Sunday, August 30, 2009

How states pull the wool over the feds' eyes

The following string of excerpts from federal and Michigan audits and evaluations is a working example of Medicaid Fraud in Child Welfare:

"Michigan staff, both at the Central Office and county level, did an excellent job of preparing for the review. Records were extremely well organized with necessary documentation of eligibility requirement readily located. The State provided a “reviewer friendly” environment for the review to take place. Of note was the willingness and untiring efforts made by the Program Office in leading this effort. DHS licensing and field staff, in partnership with personnel from the SCAO and the Wayne County Department of Children and Family Services, were most efficient in obtaining additional information or acting as resources during the onsite review. Additionally, DHS’ fiscal unit is recognized for the thorough and updated payment histories.

Michigan staff actively and enthusiastically participated in reviewing the cases.

(That's because they successfully covered up the Medicaid Fraud.)

Exemplary is the collaborative relationship between DHS and the State Court. This was evident not only in the presence of either the current or former Chief Justices of the Supreme Court at the entrance or exit conference, but also in the excellent quality of court orders observed during the review. In particular, the involvement of SCAO is noted for conveying title IV-E requirements to the court, instituting revisions to court orders and garnering greater consistency in the use of those revisions among the county courts. The ongoing collaboration between DHS and SCAO is a strong mechanism to foster an understanding of the need for and timely occurrence of appropriate and meaningful judicial determinations for children within both the child welfare and legal communities."
U.S. Department of Health and Human Services, Administration for Children and Families, Michigan Title IV-E Foster Care, Secondary Eligibility Review, April 1, 2006 through September 30, 2006, Conducted the week of March 26 through 29, 2007

“The state averted the loss of nearly $40 million in child welfare funding, thanks in part to the work of judicial branch staff.”

Clifford W. Taylor, Michigan Supreme Court Chief Justice, Annual Report 2007

“If DHS did not improve, it faced a possible penalty of $22 million”…. “The U.S. Department of Health and Human Services conducted the second eligibility review of DHS’s case files for foster care maintenance payments issued between April 1, 2006 and September 30, 2006. Prior to the review, DHS conducted an extensive case file review to identify cases that did not meet Foster Care: Title IV-E Program eligibility requirements. For cases that DHS determined did not meet the Foster Care: Title IV-E Program eligibility requirements, DHS changed the funding source on the cases to a funding source other than Foster Care: Title IV-E Program before April 1, 2006… As a result, those cases were not in the population reviewed during the federal review…The federal review concluded that DHS was in substantial compliance with federal eligibility requirements for the period April 1, 2006 through September 30, 2006.

We issued a qualified opinion on the Foster Care: Title IV-E Program. Our conclusion is different from the federal review because our sample included cases from the entire audit period.

Michigan Auditor General, 2007


During the (Michigan) onsite review, (federal) reviewers determined that criminal background checks were in evidence for all foster home files that were examined. In instances where children were placed in child caring institutions, reviewers determined that law enforcement checks had been done on administrators. Particularly noteworthy is Michigan’s practice of screening all licensed foster homes against its child abuse register on a weekly basis.

U.S. Department of Health and Human Services, Administration for Children and Families, Michigan Title IV-E Foster Care, Secondary Eligibility Review, April 1, 2006 through September 30, 2006, Conducted the week of March 26 through 29, 2007

DHS had not developed a formal policy that defined when and for what service types criminal background checks and educational qualifications should be required as a part of a human service contract (includes foster care).

Michigan Office of the Auditor General, Performance Audit of Human Service Contracting, Department of Human Services, April 2008, Report No.: 431-0110-05

Saturday, August 29, 2009

A Round of Applause for Detroit H.E.A.T.

Ladies and Gentlemen,

Let's stand up and give a round of applause to our new friends at the U.S. Department of Health and Human Services Office of Inspector General and the U.S. Department of Justice Attorney General for catching a Medicare Fraudfeasor!

This same, exact scheme is a mirror image of what is done in Medicaid. Instead of the area of physical therapy, you have it in foster care and adoption because children do not sign nor review the documents, and, parents are not privileged to even know what is going on with their own children.

Free reign on fraud, straight-up bilking tax dollars. No accountability, no transparency, no oversight.

Here is a real life example. I know because I talked to the people who were actually doing it, and I have the documents to prove it. And yes, the documents are cyber-filed protected.

In Wayne County, Michigan, there are no bids on state child placing agency (CPA) contracts. These 5 agencies provide services to abused and neglected children. Each year, the big 5 CPAs submit letters of renewal, that include an increase in the contractual fees.

Then, the big 5 submit billing to Wayne County for certain services provided to children. There is no human way possible to verify if the services were actually rendered. It is relatively economically impossible to even go through each and every billing statement to even see if the clients meet eligibility criteria. Here is an example:

In Wayne County foster care, they will use referrals to the Juvenile Assessment Center for adults. Yes, that is correct, adults. The majority of the time the services rendered to these "adults" are only on paper, the same paper that is submitted for billing reimbursements.

Then in Wayne County, you have employment services for children. Yes, employment services for children, where the county will conduct employment background checks to make sure these children are eligible for employment, sometimes 5 days a week. I would reveal who the check was made out to, but I do value my life.

But the fraud in foster care only gets better.

In Wayne County you have what is called the Will Smith/Bill Smith billing system. Basically, a child is taken into foster care and billed as a foster care child. Then, with a cut and a paste of the same Social Security number, Will becomes Bill, who is now a juvenile delinquent. And there you have it, double-billing.

Yes, there is a legitimate form of double-billing called "dual jackets". This is when a child is in one system and needs services from the other but a review of the records will show that the name remains the same.

I will be providing the Medicaid Fraud Strike Force with as much instruction as possible to assist in the detection, identification, and recovery. I want Michigan to be the model state.

I will also be coming out soon with my book to better understand how the industry functions.

Until then, bravissimo H.E.A.T., encore!

Department of Justice Press Release

For Immediate Release
August 26, 2009 United States Attorney's Office
Eastern District of Michigan
Contact: (313) 226-9100

Detroit Area Physical Therapist Pleads Guilty to Causing More Than $1.6 Million in Fraudulent Medicare Billing

Detroit area physical therapist Jay Jha, 45, pleaded guilty today to participating in a conspiracy to defraud the Medicare program of approximately $18.3 million. Jha, of Troy, Mich., pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Gerald Rosen. At sentencing, scheduled for Dec. 16, 2009, Jha faces a maximum penalty of 10 years in prison and a $250,000 fine.

According to information contained in plea documents, Jha, a physical therapist licensed in the state of Michigan, began working in approximately February 2003 as a contract therapist for a co-conspirator. The co-conspirator owned and controlled several companies operating in the Detroit area that purported to provide physical and occupational therapy services to Medicare beneficiaries. Jha admitted that he, the co-conspirator, and others created fictitious therapy files appearing to document physical and occupational therapy services provided to Medicare beneficiaries, when in fact no such services had been provided. According to court documents, the fictitious services reflected in the files were billed to Medicare through sham Medicare providers controlled by co-conspirators.

In order to create the fictitious therapy files, Jha acknowledged that his co-conspirators paid cash kickbacks and other inducements to Medicare beneficiaries, in exchange for the beneficiaries’ Medicare numbers and signatures on documents falsely indicating that they had received physical or occupational therapy. Jha admitted that he was one of the licensed physical or occupational therapists from whom the co-conspirator obtained signatures on fictitious "progress notes" and other documents in the therapy files, falsely indicating that the therapists had provided therapy services to the Medicare beneficiaries on those dates.

During the course of the scheme, Jha admitted he signed approximately 336 fictitious physical therapy files indicating that he had provided physical therapy services to Medicare beneficiaries, when in fact he had not. Jha admitted that he was paid between $90 and $110 for each file that he falsified. Between approximately February 2003 and December 2005, Jha admitted that he falsified physical therapy files that supported claims to the Medicare program totaling approximately $1,680,000. Medicare actually paid approximately $772,800 on those claims. Jha admitted that, throughout the conspiracy, he was fully aware that Medicare was being billed for physical therapy services that he falsely indicated he had performed.

The case is being prosecuted by Trial Attorneys John K. Neal and Benjamin D. Singer of the Criminal Division’s Fraud Section and by Special Assistant U.S. Attorney Thomas W. Beimers of the Eastern District of Michigan. The FBI and the HHS Office of Inspector General (HHS-OIG) conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.

Since the inception of Strike Force operations in March 2007—Miami (Phase One), Los Angeles (Phase Two), Detroit (Phase Three), and Houston (Phase Four)—the Strike Force has obtained indictments of more than 293 individuals and organizations that collectively have billed the Medicare program for more than $680 million. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Each of the Strike Force teams across the separate phases are led by a federal prosecutor from the Criminal Division’s Fraud Section or the U.S. Attorney’s Office. Each team has an agent from the FBI and HHS-OIG.

To learn more about the HEAT team, go to:

Friday, August 28, 2009

From the ashes of education comes cyber-learning

Published in the August 28, 2009

In the wake of declining enrollment, possible bankruptcy, and the worst high school drop-out rates in the nation, Detroit Public Schools, along with rest of the nation’s public school systems, educators and lawmakers are in for a rude awakening: the factory school model of education has died.

What has arisen from the ashes is Westwood Cyber High School of Westwood Community Schools of Dearborn Heights, Michigan.

The visionary pioneer of this cyber-learning inititative is Executive Director, Glen Taylor, who has proudly partnered with Inclusion Trust out of the United Kindgdom. The U.K. “Not School” program, a 100% virtual learning experience, has been operational for about 9 years with a 97% completion rate.

The Inclusion Trust of the U.K. works directly with Westwood Cyber High School, the only project-based learning online in the United States. Inclusion Trust has formed other partnerships in Ireland, Sweden, and Australia, to name a few, demonstrating a successful alternative to traditional education in the Not School program.

Inclusion Trust came twice, the last time in July 2009, to Westwood Cyber High School to train staff on how to execute the duties and responsibilities of being research mentors. The Cyber High School was originally slated to have Westwood Cyber High Schools implemented the Models of Demonstration Proficiency format in February 2009. The format is a learning effect to standard, meaning the rubrics are tailored to the learning agenda and measurement expectations to the State of Michigan educational high school requirements.

Originally targeted for a goal of 182 students with its current retention rate at 93%, expansion to capacity of 540 was authorized by the state. Staff of Westwood Cyber recently traveled to the U.K. for enhanced training to transpose the model to an increased researcher population of 1,000, authorized by the state waivers under Title I funding by the State Director of Instructional Technology, Barb Fardel (email: and Bruce Umpsted (email:

There are no students because they are considered “researchers”, as stipulated by Technology Mentor, Wanda Hudson. Each researcher is given projects to be completed. Projects range from generating newletters to film production. The most innovative part of the learning experience is that the research managers, referred to as Mentors (as there are no teachers in the Not School) work directly with each researcher. The mentor, then, integrates mathematics, economics, physics, history and the rest of the social and physical sciences into each research project (as there is no homework in the Not School) for the researcher to present for publication.

It is quite expected that one will ask how this is all funded and how all this technological teaching can be achieved during the academic school year.

You have to remember, this is Not School, meaning, the research year is all year long, 24 hours a day. Researchers work at their own pace, finding their optimal time to complete each research project at home. According to the U.K. program description, the Not School is crafted for youth who disengaged with traditional learning because of illness or phobia, pregnancy, bullying or disaffection, travelling, reluctance to learn, exclusion, or in care. These descriptives fall under the classification of “at-risk” youth, the target population of Westwood Cyber High School.

A unique component to the Not School format is that the research mentors have designed a system of encouragement to keep the researchers on task by having them log on everyday, and even come to the home when there is a need for greater assistance in research and personal management of their lives.

Researchers are provided the tools of IMac desktop 20 inch screen computers, HP Digital Camera, and HP 5-in-1 printer to document work offline, as expected to do, and to put online. Once the researchers have completed their first 12-month cycle of research, the “researching tools” are given to the research to personally own.

One component, I believe, that has yet to be explored is the fact that the Westwood Cyber High School has chosen keywords to describe their target population, meaning “at-risk” youth. This label of “at-risk” youth has traditionally been applied with the negative connotations of foster care, better known as a ward of the state, but now, at with Director Glen Taylor at the helm of this educational phoenix, these “at-risk” youth are greatly prepared for college, not just because they own state-of-the-art computer equipment, or the idea that they have mastered technological abilities to achieve a college degree, but for the simple idea that these “at-risk” youth may qualify for expanded opportunities for grants and scholarships.

The benefits of this social and technological learning greatly outweigh the sunken costs of the factory school model. Faith in the future potential of our children in the Detroit Metropolitan Area has reemerged through the reimagining of education through Westwood Cyber High Schools.

It’s time our leaders listen to our children.

For more information, contact:

Westwood Cyber High School, 3335 South Beech Daly Road, Dearborn Heights, MI 48125.

Phone: 313-565-0288, or email:


Sunday, August 16, 2009

How To Catch A Medicaid Fraudfeasor: A Primer

As those of you loyal followers who may already know, and for those who wish to learn,
The U.S. Department of Health and Human Services Office of Inspector General (DHHS OIG) in partnership with the U.S. Department of Justice Attorney General (DOJ AG) has created the Health Care Fraud Enforcement Task Force (H.E.A.T.) to stop Medicare and Medicaid Fraud.

The purpose of H.E.A.T. is to end the annual billions of dollars in fraud, waste and abuse of taxpayer dollars, because, obviously, the states Medicaid Fraud Control Units just were not doing what they were suppose to be doing, and that is stopping Medicare and Medicaid Fraud.

In addition, it seems that the DHHS OIG and the DOJ AG have publicly confessed, with its creation of H.E.A.T., to have been snoring and drooling at the helm as the overseeing admirals of the states Medicaid Fraud Control Units.

But now, since the act of contrition, we need to move forward and get these Strike Forces up and operating, quickly!

Below, is the precursor of my primer on "How To Catch a Medicaid Fraudfeasor."
(Fraudfeasor means simply, "One who commits fraud.")

The following is taken directly from the National Association of Medicaid Fraud Control Units Frequently Asked Questions:

1. What is a Medicaid Fraud Control Unit?

A Medicaid Fraud Control Unit (“Unit” or “MFCU”) is a single identifiable entity of state government, annually certified by the Secretary of the U.S. Department of Health and Human Services. The Unit has either statewide criminal prosecution authority or formal procedures for referring cases to local prosecutorial authorities with respect to the detection, investigation and prosecution of suspected criminal violations of the Medicaid program. See 42 U.S.C. §1396b(q). There are 50 state MFCUs. 43 are currently located in the office of the state Attorney General. Connecticut, D.C., Georgia, Illinois, Iowa, Tennessee and West Virginia have Units which are in other departments of state government. North Dakota received a waiver from the federal government and does not have a Unit.

Since I enjoy using Michigan as my case study, let us begin to examine the deficiencies in this description.

Michigan has a Medicaid Fraud Unit located in the Office of Attorney General, Child and Family Services Bureau, called the Health Care Fraud Division. The duties and responsibilities are to the Department of Human Services through "Medicaid fraud and patient abuse investigations, prosecutions, civil Medicaid recoveries, and vulnerable adult matters."

What is wrong with this picture? The Health Care Fraud Division does not touch "child matters." So, why is this?

Well, the proper response is that the Michigan Office of Attorney General does deal with "child matters." As a matter of fact, there is an entire division dedicated to "child matters" called the Children and Youth Services Division. Oddly enough, the Division only deals with child matters in Wayne County by making the county the only one in the state whereby the Attorney General prosecutes child abuse and neglect matters.

So, how is it that the Attorney General can investigate fraud and protect vulnerable children when the Attorney General is the one advocating for the ones who are the fraudfeasors?

The answer may not be a clear as one would imagine.

At first glance, you see an inherent conflict of interest; this being the Attorney General would have to investigate and advocate, prosecute and defend, or basically, snitch on himself. This is only the first layer.

The next layer is a question of an independent and autonomous authority to investigate and refer Medicaid Fraud for prosecution and recovery. This would be the co-location of authority of the Office of Children's Ombudsman (OCO). The office is, or was, situated in the Department of Management of Budget. Targeted Case Management is a Medicaid funded program for foster care, adoption and juvenile justice. The OCO has the formal authority, through statute and autonomy, to investigate complaints dealing with children in these Medicaid programs, and to make referrals to the counties prosecutors or Attorney General when Medicaid Fraud is suspected. OCO has never made one referral of suspected Medicaid Fraud for prosecution and recovery.

Unfortunately, the DHHS Secretary has certified Michigan's Medicaid Fraud Unit, even though its functions of controlling Medicaid Fraud in child welfare programs are non-existent.

2. Must each state have a MFCU?

Under federal law, each state must have a Unit unless the state demonstrates to the satisfaction of the Secretary of the Department of Health and Human Services that a Unit would not be cost effective because minimal fraud exists in the state's Medicaid program and Medicaid beneficiaries will be protected from abuse and neglect.

3. What is the jurisdiction of a MFCU?

A Unit's function is to conduct a statewide program for the investigation and prosecution of health care providers who defraud the Medicaid program. In addition, a Unit reviews complaints of abuse or neglect against patients in health care facilities receiving Medicaid funding and may review complaints of the misappropriation of patients' private funds in these facilities. The Unit is also charged with investigating fraud in the administration of the Medicaid program. The Ticket to Work and Work Incentives Improvement Act of 1999 authorizes the Units, with the approval of the Inspector General of the relevant federal agency, to investigate fraud in other federally-funded health care programs, if the case is primarily related to Medicaid. This section also authorizes the Units, on an optional basis, to investigate and prosecute resident abuse or neglect in non-Medicaid board and care facilities.

In Michigan, investigations of child resident abuse or neglect falls under the jurisdiction of the Department of Human Services (DHS), the same entity that is procures contracts of residential programs. The Bureau of Children and Adult Licensing (f.k.a. Office of Children and Adult Licensing and was located, independenty, in the Department of Energy, Labor and Growth) has the statutory authority to investigate and protect vulnerable children in receiving care from a licensed facility, particularly under the auspices of the state. This small group of investigators generate findings reports, but are not obligated to refer suspected and substantiated matters of Medicaid Fraud to any law enforcement authority.

4. How are MFCUs funded?

MFCUs receive annual grants (Federal Financial Participation or "FFP") from the U.S. Department of Health and Human Services. Grant amounts must be matched with state funding. Initially, a Unit receives federal funding at a 90 percent level. After its first three years, the FFP is reduced to 75 percent.

The FFP is reduced because the states MFCU are to become sustainable in the prosecution and recovery of Medicaid Fraud. Michigan has finally effectuated (rather semi-effective because there is very little civil incentive for individual referrals of Medicaid Fraud) and enhanced Medicaid False Claims Act. The point of this being the state will aggressively target and capture the recovery funds of Medicaid Fraud. By doing so, the state is allowed to recovery %10 of the FFP.

Alas, in the realms of child welfare, this has never been done.

5. What are the limitations on federal financial participation?

Federal financial participation is authorized for full-time attorneys, investigators and auditors involved in the investigation and prosecution of matters within the jurisdiction of a Unit. Full-time employees are required to be hired to perform full-time duty intended to last at least a year. Federal grant money may also be used for part-time support staff but only to the extent that these part-time employees participate in work activities that further the jurisdictional duties of the Unit. Finally, FFP is available to the Unit's parent agency to cover all indirect costs associated with the operation of the Unit.

Here is a really fun little item: "If the OCO is the co-location of authority to investigate Medicaid Fraud, matters well within the jurisdiction of the Medicaid Fraud Unit, and it never refers suspected and/or substantiated Medicaid Fraud, is FFP being used, and if it is, is being used to cover the state share of the percentage formula?

6. What are MFCU minimal staffing levels?

A Unit is intended to operate using a "strike force" concept of investigators, auditors and attorneys working together full-time to develop Medicaid fraud investigations and prosecutions. The staff of the Unit must include attorneys experienced in the investigation and prosecution of civil fraud or criminal cases, auditors capable of supervising the review of financial records, and investigators with substantial experience in commercial or financial investigations. If a Unit lacks direct prosecutorial authority, it must have a formalized procedure in place for referring cases to the appropriate prosecutorial authority.

Due to the fact that Michigan Medicaid Fraud Unit has never engaged in "strike force" operations, especially in child welfare, H.E.A.T. has stepped up to the plate.

7. What is the extent of federal oversight over a MFCU?

Each Unit operates under the administrative oversight of the Inspector General of the U.S. Department of Health and Human Services and must be recertified annually. As part of the recertification process, the Inspector General reviews a Unit's application for recertification and may conduct on-site visits. Additionally, the MFCUs are required to submit annual reports to the Inspector General. These reports include specific statistical data required by federal legislation on the number and type of cases under investigation, the number of convictions obtained and the number of dollar recoveries to the Medicaid program. The day-to-day supervision of a Unit rests with the parent agency.

8. How do Medicaid fraud cases typically arise?

While specifics may vary from state to state, a primary source of referrals is the agency responsible for auditing and reviewing Medicaid provider claims, the Medicaid agency. Other significant sources of referrals are the MFCUs in other states as well as other law enforcement agencies.

In Michigan, there are multiple "co-locations" to make primary referrals, but nobody does it. The investigative reports fade into the shadows of internet archives, and rather quickly, I must say!

This is one of my favorite examples of the non-existence of referrals in Michigan:

Michigan Office of the Auditor General, Audit Report, Financial Audit Including the Provisions of the Single Audit Act of the Department of Human Services, October 1, 2004 through September 30, 2006, Report #: 431-0100-07, (Pages 101-102). Thomas H. McTavish, C.P.A., Auditor General. (Released August 2007).

“DHS is primarily responsible for the expenditure of Foster Care: Title IV-E Program funds.

DHS has a contract with Wayne County to provide funding to Wayne County for eligible juvenile justice children. DHS considers Wayne County to be a subrecipient.

In order to be reimbursed, Wayne County submits a billing, which lists the Wayne County juvenile justice children for whom they are requesting reimbursement. DHS does not verify the eligibility of the children for whom they are paying. We were informed by DHS that the documentation would be retained by Wayne County because it was Wayne County that was responsible for continued eligibility determination. However, in our discussions with Wayne County, we were informed that it was DHS who was responsible for the continued eligibility determinations. The contract between Wayne County and DHS was silent on who was responsible for the continued determination.

As the grantor of the federal funds, OMB Circular A-133 requires DHS to monitor the program to ensure that the funds are expended for only eligible children. Because of the lack of understanding between the two parties and the lack of documentation for the items we reviewed, we have questioned all of the amounts provided to Wayne County for the two years ended September 30, 2006.” (Emphasis added)

The Audit Report continues to say in part:

“If DHS did not improve, it faced a possible penalty of $22 million”…. “The U.S. Department of Health and Human Services conducted the second eligibility review of DHS’s case files for foster care maintenance payments issued between April 1, 2006 and September 30, 2006. Prior to the review, DHS conducted an extensive case file review to identify cases that did not meet Foster Care: Title IV-E Program eligibility requirements. For cases that DHS determined did not meet the Foster Care: Title IV-E Program eligibility requirements, DHS changed the funding source on the cases to a funding source other than Foster Care: Title IV-E Program before April 1, 2006… As a result, those cases were not in the population reviewed during the federal review…The federal review concluded that DHS was in substantial compliance with federal eligibility requirements for the period April 1, 2006 through September 30, 2006.

We issued a qualified opinion on the Foster Care: Title IV-E Program. Our conclusion is different from the federal review because our sample included cases from the entire audit period.


We also recommend that DHS improve its internal control to ensure compliance with federal laws and regulations regarding subrecipient monitoring.”


9. How do the multi-state/federal global settlements arise and how are they handled?

Medicaid fraud global settlements generally arise in connection with a U.S. Department of Justice investigation against a Medicare provider. When resolving these Medicare cases, the federal government, often at the request of defense counsel, turns to the state MFCUs because it cannot settle the Medicaid portion of the case without the Units. Moreover, defense attorneys are unlikely to settle the case without the affected states because each state has the authority to exclude a convicted provider from its health care programs. The Department of Justice typically contacts the National Association of Medicaid Fraud Control Units about a potential settlement, and the President of the Association appoints a settlement team which usually consists of three to four members.

Michigan has no exclusionary database because Medicaid Fraud in child welfare programming is never referred for prosecution. In the Michigan Auditor General Annual Report 2008, the imperative was revisited for a fourth time, for Department of Human Services to engage in contractual debarment and assessing sanctions for questionable and improper payments, and lack of internal controls.

10. What federal consequences follow a felony conviction for Medicaid fraud?

Under federal regulations, providers who are convicted of a program related offense are excluded for a minimum of five years from receiving funds from any federally funded health care program, either as a health care provider or employee. Often, this sanction has a greater impact on the convicted individual and the provider community at large than the criminal penalties assessed in the case.

The world eagerly awaits the first felony conviction in Michigan.

11. What is the National Association of Medicaid Fraud Control Units (NAMFCU)?

The National Association of Medicaid Fraud Control Units (NAMFCU) was founded in 1978 to provide a forum for a nationwide sharing of information concerning the problems of Medicaid fraud, to improve the quality of Medicaid prosecutions by conducting training programs, to provide technical assistance to Association members and to provide the public with information about the MFCU program. All 50 MFCUs are members of the Association. NAMFCU is headquartered in Washington, D.C. and is staffed by a Counsel, an Association Administrator and a part-time Association Assistant.

Here is my take on the National Association of Medicaid Fraud Control Units:


I submit that NAMFCU needs to be put on the H.E.A.T. "laundry list."

Saturday, August 8, 2009

Universal Health Care: Providing For The Common Defense and General Welfare

The issues surrounding unruly town hall meetings and angry mobs were addressed over 200 years ago in the Federalist Papers, specifically #9, Hamilton and #10 Madison.

Hamilton #9: The utility of a Confederacy, as well to suppress faction and to guard the internal tranquillity of States, as to increase their external force and security, is in reality not a new idea. It has been practiced upon in different countries and ages, and has received the sanction of the most approved writers on the subject of politics.

What Hamilton basically says is that an insurgent faction disrupts consolidation and consensus of groups, better known as a republic. This idea was expounded and refined in Madison #10.

Madison identified the "inner tranquility" of the consolidation and consensus of groups as the "majority". He further spoke of the futility of non-peaceful protests as they disregarded established legislative processes, having elected government representatives.

"Men of factious tempers, of local prejudices, or of sinister designs, may, by intrigue, by corruption, or by other means, first obtain the suffrages, and then betray the interests, of the people."

Historically, civil disobedience only works when functioning under the policy of peace. These protests are not peaceful in language or activities, an early presentation of failure of the insurgence.

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise therof; or abridging the freedom of speech, or the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.The Bill of Rights: First Amendment

The key word is "peace". Once this tenet of the First Amendment is violated, peace, the government is empowered to protect the people, pursuant to the General Welfare Clause in the U.S. Constitution. The following is an excerpt of Article I, Section 8 of the Constitution of the United States, called the General Welfare Clause:

The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;

To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;

To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;

Violence, be it verbal, economic, emotional or physical, becomes grounds for government intervention, or rather the calling of the police to maintain the peace. When this happens you have an insurrection, pursuant to the General Welfare Clause. Under this light, health care as commerce, or rather Universal Health Care, is seen as a "provision for the common defense social disease, meaning maintainability of individual and social health, becoming interchangeable with the temporal terminology of General Welfare.

Quintessentially, Universal Health Care is one in the same with the Common Defense and General Welfare of the people of the United States of America. Here is a visual model for greater understanding:

Universal = Common

Health = Defense

Care = General Welfare

There is a lack of organization and understanding, as the insurrections constantly demonstrate a significant failure in mastering a rudimentary education of the social mobilization.


Thursday, August 6, 2009

Drugging Children

Someone recently asked me about Autism in the Metro Area:

The MMR vaccine has never contained mercury and the phrase “The Autism Vaccine” is an example of the lack of sophistication of the American education.

What you are referring to is what is called Thiomersal (INN) (C9H9HgNaO2S), or sodium ethylmercurithiosalicylate, commonly known in the United States as thimerosal, is an organomercury compound (approximately 49% mercury by weight) used as an antiseptic and antifungal agent.

It was invented and patented by Morris Kharasch. Eli Lilly labeled it the trade name Merthiolate. As a preservative in vaccines, immunoglobulin preparations, skin test antigens, antivenins, ophthalmic and nasal products, and tattoo inks, it has been found to be the most cost-effective preservative.

In the later part of the 1990s, the World Health Organization called upon the United States to reign in on its pharmaceutical rule of medical distribution in its usage of Thimerosal as it was demonstrating severe cognitive and psychological disorders in youths who were vaccinated.

The linkage between the vaccination preservative and developmental disorders in children did not present itself until the 1950’s. During the preceding decade, only children of privilege were able to be immunized to such diseases as Measles, Mumps, and Rubbela.

There was an such an unbelievable increase in the reporting of developmental disorders in children of European decent, that the discipline and study of psychology took off. Unfortunately, the cause had yet to be identified.

As economic equality began to balance in the United States, so did the rise of developmental disorders in children. According to a U.S. Department of Education report, there was reported to be a 38,000% increase in developmental disorders, reported, in children, K-12 over a 10 year period, (1990-2000).

It was during this time that a team of UK researchers embarked on a 10 year longitudinal study of the adverse effects of thimerosal. Even though the results dismissed claims that there was nothing wrong with the preservative, the U.S. continued its usage, (according to the CDC, another document I lost in my old computer) the longitudinal study was still under replication.

The reason why is because thimerosal provided an extended shelf life for vaccinations, particularly those in inner city municipalities. In wealthier cities, the health departments banned its usage and returned the vaccinations to the suppliers. Unfortunately, smaller, or rather, poorer municipalities did not have the oversight resources to monitor or replace this type of preventive social care.

For those cities that were able to return the mercury weight-based vaccinations to the suppliers, the suppliers were able to turn, again, a hefty profit by distributing the vaccinations to poor African and Indian continents, as a public relations campaign.

For those poorer cities that could not afford to monitor or return, the vaccinations remained on the store shelves of the community health departments because the thimerosal extended the life of the vaccinations.

Eventually, the World Health Organization “encouraged” a ban under the Regan Administration. The result was a shift to an “artificial thimerosal” preservative that did not contain the 49.8% weight-based mercury. Basically, it was the same day, different story.

It must be noted that mercury-based vaccinations is not the only source of the suspected cause of autism. Heavy metal fall-out in traditionally high areas of factory industry, such as Detroit, have produced statistics as high as 1 in 10 male children having autism.

In California, there are reports of high levels of autism in resort areas due to the high levels of mercury found in fish, a result of industry.

There are substantiated and unsubstantiated stories that are floating around that pharmaceutical corporations have promulgated the developmental disorders in children for the purposes of profiting off of more anti-psychotropic medications for children. The majority of pharmaceutical corporations fund university research studies, further developing and supporting new diagnoses and benefits of the drugs.

As the social welfare systems emerged during the early part of 2000, the medication of children became part and parcel of federally subsidized funding, in the name of Medicaid, leading to Medicaid Fraud. No one questions the "best interests of the child". Children who were prescribed these types of psychotropic medications were rated at the highest levels of Medicaid funding.

Eventually, over 90% of children under the auspices of the state are under psychiatric care.

In summation, this is all how the term “Autism Vaccine” has come to be. Damned if you do; damned if you don’t.

Tuesday, August 4, 2009


Inspire to be.

Inspire to do.

Inspire to think.

Inspire to create.

Inspire to learn.

Inspire to love.

Inspire to leave a legacy.

Inspiration for Peace.

Inspiration for Hamtramck.

(Actually, it is part of a public relations strategy, but I will make you wait until I publish the book. Notice how I did not include the words VOTE or ELECT in this.)

Monday, August 3, 2009

Part One of My Campaign Strategy

Well, it seems the time is here. The election has begun.

I am sure some of you are saying to yourselves:

"What do you mean the election has begun?"

As I have decided to run the first of its kind, "low-budget, technological top-down transference of information, engage the public, encourage civic participation, recycled, green" campaign.

I have adopted a Karl Rove type of political strategy. It seems none of the candidates really approached the absentee voters. I did, well, at least I tried. Absentee voting began last week and everyone seemed to forget about the strongest and most reliable voting population, those confined to the assisted living.

Next, there is another segment of the population that will vote absentee: women who have recently been granted citizenship. These women, so strong and vibrant, are excited to participate in the political process.

And, lest not we forget the mothers with small children. It is quite difficult to stand in line to vote with small children. I know because I did it before.

Of course, everyone should have already guessed that I have all intentions of writing a book, and an academic journal article, on the entire political process; hence, the description of my blog.

I am even drafting a House Bill on my discoveries.

Life is beautiful, share it with the world.