Michigan and Feds Keep Ignoring Billions in Medicaid Fraud

The Department of Health and Human Services has completed an onsite review of the Michigan

Medicaid Fraud Control Unit.  As a standard review, it went relatively well except for the fact that the inspections always omit any reference to identifying Medicaid fraud in child welfare.

The following is a sample what the Inspectors look for in conducting an onsite review.  My comments show how child welfare is not included in the scope.

4. A Unit should take steps to ensure that it maintains an adequate workload through referrals from the single State agency and other sources. In meeting this standard, the following performance indicators will be considered: 

a. Does the Unit work with the single State Medicaid agency to ensure adequate fraud referrals? 

The Unit works with state business licensing agency but the state does not enforce referral policy for child welfare fraud.  The Office of Children's Ombudsman has never, ever referred a case of Medicaid fraud to the Unit.

b. Does the Unit work with other agencies to encourage fraud referrals? 

Nope.  If a child welfare provider is found to have filed false Medicaid claims, the worst that will happen will be that the organization will restructure under a different name.  The Bureau of Children and Adult Licensing does not refer out cases of suspected Medicaid fraud in child welfare as it will pose a compromise to privacy laws of child welfare.  The Unit needs to train and establish policy on referring suspected cases of Medicaid fraud in child welfare.

c. Does the Unit generate any of its own fraud cases? 

There has never been a prosecution or recovery of Medicaid fraud in child welfare.

d. Does the Unit ensure that adequate referrals of patient abuse complaints are received from all sources? 

Of course not.  Patient abuse and neglect come from the Long-term care Ombudsman which strictly deals with adults.  The Children's Ombudsman keeps its investigations sealed, does not investigate a majority of the claims filed and in certain instances, will consider the claim to be "Valid-Not-Opened".

I personally know of a Detroit child placing agency which currently engages in Medicaid fraud.  The clients are living on the streets yet the agency is billing for phantom Medicaid funded services.  Michigan Children's Institute has the most occurrences of Medicaid fraud as it has never, in the history of its existence, been audited.

David Tanay is a great Director of the Unit.  I hope Michigan's politics do not hog tie him in developing new policy to stop Medicaid fraud in child welfare.

HHS Michigan Medicaid Fraud Control Unit Report 2013 by Beverly Tran

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