Press Awarded For Exposing Veterans Affairs ER Bill Denial Scandal
The American Legion recently selected Minneapolis-based KARE 11 News team of journalist AJ Lagoe and producer Steve Eckert for its annual 4th Estate award for covering the nationwide Veterans Affairs ER billing denial scandal.
Lagoe reported on my personal story last year to start his investigation. There, Minneapolis VA refused to pay for my non-VA emergency room visit where I experienced chest pains and other symptoms are heart attack.
READ @ KARE 11: Krause ER Bill Denial Story
My chest pains immediately followed the untimely death of my ex-wife, Amie Muller, from pancreatic cancer believed linked to her burn pit exposures at Balad, AB, Iraq. The stress of her passing most certainly trigged my chest pains, and we swiftly went to the nearest emergency room to be safe.
In this context, I followed the rules. I notified the agency within 72 hours of the hospitalization. I submitted my medical billing once received. The bill should have been covered.
RELATED: Veteran Takes On Minneapolis VA Over ER Bill Denial
Before receiving my denial, I was told to provide receipts of the ER visit to high-level VA executives to ensure the payments were handled appropriately.
However, after submitting the billing to the agency, I received a denial three weeks later asserting my decision to seek emergency care when I did was not what a “prudent layperson” would do. VA denied my request on that basis.
Now, I am a prominent veterans rights attorney, nationwide. Saying a made a decision that was not even on the level with a “prudent layperson” was beyond the pale for me.
Once I received the denial, I reached out to AJ Lagoe to see if KARE 11 might be interested in covering the issue.
For some background, we previously worked on the traumatic brain injury scandal where VA was caught using unqualified doctors nationwide impacting over 24,000 veterans. This means I have some reach with the press, and VA knew it.
RELATED: 3 Things Veterans Must Do After Non-VA ER Visit
For this ER story, the initial research proved the problem had national potential and AJ’s research revealed massive implications impacting billions in payouts and possibly improper denials.
Legion Press Announcement
KARE 11 did a great job digging into the story and exposing its massive scope. According to the American Legion announcement:
Legion Announces Recipients of 4th Estate Award
INDIANAPOLIS (May 14, 2018) – A Twin Cities television news station, a metropolitan newspaper and an influential online media outlet will receive The American Legion’s Fourth Estate Award during the 100th National Convention of the nation’s largest veterans organization in Minneapolis, on August 30.
The Fourth Estate Award has been presented annually by The American Legion since 1958 for outstanding achievement in the field of journalism. Nominations in 2018 were considered in three categories: broadcast, print and new media (Internet). They were selected by the organization’s Media & Communications Commission on May 8 and announced today.
Taking top honor in the broadcast category is Minneapolis NBC-affiliate KARE. In a comprehensive series titled “Disconnects, Delays & a Pattern of Denial,” the stationed examined the Department of Veterans Affairs handling of emergency claims, organ transplants and delays in its appeals process for disability claims. The series led to greater claims-assistance for veterans, exposed previously hidden problems and garnered praise from members of Congress.
RELATED: VA Engaging In Bad Faith Insurance Denials
Rohan On 4th Estate Award
“The American Legion has long recognized the essential role that the media play in contributing to a free society,” said Denise H. Rohan national commander of the 2 million member American Legion. “As an organization, we would not be nearly as effective without media coverage of our positions and programs on the national and community level. But these awards are not about us. The Fourth Estate Award winners are being recognized for outstanding works of journalism that not only stand far above normal media reporting, but have also resulted in outcomes that have positively impacted the lives of people and issues. These committed journalists have devoted long, hard hours into investigating, researching, writing and producing reports that have truly made a difference.
“I will be honored to present each of these deserving recipients with our highest recognition of journalistic accomplishment, The American Legion Fourth Estate Award, at our national convention in Minneapolis this summer,” Rohan said. “They are all credits to their occupation.”
Awards For ER Bill Denial Coverage
AJ and his KARE 11 team also received the regional Edward R. Murrow Award for the ER bill denial story. I am sure more are to come.
The TBI scandal resulted in AJ and his team winning numerous other awards including the top national award for investigative journalism and an Emmy.
That is one thing we do well here is exposing scandals through our relationship with AJ and other great video and print journalists around the country. Given the current failures to reform VA, I can only assume more stories are to come.
05/16/2018
Dear Benjamin Krause,
Congratulation on the baby Girl, I am glad you can have a family, it is the ultimate gift.
98,000 Thousand Veterans denied last year.
98,000 x 10 years is 980,000 or roughly 1 Million Veterans are denied urgent care in a decade.
Out of that One Million—how many of them did not survive?
Every year there are 55,000 serious VA cases on medication errors.
This does not include the fumbling in surgery or the other cases of wanton negligence after surgery.
Keep pushing on the VA—there is more to this “story.”
Sincerely,
Don Karg
Hey Ben, I have an even more BS scheme by VA and Choice. They arranged for me to go to outside hospital for surgery on my neck. There was a 7 in Titanium Brace put in my neck. All this was arranged by Choice and Carl Vinson VAMC. Well, for a stupid reason, they have refused to pay the $104,000 bill. The hospital charged my Medicare and now suing me for the balance. I have gone through that dept. that is supposed to handle these situations thought it was dealt with. Until last week I get a letter from collection agency. Now what the hell am I supposed to do? I am not a famous lawyer or famous anything for that matter. Just a Vet. drawing Pension and A&A benefits. Just wondering if you might have an idea. Thanks.
Thank You Ben for all of the Excellent work that you do. Also a big thank you to AJ Lagoe and Steve Eckert for all the Excellent work they do to help Veterans.
Personally I am not much on any VSO but it is good to see they can get it right sometimes with their awards. Which in this case was very much deserved.
I am grateful to dutiful Patriots like you and the publication that backed your story. It is frightening what the VA gets away with. We need to expose this madness.
Great job Mr. Krause???
Award, well deserved! Unfortunately, the platform for the story impacts us all.
I’m curious if any of the local Congress Critters took ANY opportunity to reach out.
Doubtful, as the constituants elected Frankin. (Sp)
Ben,
Can we get someone to do a story similar to the VA using unqualified providers for TBI – VA is allowing the Social Worker Department (SWD) to intentionally exclude a Veterans primary care team and has allowed the SWs to make medical determinations and perform primary care provider clinical responsibilities?
This is occurring nationwide.
That’s like the Witch Dr. outsourcing his patients to his outhouse hut for less-qualified zombie dust & chicken head on a stick! 😀
Good one, namnibor!
???
Ben-
This is happening down south. It’s so bad, when you go to the civ dr, the civ dr makes you sign a contract that says you the vet will pay all fees in the event VA doesn’t. They even do this for pre-approved Choice care.
The other part of this problem is the civ drs are greedy AF. They try to force the Vet into unnecessary medical procedures…. even procedures already done. The civ drs are part of why Choice is running dry.
I know Choice is a separate program, but it all connects. Anytime you go outside VA, on emergency or Choice you must sign contracts stating you the Vet will pay regardless. That means a lot of vets are getting screwed on Choice too. Why else would the drs try to force a contract on vets?
how do you go about getting the VA to pay for out of pocket treatment were the CHOICE system screwed up
Off Topic
@All interested in what Congress has recently done with Cerner and Choice.
As with all things Congress, know there is more to the “story”.
The article links have info that is important for all of us and the articles aren’t too long.
“https://www.congress.gov/bill/115th-congress/house-bill/4245/all-actions?overview=closed#tabs”
H.R.4245 – Veterans’ Electronic Health Record Modernization Oversight Act of 2017115th Congress (2017-2018)
“https://www.healthcareitnews.com/news/va-finalizes-telehealth-rule-let-providers-practice-across-state-lines”
VA finalizes telehealth rule to let providers practice across state lines
The final rule will override state laws to create a nationwide telehealth program to improve care access and reduce wait times for veterans.
By Jessica Davis May 11, 2018 11:52 AM
The U.S. Department of Veterans Affairs finalized its federal rule to allow providers to deliver patient care across state lines and outside of a VA facility using telemedicine. …
“https://www.healthcareitnews.com/news/house-passes-bills-improve-va-data-sharing-and-support-ehr-modernization”
House passes bills to improve VA data sharing and support EHR modernization
The bills, introduced by the Committee on Veterans Affairs, also give legislative authority for VA providers to practice telemedicine across state lines.
By Jessica Davis May 09, 2018 01:22 PM
The House Committee on Veterans Affairs passed two pieces of legislation on Tuesday that would both provide congressional oversight for the agency’s plans to replace its legacy VistA EHR with Cerner and bolster data sharing between the VA and community care providers. …
“https://www.healthcareitnews.com/news/revived-va-choice-bill-leans-telehealth-makes-community-care-program-permanent”
Revived VA Choice bill leans on telehealth, makes community care program permanent
The bill is a compromise from proposals made in the fall and would let veterans see a private sector provider if a VA provider agrees it’s in their best interest.
By Jessica Davis May 04, 2018 04:24 PM
The House Committee on Veterans Affairs introduced new VA Choice program reform legislation that would make the community choice program permanent and give VA healthcare providers the authority to practice telemedicine across state lines. …
Then you just have to get state laws up to speed. For example, NC has a law on the books forbidding script writing via telehealth. That’s great the feds are trying to fix it, but the states must fall in line too.
Congratulations to “Kare 11” and Mr. Ben Krause on receiving this award.
On the other side of the coin, as namnibor has so rightfully pointed out, When the Hell are the (outdated) VSO’s going to start doing their jobs FOR veterans?
Welcome to my world Ben. Due to my PTSD if any medical personnel would have come at me with a needle or wearing a Doctors coat, my body would react with one of two options, run or fight. And since I cant run due to 5 braces and walking with a cane, its the other object. And yes I actually have busted a jaw of a VA worker and was attempted to be banned from that VA until they read my file. In saying that the VA decided that maybe a power port in my chest would help ease my phobia about needles and such. After getting it put in at a cost of 10,000.00 the VA REFUSED to pay for it. And then spent the next year in fighting me for the heprin that I needed in trying to keep it clean (blood clogs and since this is hooked to a vein that goes to your heart, if a piece brakes off and floats to the heart, its a stroke, hence the need to clean it once a month) It was only after I contacted DC and threatened to go public with this while at my attorneys office did something happen. The head of the Hospital was demoted and reassigned, the head pharmacist was demoted, the patients rep was told to retire and the chief of staff was removed. The whole point is that neither I nor you should have had to do what we did to receive care. And if this changes things or starts to do so then more the better.
Geez Dan……They put a port in your chest, because you don’t like needles? Yikes man…
I can relate. This big burly man absolutely hates needles and needles raise my PTSD level incredibly because most cannot find my veins in the fourth stick…eek…double eek!
Reason this continues is there is no punishment for the improper denial. Ben should have received damages and interest/back pay and the “Senior Executives” who didn’t do the job correctly should be fired. A “Senior Executive” who doesn’t recognize a red flag when he sees it before it hits the press isn’t worth their salt.
Off-Topic but relevant because the VA has been talking about using “exposure therapy” as the cure-all for PTSD…
“Air Force base psychologist accused of sex abuse, rape ” (he was using exposure therapy…
“”https://www.msn.com/en-us/news/crime/air-force-base-psychologist-accused-of-sex-abuse-rape/ar-AAxizQr?ocid=ientp””
namnibor,
There is/was an article on “military.com” today or yesterday stating “Mad Dog Mattis” will have these types of allegations investigated (paraphrasing)!
Also, he said especially those types of allegations against children (again – paraphrasing)!
I can’t remember the exact title of the article! Only, from what I’ve read, he’s pissed!
All well and great as far as being recognized but I *must ask* this:
Instead of the American Legion handing-out awards, why don’t they and all other VSO’s actually do their jobs as true advocates for Veterans and we would not have investigative reporters such as AJ uncovering the scandals the American Legion, DAV, and all other VSO’s turn a blind eye to or are simply too ignorant to care?
I’m thinking we collective of Disabled Veterans and Veterans should be able to annually award the Sphincter Suction Award (SSA)…this annual award will be given to the VSO Group that sucks the VA’s ass the most profusely in order to screw-over anyone else close to the piggy trough.
Make no mistake about it: Sphincter Suction Award = VA Suck-Ass Award, are one and same. (special new funny hats are the awards….)
Well Ben you lucked out having someone in media actually do their job or help at all. Kudos to “KARE 11 News team of journalist AJ Lagoe and producer Steve Eckert.” I hope there is much more to come from them and others around the country. But expanding such journalistic professional concerns/reporting/ethics will be hard to find nation wide or in Indiana. Not going to happen in this state or college towns. Reporting truth, real news, various incidents, mass condemning the censoring and covering up by the VA, Feds, state gov to the local news arenas will be tougher to do as time goes by. Too damn late for my area.
“The American Legion has long recognized the essential role that the media play in contributing to a free society,” said Denise H. Rohan Yeah, right, “free society?” Shows how blind, totally out of touch, she is and out to follow the herd and boast about her merikan Legion that runs at the signs of corruption or harm done to vets in some states or nation wide as they must condone censoring us while spouting their usual garbage and facade of being complete do-gooders and loyalty to all vets. She sounds just like all the rest of them before her, and putting females in all these positions all over to appease special interest groups changes nothing but may increase harm done and all the covering up for appearance sake. She sure won’t make any difference in dealing with those important issues of the day like us being censored, local Legions refusal to get involved in local corrupt VA or ‘identity politics,’ or any of the retaliation some of us have to deal with as the legions and other VSOs claim their hands are tied due to politics and their ruling heads of command like her. And them never condemning local media for not reporting truths or real news that affect us all. Pretending all is well or about how “free” we are while playing PC politics n’ following the herds. Easy for her and others to say or think. She and others again show the big divide between those at the top and rubbing shoulders with the college crowds or elite, and those of us at the bottom rungs of the societal ladder, the expendables and to be ignored.
Two million Legionnaires, this blog, FB getting how many readers or those in the boasting VSO cliques… how much support or offers of help or exposing corruption and many wrongs have any of us received??? Will Rohan read the blog or get real in any way?? Ha.
Congratulations to Mr. Lagoe and the KARE 11 Team. And good for you that you continue to hold the VA’s feet to the fire on numerous subjects. In these troubled times, the Fourth Estate is really necessary to help the general populace in weathering the storm,
Big Storm about to happen in Hawaii. Seems Madame Pele is a wee bit ticked off at something lately, and is fixing to go on a Kilauea spree by blowing her top.
Looks like it is also going to be another Stormy week for our POTUS.
James I hope you and yours are far away from the heat. Take care over there. Pele is a wee bit ticked off… lol I’d reckon so. Darn foreigners ruined their culture and islands polluting the hell out of everything.
T – – – Far enough for immediate safety. Kilauea volcano bears 135 degrees 198.5 miles from my location. I now live in Kaneohe, on the North side of Oahu. Only thing immediately concerning is the prevailing winds – – – which are blowing the VOG up our way. Makes it hard for the wife who has 25% lung (on a good day) function. And of course, if Madame Pele REALLY blows – – – there does exist the possibility of some major earthquakes up the island chain.
Other than that, no worries. Still organizing and planning for our relocation to the mainland in a few months. Wife grew up here, so she is emotional about leaving her home. Me? Not at all. Been here far too long. Itchy Travel Feet Syndrome from too much military service. Feel tied down. Time to go . . .
Hope this finds you well.
James, different day same stuff here. Hanging in there, trudging on, still kicking, pressing forward.
Good to hear you’re away from the main blow, and been told/read that VOG is really really bad far reaching stuff to deal with. Yeah, I am a worry wart when it comes to people and their conditions. Hope your move goes as smooth as possible for you. G-day.
Good job Ben! Please take good care of yourself. You are a National Treasure and you know your way around this business. Thanks for all you do, and choosing the right agency to expose these scandals!!!