Why Won't DOJ Resolve False Claims in Child Welfare?

U. S. Department of Justice released the latest settlement of allegations pertaining to public health care fraud.

WASHINGTON—Visiting Physicians Association, which is based in Farmington Hills, Mich., will pay the United States and the state of Michigan $9.5 million to settle allegations that the association violated the False Claims Act by submitting false claims to Medicare, TRICARE, and the Michigan Medicaid program, the Justice Department announced today. Visiting Physicians Association is a Michigan professional corporation which has provided home health services at various times in Michigan, Ohio, Georgia, and Wisconsin. 

The agreement announced today settles allegations that Visiting Physicians Association submitted claims to the Medicare, TRICARE, and Michigan Medicaid for unnecessary home visits and care plan oversight services, for unnecessary tests and procedures, and for more complex evaluation and management services than the services that Visiting Physicians Association actually provided...read more.

Now, let's examine this a little more in depth.

First, you have to understand that this is a settlement agreement to allegations, not conviction.  What this means is the U.S. DOJ, sat the company down and said,

"Look, we know you did more crap than this but you are too big of an organization and will cripple the local economy and leave lots of your patients with no place to turn, so, this is what we are going to do.  You give us a nice token trophy of a settlement, which you can write off as a tax deduction, to scare off others from doing it and we will let you continue to do business with the government."

The DOJ is very limited on resources to properly execute regulatory oversight on fraud.  This is why there is the False Claims Act.  Similarly in the States, there are Medicaid Fraud Control Units, under the authority of the States Attorney General.  These units do absolutely nothing due to the conflict of interest in child welfare.  Some states, also have its own False Claims Acts, but these acts are, in some shape or form, constructed with limitations and barriers for the individual to bring forth claims.

In this instance, the Lincoln Law (named for the original statute of the False Claims Act to stop fraud in the Civil War.  An example was businessmen billing the military for shoes it never made.) somewhat did its job.  But, if you dig a bit deeper, Visiting Physicians Association mainly provided services to the elderly population.

So what about fraud in child welfare?

So far, there is only one successful false claims settlement case of fraud in child welfare, settled November 13, 1998.  One person received $35,000.000.00 in one small area of funding.  Think if this was applied to the entire state.

STIPULATION and ORDER, the defendants agree to pay the United States, in full compromise and satisfaction of this action, the sum of $49,000,000.00 in connection with funds received under Title IV-B of the Social Security Act, 42 U.S.C. section 620 et seq., that the United States had previously paid to the defendants. The State defendants shall pay the United States the amount of $35,000,000.00 and the City defendants shall pay to the United States the amount of $14,000,000.00. The settlement amount shall constitute a debt due and owing upon entry of this stipulation by the Court and is to be discharged by payment to the United States under the terms and conditions as set forth in this stip and order ; Subject to and upon receipt of the Settlement amount, the amended complaint and the defendants' cross claims shall be dismissed with prejudice, with each party to bear its own attorneys' fees and costs, except as provided herein. (signed by xxx) (Entered: 11/16/1998)*

 Even though the stipulation and order was entered did not mean that the false claims stopped.  The fraud only escalated because it had already been addressed.  The sky's the limit on fraud from here!

The reason it is such a challenge to bring forth these actions is because, after this, there was a regulation moritoria, meaning the Congress allowed regulation of Medicare, Medicaid and other Social Security programs to be suspended and to continue to be suspended.  This means it is not fraud because there is no rules being broken.

Secondly, going after fraud in child welfare would basically implode state and local governments because of the epidemic proportions of fraud.   

 Lastly, any relator, being a whistleblower, would have to know where to go because the legal community is in the corner, sucking its thumb, rocking in the fetal position, in fear of losing licensing and disbarment.

This is why I have this site, to educate those in positions to stop fraud in child welfare, particularly Medicaid fraud.

*If I told you everything, you would never be surprised.