• viperfred 10/18/2008 5:25pm


    Date: October 17, 2008
    TO: Operator zz
    Confidential Material Enclosed

    FAX Number: 202 619 1381
    Subject: Medicare Abuse Trailbalzer and Palmetto

    From: Fred Kinder
    408 home
    408 cell
    408 office
    408 office fax

    Dear Operator 19,

    Thank you for taking time to listen to my concerns about Palmetto GBA and Trailblazer. I sincerely appreciate your help in this matter.

    These new Medicare providers, Trailblazer and Palmetto, have removed a treatment option (SBRT/CyberKnife) for prostate cancer that is one if not the very best and most cost effective. Medicare had covered treatment of prostate cancer by the CyberKnife but effective de. 15, 2008 that treatment option is no longer available in the Palmetto region. In June of 2008 Trailblazer removed SBRT/Cyberknife as a treatment option. The alternate external beam treatment (IMRT) will cost Medicare a %100 more than SBRT/CyberKnife. This will also increase the patients’ side effects, and reduce cure rates. IMRT requires 40 days of treatment the SBRTCyberKnife requires 5 days of treatment.

    In my opinion this is criminal. Their actions increase the cost to Medicare and lower the quality and may result in death due to failure of cure by IMRT.

    I have attached my letter to the Whitehouse to fight the decline in medical care while increasing cost.

    Best Regards,
    Page 11 (s)
    If you have any questions please feel free to contact me.

    October 13, 2008
    President George W. Bush
    The White House
    1600 Pennsylvania Avenue NW
    Washington, DC 20500

    Dear Mr. President,

    I am very concerned about the economic crisis.

    It seems criminal for a Medicare service provider to eliminate a cancer treatment option that would same the country tens of millions of dollars and benefit cancer patients at the same time. Medicare providers Palmetto in California and Trailblazer (TX, OK, CO and NM) are increasing Medicare cost and providing lower quality medical care. Both have eliminated stereotactic body radiation therapy (SBRT)/CyberKnife coverage for prostate cancer treatment. The previous Medicare providers covered SBRT for prostate cancer. The alternative external beam treatment, IMRI, will double the cost to Medicare and increase the cost for patient’s transportation and lodging (if required) by 800%. Trailblazer stopped paying for prostate cancer treatment with SBRT June 13, 2008. Effective Dec. 15, 2008 Palmetto will stop treatment of prostate cancer and cancer of the pancreas.

    Patients should be entitled to have a say in selecting the best treatment for their best quality of life and most important their life. This should be a fundamental right.

    Please consider the actions of these Medicare providers and take corrective action to save millions of dollars and improve medical treatment for cancer patients. In my opinion both of these providers should have their contracts suspended for cause.

    My e-mail below to Daniel R. Levinson, Inspector General has the details for the specifics in California.

    Please feel free to have a staff member contact me at any time.

    Best Regards,

    Saratoga CA 95070

    Date: Sun, 12 Oct 2008 20:43:44 -0700
    From: Fred Kinder <>
    Subject: Medicare Abuse by Palmetto Government Benefits Administrators (GBA) /California
    Cc: Senator Barbara Boxer, Senator Dianne Feinstein, Senator Hillary Rodham Clinton, KPIX Craig Franklin
    Bcc: Accuray Susan Thompson, Accuracy Catherine_Bonetti, Accuray Debra Mills, Accuray Jim English, Doctor Adler, Doctor Clinton_Medbery, Doctor LaNasa_Peter, Dr. Alan Katz, Dr. D. Fuller, Dr. King Stanford, Dr. Spunberg

    Office of the Inspector General
    HHS TIPS Hotline
    P.O. Box 23489
    Washington, DC 20026
    Mr. Daniel R. Levinson

    Dear Mr. Levinson, Inspector General

    California Medicare provider Palmetto Government Benefits Administrators (GBA) just re-released their policy guide lines for cancer treatment by stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) in draft form. Palmetto is removing a cancer treatment by SRS/SBRT/CyberKnife for the Prostate and Pancreas. This will result in higher cost to Medicare, higher cancer failure rates adding to patient suffering and additional treatment (adding cost), higher incidence of side effects reducing the quality of life for patients. This treatment was covered by the previous Medicare administrator. Why would, SRS/SBRT, the best External Beam (EB) radiation treatment for prostate cancer be removed? The new policy now covers an External Beam radiation option (IMRT) that cost a 100% more than SRS/SBRT , has increased side effects and a lower cancer cure rate. Why? Also consider the Palmetto EB option (IMRT) requires 40 days of treatment. The SRS/SBRT by CyberKnife requires 5 days of treatment. The cost of patient travel and inconvenience is 800% higher as the result of the irresponsible actions of Palmetto.

    Palmetto was provided medical evidence by experts in the field (see attachment) for reconsideration before they re-released their policy changes. Their final comment period runs from Oct 30 thru Dec 15, 2008.

    The Center for Medicare and Medicaid (CMS) mission statement is as follows:

    CMS’ mission is to ensure health care security for its beneficiaries. A major component in achieving this mission is the successful administration of Original Medicare, or Fee-for-Service (FFS) Medicare. Medicare Contracting Reform (or section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) is a major component in achieving this mission. Section 911 mandates that the Secretary for Health & Human Services replace the current contracting authority to administer the Medicare Part A and Part B FFS programs, contained under Sections 1816 and 1842 of the Social Security Act, with the new Medicare
    Administrative Contractor authority. Through the implementation of Medicare Contracting Reform, CMS will establish a premier health plan that allows for comprehensive, quality care and world-class beneficiary and provider service.

    In summary the Palmetto changes are not in compliance with CMS Medicare Reform. World-class treatment for early state prostate cancer is SRS/SBRT. Their changes will also cost Medicare additional millions of dollars and reduce the patient’s quality of life. Patients should be entitled to have a say in selecting the best treatment for their best quality of life and most important their life. This should be a fundamental right. In my opinion Palmetto is acting as a Doctor (do they have a license to practice medicine?) for Medicare patients. If they are, then their actions are in violation of the Hippocratic Oath. Is Palmetto acting as a Doctor?

    As a result of my personal fight with Blue Shield of California for prostate cancer treatment by the CyberKnife I have become a prostate cancer advocate for research, education, screening and treatment. The story with Blue Shield can be viewed at the following CBS link . FYI, Blue Shield of California added the CyberKnife as a treatment option for prostate cancer July of 2008,

    Please enforce the CMS policies on Palmetto so they can not remove SRS/SBRT as a cancer treatment option for prostate and pancreas cancer.

    Contact me if you have any questions.

    Best Regards,

    Saratoga, CA 95070
    Cell 408

    CyberKnife Robotic Radiosurgery as Definitive Treatment for Prostate Cancer:
    May 15, 2008
    Donald B. Fuller, M.D. Iris C. Gibbs, M.D.
    Radiation Oncologist Radiation Oncologist
    CyberKnife Centers of San Diego Stanford Cancer Center
    Radiation Medical Group 875 Blake Wilbur Dr.
    2466 First Ave, Stanford, CA 94305-5847
    San Diego, CA 92101
    Christopher R. King, M.D., Ph.D. Douglas S. Wong, M.D., Ph. D.
    Radiation Oncologist Radiation Oncologist
    Stanford Cancer Center California Cancer Center
    875 Blake Wilbur Dr. CC-G213 Dept. of Radiation Oncology
    Stanford, CA 94305-5847 7257 N. Fresno St.
    Fresno, CA 93720-2950
    Collectively we represent a group of ABR Board Certified Radiation Oncologists with
    expertise and extensive experience in 3DCRT, IMRT, IGRT, HDR Brachytherapy, 125I
    permanent source brachytherapy, 103Pd permanent source brachytherapy and 131Cs
    permanent source brachytherapy. We have prepared this document in support of
    CyberKnife robotic radiosurgery as definitive prostate cancer treatment. Although the
    evidence may be regarded by some as preliminary, it is our opinion that robotic
    radiosurgery is likely to be at least as safe and effective as any other radiation method in
    the treatment of this disease. To avoid coverage confusion, it should be regarded as an
    improvement to an existing modality (radiotherapy) rather than classified as a completely
    new intervention. Our reasons for recommending robotic radiosurgery include the
    1. FDA approval
    a. In 2001, the FDA cleared the CyberKnife device for use throughout the
    body, wherever therapeutic radiation is indicated. This makes perfect
    sense, as CyberKnife robotic radiosurgery simply represents a very precise
    and powerful method of ionizing radiation delivery. The FDA 510(k)
    clearance was based on use of Varian’s Clinac as the predicate device.
    2. Medicare Coverage
    a. In 2003, CMS recognized stereotactic radiosurgery as inclusive of prostate
    cancer. To quote the CMS Manual System Department of Health &
    Human Services (DHHS), Pub. 100-20 One-Time Notification Centers for
    Medicare & Medicaid Services (CMS), Transmittal 32 Date: DECEMBER
    19, 2003, CHANGE REQUEST 3007, I, B, 4. Billing for Stereotactic
    “Stereotactic radiosurgery (SRS) is a form of radiation therapy for
    treating abnormalities, functional disorders, and tumors of the brain

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