Cocktails & Popcorn: March 26th. 2019. Live From Khashoggi One - Lockheed SNAP Rocket - Medicaid Fraud Control Units & Predictive Modeling Crap In Foster Care and Adoption

Go get that codex.

It is called Medicaid fraud in child welfare.

https://wolterskluwer.com/products-services/our-portfolio/health.html

For those of you who are unfamiliar with the university garbage can model in academic learning, allow me to provide a synopsis quickie:

The university garbage can model, an actual model of crap, is when people from the community and the profession think they are participating as stakeholders in the betterment of society, but instead, the university dumps everything in its great receptacle database of crap because they label with lump and dump qualitative categories the like to create all by themselves up in the ivory tower halls, to later fashion a propaganda campaign to support their latest and greatest predictive modeling crap to fund political campaigns to get their people in office so they can have these predictive modeling crap experts, who prophesied in the mandatory text books and academic journals of our institutions of higher learning, crafted by foreign, private corporations, to promulgate their own dumb, crappy Social Impact Bond programming so they can continue stealin' the children, the land and the votes, through the fraudulent billing of Medicaid in child welfare.

My apologies for the extremely long run on rant, but I suffer from Post Traumatic Fraud Syndrome where my sensitivities are triggered when I come upon predicitive modeling crap of Medicaid fraud in child welfare.

Now, I can take a breath.

Learn everything you ever wanted to know about Medicaid Fraud Control Units.

The following is an example of predictive modeling crap:

Wolters Kluwer Introduces AI-Powered Predictive Analytics to Federal Developments Knowledge Center

Collaboration with Skopos Labs, Inc. will enable practitioners to predict the likelihood of bills becoming law

Here is an example of predictive modeling crap:

https://www.civisanalytics.com/predictive-modeling/

Here, predictive modeling crap allegedly used to stop Medicaid fraud.

https://www.bna.com/predictive-modeling-crucial-b12884910669/

And more predictive modeling crap:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245495/

Finally, my example of predictive modeling crap for the purposes of acquisition of goods in foster care because it covers up fraud:

Can Medicaid Claims Validly Ascertain Foster Care Status?

Abstract

Medicaid claims have been used to identify populations of children in foster care in the current literature; however, the ability of such an approach to validly ascertain a foster care population is unknown. This study linked children in the National Survey of Child and Adolescent Well-Being-I to their Medicaid claims from 36 states using their Social Security numbers. Using this match, we examined discordance between caregiver report of foster care placement and the foster care eligibility code contained in the child's Medicaid claims. Only 73% of youth placed in foster care for at least a year displayed a Medicaid code for foster care eligibility. Half of all youth coming into contact with child welfare displayed discordance between caregiver report and Medicaid claims. Children with emergency department utilization, and those in primary care case management health insurance arrangements, had the highest odds of accurate ascertainment. The use of Medicaid claims to identify a cohort of children in foster care results in high rates of underascertainment. Supplementing administrative data with survey data is one way to enhance validity of ascertainment.  <=== That is Medicaid fraud in child welfare.

Revised rule aims to ease burden on state Medicaid fraud units

State Medicaid fraud units no longer need to submit an annual report for recertification but must operate under other requirements of a revised final rule.

The regulation governing state Medicaid fraud control units (MFCUs or Units) has been revised in order to: (1) incorporate statutory changes that have occurred since the enactment of the Medicare-Medicaid Anti-Fraud and Abuse Amendments, (2) align the rule with practices and policies that have developed and changed since the first version of the rule was issued, and (3) reduce the burden on the Units, according to HHS. In addition to incorporating statutory changes, the revised rule also recognizes the Office of the Inspector General’s (OIG) delegated authority, adds definitions, clarifies organizational requirements, amends prosecutorial authority requirements, and puts in communication requirements. In addition, other changes are made regarding Unit duties and responsibilities, staffing, recertification, federal financing participation and disallowance procedures (Final rule, 84 FR 10700, March 22, 2019).

Incorporating statutes. The amended final rule incorporates statutory changes that have occurred since 1977, specifically: (1) extending funding for State MFCUs by authorizing a Federal matching rate of 90 percent for the first 3 years of operation and a Federal matching rate of 75 percent after that, (2) establishing a Medicaid State plan requirement that a state must operate an effective Unit, (3) requiring the Secretary of Health and Human Services to establish standards under which Units must be operated, (4) allowing Units to seek approval from the relevant Inspector General to investigate and prosecute violations of state law related to fraud in any aspect of the provision of health care services and activities of providers of such services under any Federal health care program, including Medicare, as long as the fraud is primarily related to Medicaid, and (5) giving Units the option to investigate and prosecute patient abuse or neglect in board and care facilities, regardless of whether the facilities receive Medicaid payments. HHS notes that these statutory changes were self-implementing and have been operational since their statutory effective dates.

Recertification Requirements. Annual reports are no longer required for recertification. The rule outlines what the OIG does need, including the submission of reapplication materials and statistical data.

FUN FACT! MICHIGAN MFCU, AT ONE POINT NEVER SUBMITTED ANNUAL REPORTS TO HHS OIG.

Organizational requirements. The regulation clarifies that to be a single, identifiable entity of state government, a MFCU must have a single director with all staff reporting to him or her, operate under a budget that is separate from that of its parent agency, and have offices in their own mainly contiguous space.

Prosecutorial authority. Consistent with longstanding practice, amendments are made to the prosecutorial authority requirement options to include the prosecution of patient or resident abuse and neglect, and to include formal written procedures for making referrals to the State Attorney General or another office with statewide prosecutorial authority.

Communication with Medicaid agency. Under the amended final rule, the agreement with the Medicaid agency must establish (1) regular communication, (2) procedures for coordination, and (3) procedures by which the Unit will receive referrals of potential fraud from managed care organizations.

Duties regarding investigations. Units must submit all convictions to OIG, for purposes of program exclusion, within 30 days of sentencing. Also, a Unit must make information available to OIG investigators and attorneys, or other Federal investigators and prosecutors, on Medicaid fraud and investigations or prosecutions involving the same suspects or allegations.

Staffing requirements. The final rule clarifies that Units may choose to employ professional employees as full or part-time employees if they devote their exclusive effort to Unit functions. Also, consultants may be employed, employees may work at other jobs, and Units must train professional employees on Medicaid fraud and patient or resident abuse and neglect matters.

Data mining and other changes. With some exceptions, Units may not receive federal financial participation (FFP) for data mining activities that duplicate surveillance and utilization review responsibilities of state Medicaid agencies. However, Units may engage in activities other than data mining to identify fraud, such as efforts to increase referrals through program outreach activities. Procedures are created in the final rule for OIG disallowances of FFP and for Unit requests for reconsideration and appeal of disallowances. Amendments are also made to the CMS regulation 42 CFR 455.21 to require that the Medicaid agency has an agreement with the Unit.

Medicaid Fraud Control Units Final Rule 3-22-2019 by Beverly Tran on Scribd

FYI: Lockheed used to run Title IV-D child support.

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