Tales Of The New Crown: Is Bill Clinton's Tenet Health Abandoning Wayne State Children's Hospital Because Of Duggan?

Are Bill Clinton and Mike Duggan having a tift?

It bet it has to do with Medicaid Fraud in Child Welfare.

Wayne State leaders angered following Tenet Healthcare Corp. decision to oust WSU pediatricians from Children’s Hospital during pandemic

Children's Hospital of Michigan
Wayne State University President M. Roy Wilson and School of Medicine leadership are blasting a recent decision by Tenet Healthcare Corp., owner of the Detroit Medical Center, to oust WSU pediatricians from Children’s Hospital of Michigan after decades of service and in the midst of the city’s struggles with the coronavirus outbreak.

“Our outstanding pediatric faculty physicians, who have cared for sick children in Children’s Hospital of Michigan for decades, will now be summarily evicted from the place they practice and separated from the patients they serve,” said the university. “Their passion for children and their credentials remain steadfast. What has changed is that Tenet, a for-profit company based in Dallas, is once again prioritizing profits over patients. Rather than responding to our inquiries about how this decision was reached after prior assurances that doctors could continue to serve their patients, we were informed that we must contact a high-priced law firm hired by Tenet to defend this unconscionable decision.

“This immoral act puts children at risk and separates doctors from patients in the midst of a global pandemic. We will vigorously oppose this despicable act, and urge members of our community and government leaders to do likewise.”

So far, Tenet has refused to offer any explanation for the ban on the nearly 25 doctors who form Wayne Pediatrics, instead referring inquiries by Wayne State leaders to law firm Jones Day.

Meanwhile, Mark Schweitzer, M.D., dean of the Wayne State School of Medicine, noted that the decision to bar the pediatricians from the hospital marked a complete reversal of hospital leaders’ earlier position.

“The decision comes only a few weeks after Audrey Gregory, the new chief executive officer of the Detroit Medical Center, assured Wayne State officials that Children’s Hospital of Michigan has an ‘open medical staff,’ allowing physicians who meet requirements and standards to provide care in the hospital,” said Schweitzer. “Wayne State University physicians meet those standards.”

With Detroit reeling from nearly 10,000 confirmed cases of COVID -19, university officials expressed concern that Tenet’s decision not only marks yet another vindictive turn in the for-profit corporation’s years-long efforts to destroy ties between WSU and the Detroit Medical Center, but that it will also unfairly punish the area’s children.

“This disturbs me to my marrow and runs counter to everything I was taught by my parents and learned during my more than three-decade medical career,” added Schweitzer. “The CEO of Tenet made nearly $15 million in 2018. How many children could receive preventive medical care for that unseemly amount? Maybe every child in the city of Detroit?”

Conversely, throughout the pandemic, Wayne State has extended numerous good-faith acts to Tenet at the request of its CEO, including recently providing campus residence hall space to DMC physicians and health care workers.

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DOJ: FORMER CEO CONVICTED OF DEFRAUDING FOOD AND DRUG ADMINISTRATION AND DISTRIBUTING ADULTERATED DRUGS

And people wonder why infant mortality is so high in geographic regions with highly sought after land and resources.

Paul J. Elmer, former CEO
Pharmakon

     WASHINGTON – A jury yesterday convicted Paul J. Elmer, the former CEO and owner of Pharmakon Pharmaceuticals Inc. (Pharmakon), of conspiracy to defraud the Food and Drug Administration (FDA) and nine counts of adulterating drugs, the Department of Justice announced today. Pharmakon was a Noblesville, Indiana, drug compounding facility.

     The verdict came after an eight-day trial before U.S. District Judge James R. Sweeney II in Indianapolis, Indiana.

     Elmer, 67, formerly a licensed pharmacist and a resident of Fishers, Indiana, was charged by grand jury in a superseding indictment on Feb. 7, 2019. The superseding indictment charged that, from 2013 to 2016, Elmer and Caprice R. Bearden, Pharmakon’s former director of compliance, caused Pharmakon ─ which compounded sterile, intravenous drugs ─ to distribute approximately 70 lots of over- and under-potent drugs to military and civilian hospitals throughout the country.

     “As these convictions show, the Department of Justice takes very seriously conduct that unlawfully undermines the safety of compounded drugs,” said Assistant Attorney General Jody Hunt of the Civil Division. “We will not tolerate actions that impede the FDA’s efforts to ensure the safety of products. With its law enforcement partners, the Department of Justice will thoroughly investigate and prosecute those who knowingly prevent the FDA from protecting patients and ensuring compounded drugs are safe.”

     “The jury’s findings in this case resonate with citizens of every age,” said Josh J. Minkler, United States Attorney. “Specifically, hospitals and patients from every walk of life rely on the integrity of pharmaceutical manufacturers like Pharmakon to make safe drugs. This defendant prioritized profit over safety and the jury’s verdict demonstrates the government’s resolve to protect our citizens. Good pharmaceutical manufacturers who work with the FDA achieve that goal.”

     “Producing unsafe drugs puts patients at risk and is particularly concerning when they reach already vulnerable populations such as premature infants. This conviction demonstrates that those, including drug compounders, who distribute harmful drugs will be held accountable under the law,” said Director Catherine A. Hermsen, FDA Office of Criminal Investigations. “The FDA continues to play an important role in protecting patients—including young children—and we will continue to work with our law enforcement partners to pursue and bring to justice those who place profits before the health of U.S. patients.”

     “When drug compounders disregard safety standards and violate the law, patient health can be put at significant risk. In this case, we saw unacceptable behavior from the defendant whose company distributed dangerous products that led to serious adverse events in infants,” said Stacy Amin, FDA Chief Counsel. “The FDA is fully committed to working with the Department of Justice to stop these bad actors and protect patients from potential public health risks.”

     Bearden pleaded guilty to all the charges in the original indictment on Nov. 21, 2017.  Her sentencing date has not been scheduled.

     Evidence at Elmer’s trial showed that, from 2013 to 2016, Pharmakon routinely shipped compounded drugs at Elmer’s direction to customers without having received laboratory test results that verified the drugs were the strength they were supposed to be. Furthermore, evidence showed that, despite receiving test results showing potency failures, Elmer did not recall the drugs, notify the customer, notify the FDA of the potency failures, or conduct any root cause investigation to determine the cause of the failure. 

    

 FDA consumer safety officers testified about two inspections of Pharmakon they conducted in 2014. One inspection was prompted by Pharmakon’s distribution of 200 percent potent midazolam, a sedative that was used to treat premature infants, to an Indianapolis hospital.  They observed numerous violations of FDA regulations during each inspection, and informed Elmer. But former Pharmakon employees testified that Elmer and Bearden misled and interfered with these first two FDA inspections, in order to prevent the FDA from knowing about the potency failures as well as other aspects of the business. Former employees also testified that certain changes in process that Elmer and Bearden told the FDA Pharmakon would enact, never happened.

     According to evidence at trial, in February 2016, the multiple potency failures culminated in Pharmakon’s distribution of 2,460 percent super potent morphine sulfate, an opioid pain medication, to hospitals in Indianapolis and Chicago. Nurses at the Indianapolis hospital administered the morphine, not knowing that it was 2,460 percent super potent, to infants in the pediatric unit.  Three infants suffered adverse effects from the narcotic overdose. One infant needed to be revived through the administration of Naloxone (commonly known as Narcan) and sent by helicopter to a nearby hospital with a neo-natal intensive care unit. These adverse events led to a final FDA inspection in which FDA consumer safety officers testified that they discovered evidence of multiple previous potency failures that had been concealed by Bearden during the first two inspections. Former employees testified that Elmer and Bearden misled and interfered with this final FDA inspection as well.

     Elmer was convicted of one felony count of conspiracy to defraud the FDA and to obstruct FDA inspections, carrying a maximum punishment of five years in prison and a fine of up to $250,000. He was also convicted of three misdemeanor counts of introducing adulterated drugs into interstate commerce and six misdemeanor counts of adulterating drugs while held for sale after shipment of a drug component in interstate commerce. Each of the adulteration counts is punishable by up to one year in prison and a fine of $100,000.

     Elmer’s sentencing date has not been scheduled.

     Assistant Attorney General Jody Hunt and U.S. Attorney Minkler commended the FDA’s Office of Criminal Investigations, which conducted the investigation. The case was prosecuted by Assistant U.S. Attorney Cindy J. Cho of the U.S. Attorney’s Office for the Southern District of Indiana and Trial Attorney David A. Frank of the Department’s Consumer Protection Branch and, with assistance from Paul Joseph of the FDA’s Office of Chief Counsel.

     For more information about the Consumer Protection Branch, visit its website at http://www.justice.gov/civil/consumer-protection-branch.  For more information about the U.S. Attorney’s Office for the Southern District of Indiana visit its website at https://www.justice.gov/usao-sdin.

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Sparrow Clinton Health System Medicaid Fraud In Child Welfare Update

Just an update on my favorite Sparrow - Clinton Health System and their for their intelligible work for the sustainable industry of trafficking tiny humans, for the purposes of maximizing revenues in the best interests of the children, otherwise known as Medicaid fraud in Child Welfare.

That's it.

Sparrow announces new partnership with University of Michigan for pediatric care

LANSING — Sparrow Health System announced a new partnership with the University of Michigan Thursday.

Michigan Medicine, the academic medical center of the University of Michigan, signed an affiliation agreement with Sparrow Health System to integrate pediatric services.

The partnership is expected to officially launch in early May. The change will give Lansing-area families greater access to specialized medicine, said John Truscott, a spokesperson for Sparrow. 

“Allowing families to stay home when their children are sick is so important," he said. "And (the partnership) will hopefully mean a better experience all the way around.”

The new agreement does not impact Sparrow’s existing relationship with MSU’s College of Human Medicine and College of Osteopathic Medicine, Truscott said.

Under the new partnership with Michigan, Truscott said the school's physicians will provide care at Sparrow, which means local families won't have to travel to Ann Arbor for some specialized care, he said.

The University of Michigan's C.S. Mott Children’s Hospital already provides pediatric cardiology, pediatric gastroenterology and pediatric surgery services through clinics at the Sparrow Medical Professional Building.

A second part of the affiliation agreement is expected to be a minority investment by Michigan Medicine in Sparrow’s health plan, Physicians Health Plan, according to a Thursday news release. This investment is expected to be finished in six months or less.

Both organizations will also appoint representatives to an oversight committee as part of the deal. 

"Sparrow is a community hospital," Truscott said. "That will not be changing. This is just bringing more resources into the Lansing area." 

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Single Payer Health Care Pilot Program A Success

This is the look of the future of health insurance.  This is it.  This is a single payer program.

Congressman John Conyers, Jr. has been promoting a Single Payer Program for health care for everyone to be eligible with his United States National Health Care Act, HR 676.  This program deals with a single payer source, not specifically a "single individual" paying into the program with tax dollars.

The single payer is a financial term referring to a single funding source.  When there is a single funding source, in the instance of the CHIRPA Medicaid programs for children and families, the ability exists to provide transparency, accountability and oversight through its counter program, and that is the single audit.

In the United States, the Single Audit, also known as the OMB A-133 audit, is a rigorous, organization-wide auditor examination of an entity that expends $500,000 or more of Federal assistance (commonly known as Federal funds, Federal grants, or Federal awards) received for its operations.^[1][2][3] Usually performed annually,^[4] the Single Audit’s objective is to provide assurance to the US federal government as to the management and use of such funds by recipients such as states, cities, universities, and non-profit organizations. The audit is typically performed by an independent certified public accountant (CPA) and encompasses both financial and compliance components. The Single Audits must be submitted to the Federal Audit Clearinghouse along with a data collection form, Form SF-SAC.


OMB Circular A-133 Compliance Supplement 2009
The Single Audit ensures there is efficiency in the delivery of services, there is continuous quality improvement of programs and services, and enforces mandatory compliance with the terms of funding source, reducing fraud, waste and abuse.

With the Electronic Health Records  incentive programs, it is only with a click of the button that these single payer programs can be reviewed through auditing programs.

Even more so, there are other codified mechanisms to ensure accountability of single payer programs such as the Sarbanes-Oxley Act.

When there are such oversight mechanisms in place, there is always an improvement in program goals.  The goals of any program is to provide care for the health of society.  Through the investment in the best interests of the child, the national society profits when the program produces a future taxpaying citizen.  The child becomes a health adult.  A healthy adult becomes part of a healthy nation.  A healthy nation lessens the drain on its economical resources.

The Medicare model of the single payer will eventually be adopted.  When it does, there will already be a plan for implementation as its pilot program is dealing with children and families.

Two Year Anniversary of Children’s Health Insurance Law Sees Millions of Newly Insured Children, Families

Two years after President Obama signed the Children’s Health Insurance Program Reauthorization Act, HHS Secretary Kathleen Sebelius today announced that more than two million more children were served by Medicaid or the Children’s Health Insurance Program (CHIP) at some point over the past year.

Together, the two programs serve more than 42 million children who would otherwise not have access to regular medical care.

“The increase in the number of children served by these two vital programs is especially significant in the face of the recent economic downturn states are experiencing,” said Secretary Sebelius. “Even in times of hardship, states have demonstrated their commitment to the health of children by continuing efforts to identify and enroll them in coverage.”

To continue to advance coverage for children, Secretary Sebelius today also announced $40 million in new grants to states, community-based organizations, school systems and others to support their outreach and enrollment activities.  The grants will help states further modernize and streamline their administrative systems, as well as create and implement school-based outreach strategies and approaches for identifying children who have historically been hard to reach.

Today’s grant announcement builds on $206 million in enrollment bonuses earned by 15 states last year that increased enrollment above specific target levels.  The bonus funds help states cover the cost of enrolling additional children in Medicaid.

“As we mark the second anniversary of one of President Obama’s first actions as President, we can be confident that CHIPRA has proven to be a tremendous success,” said Sebelius. “Now we must build on our accomplishments. Today, I am again calling on leaders across the country – from federal, state and local officials to private sector leaders – to join our effort to insure more children. We all have a stake in America’s children and together, we will ensure millions more children get the care they need.”

States were able to increase enrollment in the two programs in part because of boosts in federal support provided by the American Recovery and Reinvestment Act (ARRA).  ARRA temporarily increased federal matching funds for state Medicaid programs during the recession.

While Medicaid and CHIP have helped bring the rate of uninsured children to the lowest level in more than two decades, an estimated five million uninsured children are thought to be eligible for one of these programs, yet not covered.

The Secretary’s Challenge: Connecting Kids to Coverage, launched last year, will continue support efforts to reach more children by providing leaders with critical information and support as they work to insure more children in their communities and by closely monitoring progress. 

“States’ continued progress toward enrolling all eligible children in coverage is a significant step in cushioning the recession’s impact on access to health insurance,” said Cindy Mann, director, Center for Medicaid, State and Survey and Certification Operations, within the Centers for Medicare & Medicaid Services (CMS). “As families lose employment or have their hours cut back they may lose the health coverage benefit that came with that job.  If not for these two programs, millions more children would go without critical health care services.”

In its second annual report on CHIP and Medicaid enrollment, CMS notes that:

• More than 2 million children gained Medicaid or CHIP coverage during federal fiscal year 2010 (October 1, 2009 – September 30, 2010). In total, Medicaid and CHIP served more than 42 million children last year. This steady increase in enrollment is evidence of the important role that Medicaid and CHIP play for children, especially during economic downturns.  The uninsured rate for children continues to decline at a time with the rate for adults is climbing.  The increase in children’s enrollment demonstrates that Medicaid and CHIP are serving the purpose for which they were created – providing high quality health coverage for lower-income families.
• Thirteen states implemented eligibility expansions in 2010 and many others simplified their enrollment and renewal procedures.  Forty-six states and the District of Columbia now cover children with incomes up to 200 percent of the federal poverty level (FPL) in Medicaid and CHIP; with 24 of those states and the District of Columbia covering children with incomes up to 250 percent of the FPL.  Twenty-one states now offer coverage to lawfully residing immigrant children and/or pregnant women, enabling states to receive federal funding for this coverage.
•  CHIPRA Performance Bonuses have encouraged states to adopt and augment simplification measures in Medicaid and CHIP. Fifteen states qualified for a total of $206 million in performance bonuses for FY 2010; this is a significant increase over 2009 where 10 states received bonuses totaling $75 million. These bonuses provide additional federal financial support each year to states that successfully boost enrollment above target levels among previously eligible but uninsured children in Medicaid.  To qualify, a state not only has to enroll more children, but must also have implemented program features that are designed to promote enrollment of eligible children. 
• States are increasing their use of technology to facilitate children’s enrollment and retention.  Nearly two-thirds of states (32) have an on-line application that can be submitted electronically; 29 states allow electronic signatures on those applications.  Six states have received approval to enroll children through the “Express Lane Eligibility” option created by CHIPRA.  Express lane eligibility allows states to use data gathered for other programs such as housing assistance or food stamps to determine Medicaid or CHIP eligibility. And 33 states are utilizing the CHIPRA data matching process provided by the Social Security Administration to confirm U.S. citizenship for children.
• Outreach and enrollment grants have advanced coverage and led to public-private partnerships throughout the country to enroll more children. Sixty-eight grantees across 41 States and the District of Columbia are working diligently to facilitate children’s enrollment in health coverage 

Children's Health Insurance Program Reauthorization Act (CHIPRA) 2010 Annual Report

Defensive Medicine in Child Welfare Found To Be Fraud Scheme

With the continuous lack of oversight and enforcement in children's health care programs funded through Medicaid, children suffer as privatized contractors reap the financial benefits of false claims.

On of the largest areas for Medicaid fraud, waste and abuse is in Targeted Case Management, particularly under the foster care programs.

Reimbursements are submitted by phantom and ineffective children's programming to provide non-existent health care services and/or extremely poor quality services, by persons who are not qualified, to justify the billing of more extreme and unnecessary evasive medical procedures, more readily recognized as defensive medicine.

As there is little or no redress or recourse for children under the auspices of the state who have been harmed by the relevant aforementioned Medicaid fraud scheme,  the pattern of practice continues, as does the false claims.

There is no medical malpractice liability in child welfare.

U.S. House Judicial Committee recently addressed the issues of the practices of defensive medicine in regards to Medical Malpractice Liability.  Unfortunately, nothing was mentioned regarding States Child Welfare Medicaid Programs.



Stay tuned...

Medicaid pays more, kids get less, audits show

Turning in-home and in-school treatment of some of Virginia's most troubled kids over to private providers has resulted in ballooning Medicaid costs, overbilling and treatment by unqualified staff.

Many of the hundreds of firms that jumped into the business also treated children who weren't really eligible for service, according to state records, obtained after repeated Freedom of Information Act requests to the Department of Medical Assistance Services.

Many children were not properly assessed. Providers didn't prepare formal treatment plans and didn't keep progress notes. Providers commonly claimed to provide service in improbable circumstances, including lengthy sessions of up to five hours for young children, as well as treatment after 11 p.m. and on holidays, the records show.

"It's very clear some families and children didn't get the services they needed," said Lester Saltzberg, director of licensing at the Department of Behavioral Health and Developmental Services.

It wasn't for a lack of spending by Medicaid — the joint state and federal health care program for the poor and disabled that's been struggling for years with limited funds.

Medicaid's expenditures on the in-home service has grown 250 percent since 2006, to reach $176.5 million, according to data compiled by the House of Delegates' Appropriation Committee. Just last year, as the state began auditing providers, spending rose 20 percent, according to Medicaid's own data.

Spending on the day-treatment service, generally delivered in schools when children are not in mainstream classes, rose by 418 percent, to $144.9 million. Even after auditing started last year, this spending rose 28.5 percent.

An outside auditor's review of 70 providers' 2008 operations identified $14.9 million of questionable payments. The state attorney general's office prosecuted three cases involving more than $4.6 million of fraud.

"Given the number of new providers and the focus on providing services to children in the community, increasing expenditures were expected," said Medicaid spokesman Craig Markva.

He also said the services were overused as some providers misinterpreted who was eligible and what exactly was required of them.

In July, Medicaid started using a firm to check whether particular children actually need the service for authorizing payment. It strengthened requirements for staff qualifications in September, Markva said.

The two services used to be offered through community services boards, the state's local mental health agencies, usually with staff who held master's degrees or had several years of experience.

In a bid to expand the service, the state opened the service up to private firms three years ago — but didn't update regulations, which meant the private firms could legally send people with only high school diplomas to do clinical tasks in homes and schools, said Saltzberg, at the behavioral health department.

At the $70 an hour Medicaid was paying for the two services, the boards were breaking even on the services provided by their professionals.

But the $70 rate looked like a business opportunity in the private sector. Hundreds of firms signed up for the work — 401, up by nearly 200 in the past two years — and many hired staff with minimal qualifications.

And with nobody in state government checking who the companies were serving, the number of children and families in the system rose too — many were children who were more appropriately served with other kinds of outpatient services, for which Medicaid pays public and private providers $46 an hour, Saltzberg said. It's been tough to keep those programs going, financially.

In one case, Denise McCreary, a suburban Richmond provider billed Medicaid for:

Services the city's Behavioral Health Authority actually provided one child.

Services for three boys, telling Medicaid they were seriously disturbed while telling their guardian she was providing them a Big Brother program. One of the boys was an honor roll student; none had been diagnosed with a mental health issue or been found to be at-risk youth.

Therapy provided a 6-year-old and a 7-year-old, which turned out to be one trip to a Chuck E. Cheese restaurant and another to a city park. Their guardian thought McCreary was providing a Big Brother/Big Sister program; neither of the two were considered at-risk children.

A federal judge last fall convicted her of defrauding Medicaid of $601,580 over a 10 month period.

"The aim was to expand access," Saltzberg said. "But if you expand access without looking at how you regulate, there can be unintended consequences."

Virginia Medicaid Program Costs and Trends 2010

Most Medicaid Children in Nine States Are Not Receiving All Required Preventive Screening 2010

Medicaid Fraud Conference Ignores Medicaid Fraud

Ever wanted a good laugh on Medicaid fraud?  Well, here is your chance.


This group charged $500 a pop to come to a national conference to focus on internal controls and to ensure accountability in Medicaid programs.


Guess what they did not cover?  Child welfare!


I was not even in attendance and I know they did not even come close to this subject matter.


How do I know this fraud conference did not even slightly mention Medicaid fraud in child welfare?


Because I was not there.

Plans Under Way for September Fraud Conference

Join AGA at its Fifth Annual Internal Control & Fraud Conference, set for Sept. 15–16 at the Ronald Reagan Building and International Trade Center in Washington, D.C. Worth 14 CPE hours, the conference will focus on management’s responsibility for ensuring a good system of internal controls and the role of all accountability professionals in minimizing the risk of fraud, waste and abuse.

Hear from leaders in government and private industry discuss the latest discovery techniques and lessons learned from various schemes; how poor internal controls can lead to fraud, waste and abuse; and how different levels of government are cooperating to improve services to citizens. The conference will also cover such interesting topics as cyber crime, using suspension and disbarment actions for poorly performing contractors, war against improper payments, municipal market enforcement and regulatory reforms, mortgage and bank fraud, Medicaid investigations, managing construction project risks, and Recovery Accountability and Transparency Board and GAO oversight activities.

Fees are $500 for AGA members and $675 for nonmembers until Aug. 30 when they increase by $100.

5 Fraud, Abuse Laws Med Students Should Know ...that do not apply in pediatric medicine

5 Fraud, Abuse Laws Med Students Should Know ...that do not apply in pediatric medicine

As we all know, these laws do not apply in the child welfare industry.  Information received by medical schools in the area of pediatric administration comes from either, pharmaceutical companies or child welfare propaganda machines.

Cheryl Clark, for HealthLeaders Media , October 20, 2010

More than half of U.S. medical schools don't provide any instruction on federal fraud and abuse laws, according to a report from the Office of Inspector General.

100% of U.S. medical schools don't provide any instruction on federal or state fraud and abuse laws, according to me.

That should change, the report said, because Medicare and Medicaid fraud and abuse cost billions each year "and put the programs' beneficiaries' health and welfare at risk," the OIG says.

Finding from 131 medical school deans:

• 44% (or 57 deans), say they provide instruction dealing with fraud and abuse laws
• Of those 57, 53 deans say the instruction takes place in the classroom
• 38% say they provide the training annually
• 38 deans said they covered the False Claims Act while 35 teach nuances dealing with the anti-kickback statute.

Medical schools have opportunities to address these topics, even though there is no federal requirement that they do so, the OIG report states.

There is no reason to even incorporate pediatric fraud laws into any medical program, let alone political science or social work because there is nothing anyone will do about it but me.

Of the 387 institutions offering residency and fellowship programs in medicine that responded to the OIG request, 263 or 68% provide instruction on fraud and abuse and of those, 81% did it using conferences and lectures.

The OIG highlighted five areas of fraud and abuse law that the office thinks medical students need to learn. They are:

1 The civil False Claims Act, which charges anyone who knowingly submits a fraudulent claim for services to the federal government. Violations generally are punishable by a civil penalty of up to $10,000 an three times the amount of damages suffered by the government.

2. Anti-kickback statute, which imposes felony charges and fines up to $25,000 to anyone "who knowingly and willfully receives or pays anything of value to influence the referral of federal healthcare program business.
Violators also are potentially subject to civil penalties up to $50,000 and prohibited from participating further in federal healthcare programs.

3. Physician self-referral statute, which prohibits the practice of physicians' referring patients to facilities in which they have ownership or other financial interests, can be punished with civil penalties of $15,000 per improper claim, denial of payment and refunds for certain past claims.

4. The Civil Monetary Penalties Law may result in penalties between $10,000 and $50000 and up to three times the amount unlawfully claimed.

5.  The Exclusion Statute excludes entities or individuals from being reimbursed or participating in Medicare or Medicaid programs for a minimum of three years, depending on the offense, to lifetime exclusion.

The OIG says it "has dedicated significant resources to promoting the adoption of compliance programs and encouraging health care providers to incorporate integrity safeguards into their organizations as an essential component of a comprehensive antifraud strategy," steps that it will continue and beef up.

It regularly, for example, posts advisory opinions on whether specific business arrangements constitute fraud or abuse and periodically issues fraud alerts and advisory bulletins to alert and inform the industry about areas of special interest.

The OIG says that it plans to take steps to improve awareness among medical schools about the law by preparing and distributing educational materials for medical schools, and residency and fellowship programs. It also plans to seek feedback on compliance challenges that physicians, hospitals and other providers face.

I strongly encourage all institutions to refer all students to the one-stop National Archive on Child Welfare Fraud to access the latest audit reports and federal lawsuits on fraud, waste and abuse of Medicaid fraud in child welfare.

Also, subscribe to my RSS to find out of all the relevant statutory and revenue maximization schemes in child welfare.

HHS OIG Medicare and Medicaid Fraud and Abuse Training in Medical Education

Federal Probe Into Research Conflicts of Psych Drugs

Even though the following article does not specifically mention child welfare or anything relating to pediatric or juvenile medicine, it is all inclusive in dealing with the inherent conflict of interests of major research institutions and fraud.

Just look at Cornell.

Disclosure of conflicts of interests is not a political issue, it is an issue of preserving the economic security of the nation and the health of the public.

Pharmalot
Grassley Probes Nemeroff and University of Miami

By Ed Silverman

June 8, 2010

The Charles Nemeroff (right) affair encompasses more people all the time. Now, the University of Miami Medical School has become ensnared in the ongoing probe launched by US Senator Chuck Grassley, who investigated Nemeroff as part of an inquiry into undisclosed financial conflicts of interest among academic researchers who receive federal grants.

You may recall Nemeroff, who was recently hired by the University of Miami, had departed Emory University after the Senate probe disclosed he was accepting sizeable consulting fees from GlaxoSmithKline at the same time he was the primary investigator on an NIH-funded grant for research into a Glaxo drug (see this). Before his departure, Emory imposed a two-year ban on grants for on Nemeroff. This week, however, the U of Miami med school head, Pascal Goldschmidt, was quoted as saying the ban was “an immediate reaction to political pressure” (see here).

Angered at the remark, Grassley has sent a letter to Donna Shalala, the University of Miami president and a former US Secretary of Health and Human Services to say “I hope that you would agree - contrary to Dr. Goldschmidt’s views that disciplining researchers for failing to disclose conflicts of interest is merely a political issue - that enforcing federal conflict of interest policy iinvolves ethical and legal issues that ensure taxpayer trust.” Grassley wants Shalala to provide all conflict of interest forms filed by Nemeroff, as well as all e-mails and communications by Goldschmidt and Nemeroff’ about conflicts and NIH grants.

But there’s more. Grassley also wrote a letter to HHS Office of Inspector General Dan Levinson to examine the ties between Nemeroff and NIHM director Tom Insel. Insel apparently helped Nemeroff win his job at the University of Miami (see this) and Levinson is already investigating Nemeroff (look here). Ironically, the NIH has just proposed new rules on conflicts, although Insel is one of Nemeroff’s long-standing allies and he was on the panel that reviewed the new rules (background).

Now, where did I read about this before...hmm...I remember!

DHHS OIG Speech: Trust, but Verify

Michigan Compassionate Policies

Unfortunately, it takes major legal action in Michigan before compassionate polices are created.

I am still developing the final component: Michigan Medicaid Fraud Control Unit Model

Michigan Corrected Mediciaid Final Departmental Review for Crawley Lawsuit

$100 Billion Investment in Science

It has taken many decades, but it finally looks like the death of psuedo-empirical science has arrived.

Sometime ago, the federal government took a major departure from the path of democracy. I do not speak of the political parties, I speak of scientific methodology. In order for a theory to be a theory, it must withstand robust challenge and the test of time.

In order to have a democracy, there must be dissension. There must be a logical and peaceful voice to stand up and challenge the status quo. In the scientific community of the United States, empirical queries has been silenced for far too long.

For the purposes of discussing child welfare, I will use the threshold of 1974, the inception of the Child Abuse Prevention Treatment Act. It was almost exactly this time when the Request For Proposal (RFP) format came into existence. Federal government "told" what was to be expected, and the states custom designed the proposals to tailor the request. There was no innovation. There was no inspiration. There was only a culture of psuedo-empirical science that was being bred, and a reverent class of people who were trained never to challenge authority.

Prior to this, there was the model of philanthropic investment in scientific research, where a scientist would develop a project and present it to his benefactor, who would in turn profit from the scientific speculation.

We "used" to invest in our children's dreams. Now, we tell them what how to think, in many shapes and forms of psychotropic and anti-psychotropic medications. We have drowned scientific determinism through the investments of fear and trembling with the RFP.

Now, the Administration is bringing back the spirit of discovery by investing in the profitable future of society by inspiring new thought, new challenges, new beliefs for the future and health of society.

This is how one stops the child abuse propaganda, horribly biased research and the imperialistic morality parade: by continuously searching for truth, truth from the people, not multi-billion dollar lobbying machines.

Let's recovery truth by reinvesting in discovery.

FOR IMMEDIATE RELEASE Friday, May 14, 2010

Contact: HHS Press Office (202) 690-6343

HHS Secretary Sebelius Announces $1 Billion in NIH Recovery Act Awards

Funds Used to Construct or Improve Biomedical Research Facilities

Grants expected to create or sustain jobs while advancing research nationwide

U.S. Health and Human Services Secretary Kathleen Sebelius today announced one billion dollars of American Recovery and Reinvestment Act funds have been awarded to construct, repair and renovate scientific research laboratories and related facilities across the country. The National Institutes of Health (NIH) National Center for Research Resources (NCRR) administered the grants, which are expected to create or sustain jobs nationwide and to help foster scientific advances that may lead to improved human health.

A total of 146 grants to institutions in 44 states, the District of Columbia and Puerto Rico were awarded to upgrade and construct buildings, laboratory spaces and core facilities that are crucial to biomedical and behavioral investigators.

“This unprecedented Recovery Act investment in research facility construction will not only give our world-class scientists the modern facilities they need for impact research, it will also help create and maintain jobs in varied business sectors and in all regions of our country,” said Secretary Sebelius.

These awards are part of an overall $100 billion federal government investment in science, innovation and technology the Administration is making through the Recovery Act to spur domestic job creation in emerging industries and create a long-term foundation for economic growth.

"These Recovery Act dollars will provide state-of-the-art facilities for hundreds of researchers to conduct cutting-edge science with the latest technologies," said NIH Director Francis S. Collins, M.D., Ph.D. "At the same time, they will create job opportunities nationwide."

Highlighted below are four examples that provide a snapshot of how institutions coast-to-coast will use these funds to help advance studies in disease areas such as cancer, HIV/AIDS, autism, pediatric illnesses and other health disorders.

• Renovation of Children’s Health Research and Evaluation Facility, Indianapolis.
  Nearly $8.5 million in grant funding will help to create a state-of-the-art facility for pediatric clinical research and to create a core facility of pediatric phenotyping laboratories and patient research resources at the Indiana University School of Medicine. Phenotyping is the use of epidemiologic, biological, molecular or computational methods to systematically select features of a disorder that might result from distinct genetic influences. The project will bring together a range of existing pediatrics laboratory programs into a single core to create collaborative, quantitative phenotyping of diseases and treatments.
• The Genome Data Center Initiative, St. Louis.
  The Washington University School of Medicine (WUSM) will use a $14.3 million award to build a world-class data center to support human genome research. WUSM has been involved in genome science since the inception of the field. Its genome center recently embarked on several ambitious projects to decode the genomics of hundreds of cancer patients and their tumors. The research has the potential to transform the diagnosis and treatment of cancer. The new 15,000 square-foot data center will support the computational power and storage needs that projects like these require.
• The San Francisco Office of AIDS Renovation (SOAR) Project.
  A grant of more than $9.5 million will allow three prominent United States-based HIV/AIDS prevention research units within the San Francisco Department of Public Health to increase their capacity to recruit, enroll and retain large, diverse populations of study participants efficiently and effectively, and to provide critical data on new HIV/AIDS cases to investigators worldwide. The SOAR project will provide researchers with the space and data needs required for large patient studies, improved security for records storage and space needed for training. The project also will have an impact on current and future biomedical HIV/AIDS research and training initiatives.
• Cell and DNA Repository Renovation, New Brunswick, N.J.
  Data sharing is essential for expedited translation of research results into knowledge, products and procedures to improve human health. Central storage units such as the Rutgers University Cell and DNA Repository (RUCDR) help investigators nationwide share data and biological specimens. To address space shortages and infrastructural needs and to broaden the scope of the molecular biology services, RUCDR has been awarded $9.5 million to renovate their biology laboratory. RUCDR’s services provide approximately 90 NIH-funded grantees with resources that aid research in disease areas, including autism, schizophrenia, bipolar disorder and kidney diseases.

“These Recovery Act awards literally and figuratively are laying the groundwork to accelerate research in disorders that affect the health and productivity of so many families — both children and adults,” said NCRR Director Barbara Alving, M.D.
Environmental impact is a key component of the Recovery Act and was a prominent theme of the related NCRR construction application and awards process. The construction grants awarded through the Recovery Act encouraged, and in many cases required, grantees to implement several primary elements of sustainable technologies and design principles. These elements ensure energy efficiency, reduction of the environmental impact of building materials and minimized use of compounds that deplete the ozone.
More information about NCRR’s Recovery Act grants can be found at www.ncrr.nih.gov/recovery/construction.

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The activities described in this release are being funded through the American Recovery and Reinvestment Act (ARRA). More information about NIH's ARRA grant funding opportunities can be found at http://grants.nih.gov/recovery/.
To track the progress of HHS activities funded through the ARRA, visit www.hhs.gov/recovery. To track all federal funds provided through the ARRA, visit www.recovery.gov.

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