Monday, March 6, 2017

HHS Medicaid Fraud Control Units 2016 Annual Report & Me

When dealing with Medicaid Fraud in Child Welfare, the Medicaid Fraud Control Units are useless,
pursuant to statutory authority.

Yes, that is correct, Mediciad Fraud in Child Welfare is the biggest racket where one is, guaranteed, never to be criminally prosecuted, nor civilly penalized, because, it is all in the best interests of the child.

Let us examine the Michigan.

Rumor has it Michigan is so jacked up when going after Medicaid Fraud, that the U.S. DOJ and OIG HHS have teamed up to use the state as an example of "what not to do" when going after Medicaid Fraud.

A few years ago  I had FOIA'd for its mandated annual report to the OIG.  They told me they did not have one.


Then, this one time I had to call the U.S. OIG HHS to let them know that they had substantial errors in its review of Michigan's False Claims Act.  At least they thanked me.

So, for your reading pleasure in learning about MFCUs, allow me to do what I do best, in fuchsia.

Transcript for audio podcast: Medicaid Fraud Control Units

[Don White] What role does OIG play with State Medicaid Fraud Control Units and why are they important? I'm Don White in public affairs with the Office of Inspector General, and today, we're here with Richard Stern, OIG's director of program oversight for the Medicaid Fraud Units, and from our regional Office of Investigations, Special Agent in Charge Shimon Richmond of the Miami region. Shimon, what is a MFCU?

Greetings Don, Richard and Shimon.  I am here to bring jolly into your professional lives and do something about Medicaid Fraud in Child Welfare.

[Shimon Richmond] Well, Don, aside from being an awkward acronym, MFCUs are Medicaid Fraud Control Units. And as that name suggests, they investigate and prosecute Medicaid provider fraud, as well as patient abuse and neglect in health care facilities. They are state-based agencies and there is one of each in 49 states and the District of Columbia.

Well, Gentlemen, you failed to state that the States MFCU were never designed to go after Medicaid Fraud in Child Welfare, and have yet, to the date of this post, publicly addressed the fact that child welfare programs of the Adoption Safe Families Act were enshrined by the Congress to be impervious to any form of external scrutiny of its operations through IRS non-profit certifications.

[Don White] Well Richard, so you understand this best, why do we need Medicaid Fraud Control Units anyway?

[Richard Stern] Well, while we hear a lot about Medicare Fraud, involving the program for the elderly and the disabled, total taxpayer costs are actually higher in Medicaid, than in Medicare, with total yearly expenditures for Medicaid of over $500 billion dollars. And fighting fraud in Medicaid can be especially challenging. Each state runs its own program, So the rules vary from state to state. And we don't have good data at the national level. As we often hear, once you've seen one Medicaid program, you've seen one Medicaid program.

Guys, you failed to mention that child welfare programming, now, almost completely privatized, is untouchable when it comes to its state operations.  See, child welfare so-called oversight has been placed in the make shift huts called ombudsman offices, due to the fact that the original statute for the creation of MFCUs was exclusively designed for the aged.

Ombudsman offices of the States are then, on a secondary level, with watered down oversight authority of referral to law enforcement, further constrained due to privacy laws.  This means that there are no mandates for the States to adopt any policies for mandatory referral of suspected Medicaid Fraud in Child Welfare, to the State Attorneys General for prosecution, recovery, sanctions, exclusions, contractual debarment or criminal prosecution.

Why, you may ask?  Well, boys, the reason is two-fold.  First, you cannot audit God, meaning, any IRS charity/non-profit cannot be audited.  Secondly, anything dealing with child welfare is exempted and excluded from FOIA, as well as any other public disclosure, in the best interests of the child, you know.

[Don White] I understand that MFCUs have an important role in investigating and prosecuting patient abuse and neglect in nursing homes and other health care facilities as well, is that true?

[Richard Stern] Yes, that is true.

Richard, I understand that MFCUs do not do a damn thing about children being legally kidnapped by Child Protective Services, being drugged, raped, beaten and tortured in foster care, where each and everyone of these activities are cost-reimbursed through Medicaid.

[Don White] I can see that investigating Medicaid fraud would certainly be challenging given how different each State's programs can be. So since fighting Medicaid fraud is an OIG priority and a Top Management Challenge for the U.S. Department of Health and Human Services, I'm wondering how OIG works with these State MFCUs? Richard?

The OIG does absolutely nothing to work with the States MFCUs because the administrators of the HHS Children and Families Administration are the same people who were running these fraudulent child welfare programs, grant research and are, also, lobbyists.

I would be so remiss not to mention that the legislators benefit from the campaign contributions from the booty of Medicaid Fraud in Child Welfare to keep the same lack luster culture in place of willful ignorance to the blatant defalcation through double billing and phantom billing.

[Richard Stern] Well, yeah. Well, OIG administers a grant to each of the units that provides 75% of their funding. We also set performance standards, we review each state's program, we provide technical assistance identify best practices, and we collect and analyze statistics that we make available to the public on OIG website.

And you still fail to acknowledge that Medicaid Fraud in Child Welfare is an intentionally omitted variable in the annual report, I have so graciously provided, below.

Here are the data for FY 2016 Medicaid Fraud in Child Welfare prosecuted and recovered through the States MFCUs: 99 - missing data; $0.00

[Don White] How does that grant program work, Richard?

[Richard Stern] Well, as part of the Medicaid program, each of the States is required to have a MFCU or to receive a waiver. And the way it works, in exchange for receiving Federal matching funds, the States run a self-contained unit that includes investigators, auditors, and prosecutors or other attorneys. This model of having prosecutors work side by side with investigators and auditors has proven to be very successful. Most of the units are in the State Attorney General's Office and either prosecute cases themselves or refers cases to other State, County, or Federal prosecutors. MFCUs also collaborate closely with their State Medicaid programs, the OIG Office of Investigations and the FBI, as well as Department of Justice and U.S. Attorney offices nationwide.

Hold on a minute.  Let me put my 2 cents in about those waivers.  Those waivers created another quagmire when it comes to conflicts of interests, but let us start with the States Attorney General.  

How is it the States Attorney General can prosecute contractual entities it contemporaneously advocates, while prosecuting cases in child welfare proceedings?  See, it is like this.  The state contracts privately with a child placing agency to provide Targeted Case Management services to a foster child.  The agency proceeds to submit fraudulent Medicaid billing for cost reimbursement and uses those exact same need for services as legal standing to proceed with termination of parental rights, which is litigated by the States Attorney General.  

So, what some states did was to accept the waiver and house its MFCUs in places other than the AG, even though there are only a few states which have done this.  Placement of its MFCUs are then ensconced deep within the same agency which reimburses Medicaid costs.  Yes, this is an inherent conflict of interest but, under ASFA, there is a "right to lie" when submitting the false claims of Medicaid cost reimbursements in child welfare.

To top all this off was another set of Medicaid waivers in child welfare.  These waivers allowed States to use Targeted Case Management funding for what they attempted to coin as "home-based/community-based" services under family preservation.

[Don White] But I'm wondering how successful have these MFCUs been when working with OIG in fighting Medicaid fraud?

I am going to go out on a limb and say that these MFCUs have not been very successful when working with OIG in fighting Medicaid fraud because Medicaid fraud is a major funding mechanism when it comes to human trafficking.  Oh, you do know human trafficking is exactly what child welfare is, right?  Right?  I'll let Shimon answer that.

[Richard Stern] I'll let Shimon answer that. Florida, and especially South Florida, is one of our hot-spots for health care fraud.

[Shimon Richmond] Sure thing. So around the country, the OIG works a lot of cases with the Medicaid Fraud Control Units. In 2016, our Medicaid cases resulted in 312 indictments, 348 criminal actions, and 222 civil actions. These Medicaid cases - some of which also involved Medicare - resulted in almost $3 billion dollars in expected recoveries.

Shimon, you did not answer how successful the OIG has been in working with MCFUs in stopping Medicaid Fraud in Child Welfare and its human trafficking.  Around the country, Child Protective Services targets populations for Medicaid fraud billing opportunities through Targeted Case Management.

[Don White] So how important would you say these Medicaid Fraud Units are to your operations, Shimon?

[Shimon Richmond] Well Don, they're absolutely critical to our efforts.

So, what exactly are your efforts to stop Medicaid Fraud in Child Welfare?

[Don White] Can you give us some recent examples where your people worked with the MFCUs?

Hello?  Can someone please answer my question as to what are your efforts to stop Medicaid Fraud in Child Welfare?

[Shimon Richmond] Sure Don, we work with the Florida MFCU quite a bit. And there are several cases that come immediately to mind. First, working with the Florida MFCU, we charged 10 owners of a Miami-Dade county Assisted Living Facility with health care fraud and receiving illegal cash kickbacks in return for referring residents to a specific pharmacy. The pharmacy owner was sentenced not long ago, to federal prison and ordered to pay back more than a million dollars to the Florida Medicaid program. This ring was exposed by joint efforts between OIG agents and MFCU agents working in undercover capacity.

Have you guys ever hear of the Medicaid defalcation stories in residential institutions through what I like to call kiddie kickbacks?

[Richard Stern] You know I should also say, however, the MFCUs work many of their own cases without assistance from other agencies, and do so very successfully. MFCUs investigate, and prosecute, patient abuse or neglect in nursing homes, and hospitals, as well as in assisted living facilities. Sadly, the abuse of the elderly and other residents of these facilities has become a major social issue. These are difficult cases, and MFCUs are one of the few State or Federal agencies devoted to criminal prosecution of patient abuse or neglect.

Well, boys, if MFCUs can work on their own cases without assistance from other agencies, that would mean that the Unit would end up prosecuting its state attorney general by accessing information of child welfare cases without authorization, contaminating any evidence, leaving the state contractual entities to continue to fraudulently bill Medicaid.

[Don White] Well, Shimon, could these Medicaid Fraud Control Units be doing even more?

Let me answer that for you, Shimon.  Yes.  These Medicaid Fraud Control Units can be going after Medicaid Fraud in Child Welfare by starting with a public admission that it needs congressional help in implementing parallel jurisprudence and civil rights in child welfare.

[Shimon Richmond] Absolutely they could. But many of the MFCUs really need additional resources to fight the fraud in their jurisdiction. And currently there are no MFCUs in Puerto Rico or North Dakota. Also, the Medicaid Fraud Control Units need the legal authority to investigate and prosecute patient abuse or neglect in home- or community-based settings in addition to institutions. The current rules made some sense when Medicaid services were primarily provided in institution in times past, but as those services are increasingly provided in the home and the community, things really have changed.

Hey, I have a better idea and it will not cost as much.  How about setting up a bounty program?  I am not speaking upon the False Claims Act, as the victims of Medicaid Fraud in Child Welfare are, meeting the criteria of Title IV-A, are in the exclusive category of "The Poors".  No money, no justice.

So, instead of an impossible qui tam, how about an administrative program like the IRS Whistleblower program?  Yes, it will take time, but you will be doing "hands-free" data collection on Medicaid Fraud in Child Welfare, then, can run those data with program performance, well, let us just say the possibilities are endless.

[Richard Stern] Right. We will need Federal legislation to make that happen and there does seem to be interest for that happen on Capitol Hill.

I just told you guys that Medicaid Fraud in Child Welfare funds their political campaigns, so, of course, there is no interests on Capitol Hill, nor the White House.

[Don White] Well, I hope that this podcast has provided some helpful information on the important work by of the Medicaid Fraud Control Units.

And I hope that I have provided some helpful information on the important work the Medicaid Fraud Control Units do not do.

[Richard Stern] Thank you for the opportunity to speak about the work of the over 1900 MFCU professionals across the nation.

I would like to thank everyone who has taken the time to find out more on Medicaid Fraud in Child Welfare and the constraints of the States Medicaid Fraud Control Units.  Remember to sign up for your daily dose of me!

[Don White] Any last words, Shimon?

[Shimon Richmond] Well, just that the MFCU's play a critical role in protecting the taxpayers and the residents of health care institutions, so I'm happy to participate and glad that we can discuss this today.

[Don White] Thanks a lot.

Thank you, gentlemen, for allowing me the opportunity for another glorious castigation on the DOJ's and HHS' complete and utter failure to end Medicaid Fraud in Child Welfare.

On of these days, the world will finally listen to me.

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