Be Very Medicaid Fraudulently Quiet

In an editorial posted October 22, 2009, the Michigan Department of Community Health Director, Janet Olszweski, drastically failed to identify numerous key issues, outside of “efforts to leverage federal funding” as to why the state is challenged in meeting the needs of the people.

Ms. Olszweski has failed to identify herself as the State Medicaid Director. The role of the State Medicaid Director is to establish policy under the guidance and clarification from the U.S. Department of Health and Human Services (DHHS) Centers for Medicare and Medicaid Services (CMS). Unfortunately, she has neglected to address Medicaid policy in dealing with fraud, waste and abuse.

Senator Kahn recently introduced SB 942 calling for the creation of a State Medicaid Inspector General to open discussions surrounding Auditor General reports documenting evidence of over $1 billion in Medicaid fraud, waste and abuse.

As it stands, the state is in a position of a future decrease in the Federal Funding Percentage, meaning it will loose even more federal dollars. The program’s funding levels have remained stagnant since 2000 because the state is not in compliance with federal funding mandates.

Olszewski may place the state in a precarious position if she were to raise the issue of Medicaid fraud, waste and abuse because the Michigan Medicaid Fraud Unit, housed in the Department of Attorney General and funded DHHS, does absolutely no activities in prosecution and recovery of Medicaid fraud, waste and abuse in child welfare, as it would be an inherent conflict of interest: the Attorney General cannot prosecute itself.

In essence, if the State Medicaid Director even whispered one word regarding the issue of Medicaid fraud, Michigan would be faced with even more substantial cuts in federal funding or possible federal receivership.

There is funding for program services and the opportunity for even more and efficient servicing will only come once the state takes a mea culpa stance for dropping the ball on accountability and transparency, because it never refers violations of federal and state law in Medicaid funded programs to the Attorney General.

Until the state implements policy for contractual debarment, revocation, sanctions and prosecution for recovery of funds in dealing with Medicaid fraud, waste and abuse, the only recourse for the existence of Medicaid funded programming will be through begging and taxing, at the expense of our most vulnerable populations.

Fiscal Fiasco

Fri. 07/10/09 07:59 AM
The Detroit News

Survey Tax: cut to close deficit

If the state continues to minimize the budget crisis by limiting its options to "cut and tax", we are in for a bumpy ride.

There are other ways of addressing the fiscal fiasco. The first, and foremost would be to implement some oversight mechanisms for Medicaid funded programs. In particular, I speak of those social programs that are protected under the Freedom of Information Act. The top of the list would be the state's child welfare system because anything dealing with children's issues are sequestered from public scrutiny.

As these programs function devoid of any accountability, the first instance would be to effectuate financial sanctions and contractual debarment with privatized agencies. Then, as most privatized agencies operate as not-for-profit, they are excluded from external audits. The largest federally funded component of child welfare is not the Social Security Title IV-E, as everyone would like to believe, it is Medicaid: Targeted Case Management.

Secondly, the state needs to decrease its percentage in the federal formula for Medicaid funding. Right now it is at 50%. It seems it is more cost effective for the state to continue sinking money into a dysfunctional child welfare system than come into federal compliance with its operations, such as enforcing existing accountability statutes in dealing with fraud. Even though there is a resounding paranoia of violating the federal settlement agreement, only dealing with a portion of the child welfare system, this is not justification for miserably failing to address waste and abuse by the funding of fraudulent activities.

Thirdly, Michigan needs to finally step up to the plate and start aggressively going after Medicaid fraud in child welfare. If the Attorney General is ever able to release himself from the statutory constraint of only advocating for transgressors of law, the recovery percentage of the federal portions of the fraud would be situated at 10%, bringing back in billions of lost funds from over the past few years.

Simply put, the state cannot prosecute itself. Michigan Federation for Children and Families, accredits the fraudulent activities of these privatized child placing agencies through its lobbying and non-existent continuous quality improvement operations.

Lastly, as Michigan is the only state that does not breakdown its Medicaid spending reports, no one knows how much is streamed through child welfare and adults. This means top heavy local administrations do not have to streamline the operations of child welfare because they are held accountable to nobody, not even the taxpayer. Basically, it's a "don't ask; don't tell" policy in dealing with waste, abuse, and fraud in child welfare.

The answer to this fiscal fiasco is sitting right under the noses of our state leaders, published in the State Auditor General Reports.

If the state will not do anything, then I will.

Beverly Tran

Hamtramck City Council Candidate
beverlytran, Michigan, MI

Where Are The Children?

Wednesday, July 8, 2009

Cox considers Medicaid fraud unit

Associated Press

The Detroit News

Lansing -- Michigan Attorney General Mike Cox wants the state to create an independent office to investigate Medicaid fraud.

Cox on Wednesday backed bills being drafted by Republican lawmakers in the Michigan Legislature. The bills would create an office with powers to oversee and audit Medicaid systems and records separate from the state's Department of Community Health.

Cox says that would lead to better enforcement and discovery of fraud, potentially saving the state more than $100 million a year. He says six other states have similar offices.

Cox is one of the candidates seeking to become the Republican nominee for governor in 2010.

What makes this item so interesting is that I thought the Attorney General was already receiving federal funding for this...


About The Health Care Fraud Division

Medicaid Fraud Control Unit

Medicaid, or the Medical Assistance Program, was established by Congress in 1965. The Medicaid Program is administered at the State level by the Medical Services Administration in the Department of Community Health. The Michigan Medicaid program, over $4.5 billion, is 50% funded by the Federal government and 50% funded by the State of Michigan. Medicaid helps eligible individuals and families who need assistance paying medical bills.

In 1977, the United States Congress recognized that fraud was occurring in the Medicaid program and that special investigative/prosecution units were required. As a result, legislation was passed providing for the establishment of state Medicaid Fraud Control units. In 1978, the Office of Attorney General created a Medicaid Fraud Control Unit, and it was certified by the Federal government the same year. In 1986, it became the Health Care Fraud Division of the Attorney General's office.

The division is comprised of attorneys, investigators, auditors, other professionals and support staff. Pursuant to Federal certification, it has jurisdiction to investigate and prosecute Medicaid provider fraud and abuse and neglect in facilities receiving Medicaid dollars. The division also has jurisdiction to seek civil recovery of fraudulently obtained Medicaid dollars.

Health Care Fraud

The Health Care Fraud Division exists to identify, prosecute, and prevent fraudulent activity by doctors, dentists, pharmacists, and other health care providers participating in the Medicaid program. Allegations of misappropriation of patient trust funds and identity theft in resident care facilities are also investigated. Taxpayer dollars provide health care to indigent patients and other recipients. It is vital that these dollars be effectively spent to help those in need. Fraud affects everyone--the recipients of care, the taxpayers who pay for it, and the overwhelming majority of providers who conscientiously provide quality care.

Since its inception, the HCFD has obtained criminal restitution orders totaling $7,401,187.70; civil judgments totaling $11,082,643.53; and settlement agreements providing for the recovery of $3,137,154.65 to the Medicaid Program. In total, the HCFD has obtained court orders and settlements requiring the return of $21,620,985.88 to the Medicaid Program. Additionally, the HCFD has collected $1,131,397.15 from Medicaid providers to offset the HCFD's investigation and prosecution costs.

Nursing Home Abuse/Neglect

The worth of a society is often measured by the care and protection afforded to its weak and dependent members. No one should live in fear of being harmed, especially by persons legally charged with and paid for attending to his or her needs. The Health Care Fraud Division investigates and prosecutes Medicaid-funded health care facilities and their employees who harm or neglect their patients or residents.

Not every instance of patient injury is the result of a crime. Inappropriate non-criminal treatment to a patient or resident of a health care facility should be reported to the facility through the administrator, director of nursing, or the charge nurse, AND to the Department of Community Health, which has a statutory obligation to monitor and assess the care rendered to patients.

Now, what's wrong with this picture?

HINT: There are no children.