Why Michigan Attorney Medicaid Fraud Control Unit Will Not Investigate Medicaid Fraud In Child Welfare - Wayne State University, MSU & Stealin'

Did you arise from a sound slumber to wonder why the Michigan Attorney General refuses to investigation Medicaid fraud in child welfare?

Probably not, but just in case you did, I have provided a lovely 1980's style industrial organizational instructional video, hailing from that wonderful period in history when everything was being programmed by that first, selected, generation of masses who were able to access institutions of higher learning and create your belief systems, represented by Zippy the Hippy.

For those of you who did not take the time to watch the video, probably because you think you are know more than me, allow me to present a few more probabilities as to why the Michigan Attorney General will not investigate Medicaid fraud in child welfare:

• Stealin';
• Michigan is at the threshold on a federal ruling on the Michigan Child Welfare System in the court of Nancy Edmunds, who seems to be covering up Medicaid fraud;
• Michigan Medicaid Fraud Control Unit is under federal investigation for covering up Medicaid fraud in child welfare;
• My old qui tam is back open as an investigation because the Court just threw my case on a pile of desk paper dung mounds and completely just spat in my face when it came to basic due process because I had to call the court to remind them that they were supposed to at least follow the False Claims Act and issue an order to dismiss.  Considering that the Court totally violated the Act and my civil rights, the case was wiped from the docket so you cannot find it, but I have it on my Scribd somewhere if you would like to search;
• Michigan Office of Attorney General is under international investigation for stuff, that I shall just leave it right there for everyone to speculate, unless you follow my reporting;
• Dana does not have a freakin' clue of what is going on or what to do as it shall probably self-implicate herself; or,
• #warcrimes

I am going with all of the above.

You know what they say,  "Gotta fund those campaigns!"

State still considering Wayne State's request to investigate Medicaid payment program

• Officials with Department of Health and Human Services are considering Wayne State's request to audit Medicaid program spending
• WSU officials have said they have used program funds appropriately
• University Pediatricians officials have charged that Wayne State has misused and possibly diverted nearly $61 million

Officials from the Michigan Department of Health and Human Services are considering a request from Wayne State University to hire an outside expert to review the university medical school's handling of funds from a Medicaid program after questions about it were raised by several medical groups.

Last month, Wayne State University President M. Roy Wilson, M.D., asked MDHHS to review its management of the 15-year-old Medicaid Public Entity Physician Payment Adjustment Program.

The request was prompted after several clinical groups affiliated with Wayne State, led by University Pediatricians, charged the university could be skimming as much as $61 million from the estimated $150 million to $200 million in annual state funding, a charge the university denies.

Under the program, Wayne State and six other "public entities" manage money for a program intended to pay physicians who treat Medicaid patients a higher rate to encourage their participation and expand access to care for Medicaid patients.

Officials from MDHHS confirmed they received the request from Wayne State for the review. "We continue to work with them on the administration of the program. At this point, we are not sure it is necessary for the department to undertake a review, but would evaluate any analysis undertaken by a third party."

After MDHHS issued that statement, Crain's received another email from a state spokesman saying that it is considering Wayne State's request to hire a third party. The spokesman said the state continues to work with WSU to resolve any issues.

Two weeks ago, MDHHS told Crain's in an email that it is not the state's role to get involved with a dispute between a public entity and one of its subcontractors. Other public entities in Michigan include the University of Michigan and Michigan State University.

"We, of course, would be happy to review the results of any independent audit of Wayne State University's administration of the PEPPAP program, should they choose to pursue such a formal review," a state spokesman said in an email.

In mid-April, Wilson penned an email to pediatric faculty to explain the ongoing dispute with University Pediatricians and at least three other clinical groups over the university's use of PEPPAP funds.

"Whether or not the Wayne State School of Medicine has the legal standing to keep part of the (Medicaid Public Entity Physician Payment Adjustment Program) funds to achieve the intent of the authorizing legislation is not a debatable question. It does," said Wilson in the email.

"The question of whether the amount kept is appropriate or not is a related, yet different issue that should be addressed. It is important and cannot be adjudicated through the media," he said.

Wilson then asked MDHHS to hire an independent "outside adjudicator of their choosing, expert in matters of PEPPAP funds, to review the School of Medicine's past and current practices with regard to these funds."

Over the past two months, WSU has declined several requests from Crain's to account for the funds.

Wayne officials insist they are managing the funds appropriately and according to state law. However, Crain's and several of the contracted clinical groups are asking the following questions.

For example, how much does Wayne State receive each year through PEPPAP? Sources have estimated $150 million to $200 million, but that number has never been confirmed. How much of that goes to the contracted 23 clinical groups, including University Pediatricians? How much is retained in administrative fees and how much toward other projects to expand access to Medicaid patients?

Based on the 6 percent administrative fee that Wayne State collects for the program, the annual amount of administrative fees could range from $9 million to $12 million. But it is not known how much more in PEPPAP funds are retained by Wayne State for other unspecified strategic initiatives.

Wayne State said these initiatives include programs provide "access to specialty and sub-specialty providers for Medicaid patients and the impoverished populations in the City of Detroit."

On April 5, Crain's reported that University Pediatricians questioned whether Wayne State has inappropriately retained $60.5 million in payments. Since then, three other of the 23 clinical groups under contract with Wayne State for enhanced Medicaid funding have questioned whether they also have been shortchanged.

Wilson has defended Wayne State's use of the funds, saying every one of the 23 groups it contracts with has received "every penny ... due under this program." But WSU said the state has granted it great latitude in how it uses the funds.

UP, which has dropped its formal affiliation with Wayne State and is having a running dispute with the university over a variety of other issues, is a 220-physician private medical group that serves DMC Children's Hospital of Michigan in Detroit. Some of its pediatrician members are on the faculty of Wayne State medical school.

The Medicaid enhanced payment funding issue between UP and Wayne State came to a head last fall during bankruptcy proceedings of University Physician Group, a multispecialty faculty practice plan affiliated with the Wayne State University School of Medicine.

Last November, UPG filed for bankruptcy protection after its three-year turnaround hit a wall and losses were starting to mount again, projected to exceed $10 million for 2018. WSU has been subsidizing UPG's losses the past 3 1/2 years.

UP and other groups have asked in bankruptcy court proceedings for a full accounting of the PEPPAP funds. "We don't want excess money used to create an entity by Wayne State that is in competition with UP" or to subsidize losses at the medical school or UPG, said a pediatrician source, who asked to remain anonymous.

The UP source said the pediatrics group is concerned Wayne State plans to use about $25 million in PEPPAP funds to build a new pediatric clinic that would compete with UP for patients.

Last month, WSU announced a plan to form Wayne Pediatrics, a new clinical service group of the university's medical school that is intended to replace longtime partner University Pediatricians. The decision was in response to UP's decision to terminate its relationship with Wayne State.

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