and this company, they will jointly continually submit claim and resubmit claims to the insurance provider. When the fund are received the majority will go the this company and whatever was agreed upon will go to the medial providers.

This company approaches these claims as if they are small medical claims attaching the out of network out of pocket to avoid clearhousing processing. At the same time, in the event the company nor the doctor's office can not recovery any funds, the company will levy the customer and process leans against the customer. The company will then wait another 60 days pass original payment and request another payment from the insurance and with different or the same billing codes.

The main company that owns all the other ones is Patheon Global Holdings. This company owns, Advanced Reimbursement Solutions, American Surgical Development, ANMM Surgical, BIO OPUS, Four Seasons, Healthcare Benefits, Physician and Surgical Reimbursement. The company uses different address from Delaware and established itself as managed from a foreign entity so avoid paying state taxes.

Also, The company will continually change phone numbers and addresses so that insurance companies do not catch on to them for double billing. The owners will continually stand on other companies and change names to shift liabilities and layer funds to show losses. The company will receive funds from the insurance company of what they recovered and the process it in house and then pay it from one of the other companies. Making it look the company is paying another company and showing a lose.

These companies also like to over charge on bill codes. There is a company also called Advanits Health, where the company will provide a medical device to try to recoup funds from the insurance. This company will be for twice the amount of codes with one device.

Patient discrimination by customers selection:
There is a department discriminate against the customer based on weather or not there is enough funds, out of pocket maximum and or limits of their out of pockets. If the customer does not have enough money and or limits are not appealing. There are many variables that come in to the process. 1. internal staff calls medical insurance to get all information the determines if the patient is a good candidate. If not then they are moved to a not appealing customer and or designated a red color. Candidates with money in the insurance benefits than they are processed forward with the colors of green or yellow.
Medical Bill code guiding:
With the approval process the company then runs historical reports to see what prior medical codes minium were able to be recovered from other medical providers. This information is then used to inform and guide the medical providers to adjust their claims prior to send to the insurance company. If not then a resubmission is then reissued with the difference to the insurance company. The recovered amount is then split with with the company and doctor office.

Money Movement
During the process of payment here is how the primary company moves money.
Patheon is the holding company that own the medical facilities in which the procedures takes place. The billing is done by another company that own is own by Pathoen Global Holdings. The Doctor are then paid by the insurance company. The the doctor turns around and pays the holding company a percentage or a rate back to the holding company. Details accounting is kept on two different computers in the accountants office with three different quickbooks accounts. The holding company owns the billing company that helps doctors bill, owns the medical web application that guides and qualifies the patient, owns the facilities, owns the medical devices, owns the medical cold therapy machines.

Money and executive expenditure.
Each one of the main owners and extended family is provided American Express Black cards with $200,000 limits. Each month the main owner pays off all the card holders credit cards as business expense. The company even went as far as buying houses and vehicles under the business names and then claim them to family members.