Michigan Department of Health and Human Services has proposed policy for the Community Health Automated Medicaid Processing System (CHAMPS) by having providers enroll.
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| Why not hold private contractors to similar standards as individuals? |
Effective January 1, 2018, any individual or entity that provides services to, or orders, prescribes, refers or certifies eligibility for services for, individuals who are eligible for medical assistance under the State Plan participating in a managed care organization’s provider network are required to be screened and enrolled in the Michigan Medicaid Program. Managed Care Organization (MCO) providers furnishing services to Medicaid beneficiaries must enroll in CHAMPS.
Interestingly enough, if a client of Medicaid, particularly children, are screened for eligibility before of Medicaid services before being treated, which is more than just going to the doctor, then, by similar standards, providers should also be held to the same eligibility criteria.
In the same light of eligibility to submit cost reimbursement to Medicaid, providers should also be contractually disbarred, licensed revoked, sanctioned, prosecuted, with recovery, if it is found that a provider has engaged in any activity of fraud, resulting in the submission of false claims.
U.S. HHS maintains an exlusionary database of providers who have been found to engage in fraudulent activities.
Why not the States?
This is an excellent opportunity for Michigan to lead the nation by closing out the Medicaid loopholes in CHAMPS.
This is an instant solution to address one of the main issues of privatization.
The States Medicaid Fraud Control Unit do not possess the authority to go after Medicaid fraud in child welfare due to the fact that there exists an inherent conflict of interst, being that the States Attorney General contemporaneously advises and advocates for the privately contracted child welfare agencies.
CHAMPS can be constructed to analyze metadata to quickly identify, and address through administrative action, as the child welfare organization is privately conducted, for resolution, whatever that will be.
Michigan has the electronic records, but has done absolutely nothing in dealing with Medicaid fraud in child welfare.
As it stands, any transgression, be it financial or physical, goes untouched, because the Michigan Attorney General Bill Schuette will tell a parent that they have to go get an attorney to sue in a civil action.
Parents with children receiving Targeted Case Management Medicaid services cannot afford attorneys, which is why they are eligible for Medicaid.
It is time to stop financial crimes against children.
Corporations are also considered to be legal individuals, why not hold them to the same standards as individuals?
This is why I have always been, and always will be a Sarb-Ox gal.
If they can put us on a central registry; then I say we can put them on a central registry.
For many years the Congress of the United States has worked diligently to protect the health and welfare of the nation's elderly and poor by implementing legislation to prevent certain individuals and businesses from participating in Federally-funded health care programs. Legally Kidnapped has mandated that the health and welfare of the nation's children and families must be protected by including Child Welfare Agencies in this exclusion database. Foster Care and Adoption Agencies should be banned from entering contracts using federal funds if the bases for exclusion have been met.
Bases for exclusion include for child welfare program-related fraud, child abuse, child deaths, licensing board actions, improper and questionable claims, false reports.
The effect of not being able to participate in federally funded contracts is:
- No payment will be made by any Federal child welfare program for any items or services furnished, ordered, or prescribed by an excluded individual or entity. Federal foster care and adoption programs include Medicaid Targeted Case Management, and Social Security Title IV A, B, D, and E, Maternal and Child Health Services Block Grant (Title V), Block Grants to States for Social Services (Title XX), State Children's Health Insurance (Title XXI) and all other plans and programs that provide health benefits for foster care and adoption funded directly or indirectly by the United States.
Learn more: BEVERLY TRAN: Medicaid Exclusion Program Has Loophole http://beverlytran.blogspot.com/2010/05/medicaid-exclusion-program-has-loophole.html#ixzz4zlWYBNey
Stop Medicaid Fraud in Child Welfare
Comments on this proposed policy are due January 1, 2018.
Comments may be forwarded to Sharene Johnson at JohnsonS14@michigan.gov or to the address noted on the proposed policy transmission, below.
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