In the name of the U.S. and us: stop fraud now

Now that all the excitement in the child welfare reform movement has died down, it's my time to step in.

The Law Project for Psychiatric Rights (PsychRights®) announced the unsealing of a major Medicaid Fraud lawsuit against psychiatrists, their employers, pharmacies, state officials, and a medical education and publishing company for their roles in submitting fraudulent claims to Medicaid.

Great.

So why do I have the authority to analyze Jim Gottstein's actions? Well, because I have been there, done that and bought the rhinestone t-shirt.

Interestingly, Gottstein brought the suit as a corporate individual PsychRights®, but did not clarify the authority of PsychRights® nor its standing to bring forth the action. As a corporate individual, does he meet the criteria as an original source? I doubt it because it was never addressed in the original complaint.

PsychRights®, owned and represented by Gottstein, did not submit any proofs, which, normally, would get him kicked right out when the defendants file their motion to dismiss for failure to state a claim, which the complaint fails.

Just because the case was unsealed does not mean the case will proceed, as we do not know if there were any other filing or pending motions before the court.

The U.S. government failure to intervene in the matter is not a serious issue, as it preserves the right, at any time to intervene. It is best, at times for the government to not intervene, giving the relator, the person who is the whistleblower, grounds for the highest level of percentage of the bounty, being 30%. The more the feds step in and intervene, the lower the percentage ratio.

I am betting the feds did not intervene for possibly two reasons:

(1)PsychRights® has no legal standing as an original source, even beyond the open and obvious issue of self-representation;

(2)The feds are currently learning how to approach the issues of Medicaid fraud in child welfare. I know DHHS OIG is only beginning to identify and understand the fraud schemes in child welfare, (the purpose of this blog) but it is still in the initial phases. The federal government is a slow yet deliberate process of handling matters. The purpose being, once they do anything, it will be done effectively. Currently, there is the federal task force of H.E.A.T., the joint partnership with DOJ and DHHS OIG developing its tasks forces to attack Medicaid fraud in child welfare. They will approach from a different angle, leaving a stronger punishment by deterrence message upon the public.

Fraud detection and prevention in health care (Medicaid, Medicare, Tricare, Children's Health Insurance Program) is an industry that has the potential to create a massive number of jobs. The push in the direction of informational technology will only enhance the ancient mechanism called the writ of qui tam.

Qui tam pro domino rege quam pro se ipso in hac parte sequitur,

meaning,

"[he] who sues in this matter for the king as [well as] for himself."

Actions such as this benefits all of us, all taxpayers as it is taxpayer monies that are being taken, threatening our economic security, which is our national treasure. The feds cannot be everywhere at all times, contrary to most beliefs; the feds rely upon us, the taxpayer to communicate and to blow the whistle when we know of fraud schemes. The qui tam was created within the platform of the Magna Carta to do just that. President Lincoln reanimated this ancient writ, as well as a few others like habeus corpus, to fight the war within the Civil war, and that was the war on businesses defrauding the federal government. It was called the False Claims Act.

The only setback to the qui tam is the language of the False Claims Act statute, which has been ambiguously interpreted by the Supreme Court to make it impossible for an individual to bring an action without an attorney.

PsychRights® and Gottstien have once again pushed this envelope back in the face of the judicial community.

Just as we had in the financial industry with the likes of the ponzi scheme, there are similar, yet far more intricate fraud schemes in child welfare. Child welfare is an industry that has never been regulated as there is no transparency nor accountability. The con artists in child welfare are far more sophisticated when it comes to public awareness campaigns of abuse and neglect, and the subsequent fundraisers.

It takes individuals such as Gottstein and his non-profit PsychRights® to remind the people that we are the ones who possess the power of government, and can call it in at any time through the extraordinary writs.

I wish him, PsychRights®, the Department of Justice and the Department of Health and Human Services the best of luck in their fight to end Medicaid fraud in child welfare.