HealthNet pays $4,500 to Scope Orthotics but denies $1,800 previous claim

I just reported fraud, waste and abuse to Navex Global for HealthNet's payment to Scope Orthotics' April 2016 invoice for my medical lymphedema compression garments. Scope billed HealthNet $8,347.52 and HealthNet just paid them $4,507.66 after several denials, and we paid the $400 co-pay. HealthNet denied my Oct. 2015 claim for $1,800 for the same garments that I got after my out of pocket lymphedema surgery thanks to all my friends help. The garments all come from the same manufacturer and need to be replaced every 6 months. They denied my Oct. 2015 claim since I didn't go through my primary care physician and the vendor that they want me to use. So they are willing to pay $4,500 and not $1,800? Sounds like fraud, waste, and abuse to me and the system is rigged against the patients.