Michigan Medicaid Fraud Control Game

There are times when I become just utterly disgusted with blatant lies.  This is one of them.

I recently submitted a FOIA to find information on Michigan's Medicaid Fraud Control Unit.  I called the Office of Attorney General who referred me to the Michigan Department of Community Health.

The FOIA was quite simple.  All I did was to take the federal statute, and cut and paste the criteria for the Medicaid Fraud Control Unit.

  1. Details of Statewide authority to prosecute individuals for violations

  of criminal laws with respect to fraud in the provision or administration
  of medical assistance under the State plan;

  2. Assurances for referral from all State Departments for violations of

  criminal laws with respect to fraud in the provision or administration of
  medical assistance under the State plan;

  3. The organizational structure and chart;
  4. The number of employees, description of duties and qualifications for
  all professional positions;
  5. Federal Memorandum of Agreement and/or orders, if any;
  6. Copy of agreement with the Department of Community Health;
  7. Annual reports of Fiscal Years 2001, 2002, 2003, 2004, 2005, 2006,

  2007, 2008, and 2009; and,

  8. Projected operations and budget for FY 2010

The reason why is because I was tired of the games and it personally hurts.

Medicaid fraud in child welfare is horrific and no one will speak upon this crime.  For years, there are reports generated by the State Auditor General and it gets brushed aside by legislators.  The most recent report documents almost $5 billion in questionable costs.  The only thing that happened was a hearing in Lansing where everyone looked around the room staring at each other, rambling big words on correcting the situation.  It was a joke.

I filed an action to make the state, in accordance to its own laws, stop Medicaid fraud by referring to the Attorney General for prosecution and recovery.  Within a few weeks of my filing, the following was produced:

Michigan Medicaid Integrity Program

After some public posturing, the position of Medicaid Inspector General was created....
Michigan Executive Order On Creation of Health Services Inspector General
...in the Department of Community Health.

This takes us back to the FOIA.

I received, today response to my query on the structure, operations and authority of the Medicaid Fraud Control Unit.  It was a package with an organizational chart of the Department of Community Health, a copy of Senate Bill No.1152 and a bill.

The Department has identified approximately 19,460 pages of documents responsive to your request.  Using the hourly wage of the lowest paid department staff capable of searching for, retrieving, reviewing, examining, and separating exempt material, the cost for processing the request is calculated as follows:

•   20 hours labor @$22.15 per hour to search and retrieve records..............................................................................................................$443.00
•   20 hours labor @$22.15 per hour to review, examine and separate exempt from non-exempt records..............................................................................................................$443.00
•    19,460 pages @ .25 per page.......................................................................$4,865.00
• Total..............................................................................................................$5,751.00

TRANSLATION:  We do not have the information you requested because it does not exist.  If we charge you exorbitant amounts, knowing that you could never possibly pay it and pretty secure in the fact that you will you use the information in litigation against us, we ain't giving you shit.

I can easily FOIA the U.S. Department of Health and Human Services Office of Inspector General and say,

"Dr. Levinson, did you know the stuff Michigan Office of Attorney General sends in to garner your approval for its Medicaid Fraud Control Unit does not exist?  The Department of Community Health, State Medicaid Director, just sent me a FOIA response saying it does not exist so I was wondering if you would have your staff send it to me, because, of course, you did approve its operations and fund 90% of the Medicaid Fraud Control Unit which does absolutely nothing to end Medicaid fraud as the state does not comply with its own assurances for referral when there is suspect of Medicaid fraud.  I would really appreciate it if you would send those docs to me so I can give them to the Office of Attorney General and the Department of Community Health.  I promise to upload each doc to my Scribd account.

I will do that later.  Stay tuned.

I am a public official.  That means whatever I say goes on public record; therefore, let the record reflect that I am officially calling upon the Democratic candidate for the Office of Attorney General for the State of Michigan, David Leyton, to address the issues of the Medicaid Fraud Control Unit and what will be done to end Medicaid fraud in child welfare.

My following may be small but those who visit my site are powerful.  Let Mr. Leyton know I will be looking for him at Cobo Hall.

Michigan Gives

The Michigan Department of Community Health (DCH) has initiated Medicaid policy proposal that will impact the way the state deals with the need for services.

What makes this policy proposal so progressive is that it will expand the role of Medicaid funding to provide proactive services to new mothers.

The focus is on home visits by physicians prior to the birth and immediately after to "prescribe" needed services to new mothers. This will include transportation to medical appointments and housing assistance.

In the event further assistance is necessary, the physicians will work with Child Protective Services to provide further services.

Instead of relying upon the current state policies of taking children into the child welfare system in order to create eligibility of services, this policy will eliminate that criterion.

My only concerns would be in the area of Receipient Rights. DCH has in place, a formal grievance policy, but I would like to see this new policy proposal to reflect the mandatory informing of each client.

This would also demand further policy changes within the Department of Human Services (DHS) and the Department of Attorney General for uniform implementation to address potential fraud, waste and abuse. An example would be the mandatory reporting of all violations of law to the Attorney General Medicaid Fraud Control Unit.

The policy will even empower the people to provide the transparency and accountability by encouraging program oversight and report fraud, waste and abuse.

What excites me the most is that these new policies expand the potential usage of Targeted Case Management and may be viewed as job creation. By this I mean Michigan, being a service-orientated state, will evolve a new future industry by investing in its people. Jobs in the areas of education, health care, home repair and transportation would not be through the traditional corporate structure, but may be the beginning of an entrepreneurial trend of allowing home businesses to contract with the state. This will be the new privatization.

Since Ingenix has the contract with DHS to maintain a database for services, it must cooperate with DCH, the Auditor General and the Attorney General for the DCH policy to have maximum effect.

Who knows, if Michigan can execute this and establish health information technology, the state may just be able to adjust its Federal Funding Participation rate.

Now, dismantle Michigan Children's Institute (MCI) as it is contradictory to this policy initiative. 

MCI Superintendent Bill Johnson bases his decisions to grant or withhold grant to adoption, including the power to make or change the placement of a child, based on the needs this policy addresses.  Even though this only affects a small portion of the state population, it is still an antiquated belief that poverty is considered as abuse and neglect. 

This policy allows, the state to give to the child, not to take the child.

Michigan Medicaid Policy Proposal 2010

Public comments are encouraged. Comments on this proposed policy are due March 26, 2010.

Comments may be forwarded to Judith Tubbs at tubbsj@michigan.gov or to the address noted on the attached transmittal sheet.

Michigan Database Begins To Grow

The necessity of this central database was a result of the aberrant billing practices of the contractual arms of DHS and its county departmental level providers.

There has never been oversight of any of the operations within the state child welfare system as SCAO has demonstrated, in multiple Auditor General reports, that fraud is a standard in its activities.

This is the first time the state will begin warehousing credible data, as it has been well documented, even on county levels with its own Auditor General reports, that false billing and fraudulent documentation has allowed Medicaid fraud in child welfare to flourish. Collaboration needs to include the Department of Community Health, as the Director is the State Medicaid Director.

The final missing component to the construction of this database is for the legislature to mandate that any suspicion or substantiation of violation of federal or state law be immediately reported to the attorney general for prosecution and recovery. As it currently stands, the state's Medicaid Fraud Control Unit does nothing in the realms of acknowledging Medicaid fraud in child welfare.

An effort of this magnitude will be for naught if there is not included, a regulation mechanism, and that is reporting to the Attorney General. Recoveries of funds and efficiency of operations can now exist through contractual debarments, sanctions, license revocation, and fines.

Most importantly, there needs to be more transparency and accountability in the ability of consumers and whistleblowers to report questionable billing activities to the Attorney General Medicaid Fraud Control Unit, further allowing the Attorney General and the Auditor General to investigate double-billing, false claims, kiddy kickbacks, Stark law violations, and other forms of fraud, waste and abuse.

Ingenex needs to be under statutory control to report quarterly all activities.

Michigan is embarking on a groundbreaking initiative, but this may only be successful if all agencies are involved: Auditor General, Attorney General, Department of Community Health, Department of Human Services, SCAO. If not, then it shall be business as usual, meaning the state will continue its downward spiral of fiscal integrity, all done in the best interest of the child.

Michigan turns to data warehousing to improve child services

January 19, 2010
by Jeffery Smith

The state of Michigan recently announced the expansion of a pilot program, using data warehousing and analytics to develop performance measurements for children enrolled in protection services. Both the State Court Administrative Office (SCAO) and the Michigan Department of Human Services (MDHS) are using Ingenix technology to improve children’s safety, health and living situation stability.

First developed in 1994, Michigan was the first state in the nation to use data warehousing technology to monitor Medicaid quality of care, fraud, abuse and overpayment. For the last year, a pilot project launched in Genesee, Saginaw and Livingston counties have completed nine of 62 performance measurements to improve child welfare.

“Our goal is to do a better job protecting the children in our care, who may be in an abusive or neglectful environment, by measuring our performance and prioritizing the areas that need improvement most,” State Court Administrator Carl Gromek said in a statement.

As the administrative arm of the Michigan Supreme Court, SCAO is charged with collecting data on courts’ caseloads, including case history and type. SCAO is also in charge of child welfare oversight when the courts make a decision and they can act as advisor to the court when children are or may become court wards.

For the current project, SCAO teamed with MDHS in order to share information accumulated by each agency to protect children, DHS Director Ismael Ahmed said. “We’re pleased to work with SCAO on this ambitious effort. It’s an excellent example of working not only across agencies, but across branches of government, to achieve a worthwhile goal – in this case, doing everything we can to protect children,” he said.

MDHS has over 16,000 children currently receiving foster care, residential or adoptive placement services. And last year, more than 124,000 complaints of child abuse and neglect were filed with DHS. In addition to MDHS and SCAO, the Michigan Department of Community Health (MDCH) has expanded the data warehouse to include information from the state’s largest programs.

Ingenix is providing the informational and analytical backbone for the project, which seeks to monitor performance and case management in five areas: Safety, Permanency, Due Process, Timeliness and Well-being. more

Michigan, this is only the beginning. Thank you for finally listening.

Michigan Adopts Transparency and Accountability

It is always easy to stand up and complain, but it is more honorable to create and present solutions. Michigan has stood up to take a leadership role in transparency and accountability in child welfare through information technology.

This pilot program is only the first step, breaking grounds to erect a national edifice to end fraud, waste and abuse in child welfare.

I cannot hail the work of the Michigan State Court Administrative Offices, Department of Human Services, and Department of Community Health enough on this initiative.

This centralized database has so many future implications and applications, the most important being the dismantling of the archaic Michigan Children's Institute, because I am sure the Superintendent would not grant the state consent to this adoption. Let's come together as a nation and help Michigan raise its two newly adopted children, Transparency and Accountability.

Congratulations, Michigan, Welcome to the 21st Century! Bravissimo!! And thank you, Ingenix!!!

Michigan State Government Uses Technology to Enhance Child Protection Services

LANSING, Mich. & EDEN PRAIRIE, Minn.--(BUSINESS WIRE)--
Two branches of Michigan state government are sharing information and using advanced analytics to better protect and care for children in a program slated to expand this year.
The State Court Administrative Office (SCAO) and the Michigan Department of Human Services (MDHS) have piloted a program in Genesee, Saginaw and Livingston counties aimed at measuring and improving performance and accountability in cases involving child abuse, neglect, foster care, adoption, and legal guardianship among the 16,000 children enrolled in child welfare services in Michigan. The program will expand to include additional performance measures this year.
The goal is to improve children’s safety, health and living situation stability – known as “permanency” – and to improve compliance with due process and timeliness in the court’s disposition of cases.
Both agencies are working in partnership with Ingenix, a leading health information, technology and consulting company, which is developing the analytics and performance measurements for the program. SCAO and MDHS data are included in Michigan’s statewide data warehouse – one of the most comprehensive in the nation – which serves as the informational and analytical backbone for the project.
“This collaboration with MDHS and the use of advanced technologies will help us achieve our ultimate goal of improving the lives of Michigan’s children,” said State Court Administrator Carl Gromek. “Our goal is to do a better job protecting the children in our care, who may be in an abusive or neglectful environment, by measuring our performance and prioritizing the areas that need improvement most.”
“We’re pleased to work with SCAO on this ambitious effort,” said DHS Director Ismael Ahmed. “It’s an excellent example of working not only across agencies, but across branches of government, to achieve a worthwhile goal – in this case, doing everything we can to protect children.”
The specific performance measurements, 62 in all, are based on recommendations in a white paper titled Building a Better Court: Measuring and Improving Court Performance and Judicial Workload in Child Abuse and Neglect Cases, published jointly by the American Bar Association’s Center of Children and the Law, the National Center for State Courts, and the National Council of Juvenile and Family Court Judges.
The measurements are divided into five areas:

• Safety: To ensure that children are safe from abuse and neglect while under court jurisdiction
• Permanency: To ensure that children have stability and permanency in their living situations
• Due Process: To ensure that cases are dealt with impartially and based on evidence before the court
• Timeliness: To enhance the “expedition to permanency” by minimizing the time from filing of the petition to take jurisdiction over the child to permanency
• Well-being: To examine and address factors other than safety and permanency that relate to a child’s future welfare. There are specific measures within this area that focus on physical health, mental health, and special education needs.

The Michigan program has been in the pilot stage for the past year. So far nine of the 62 measures for Genesee, Saginaw and Livingston counties have been completed. The nine measures, compiled from data already stored on the data warehouse, will be expanded during 2010. SCAO’s Child Welfare Services (CWS) division was awarded a federal Court Improvement Program (CIP) grant to help fund the project.
Measurements in the five areas provide officials with the opportunity to improve performance in very specific ways. For example, the “Timeliness” category measurements include: “Number of days from initial petition to adjudication” of court cases, and “number of hours from initial complaint intake to the commencement of the investigation.” The “Permanency” measurements include: “number of placement changes each child has had during each foster care episode;” and “number of children who are dismissed from court jurisdiction at age 18 and over and have two or more of the following within 6 months of emancipation,” with the choices that follow including high school diploma/GED, steady employment, housing, entering college or trade-school, and several others. “Well-being” measurements include “percentage of cases where children are placed together” and “percentage of children with identified health needs receiving services to address the need.”
The program is already delivering results. For example, from late 2008 through August of 2009, the State increased family reunifications 34 percent among temporary court wards (TCW). This is a group of children who were identified in a Michigan children’s rights lawsuit as having remained in the system for one year or longer. By combining the “timeliness” and “permanency” measures, the State can identify and work on reuniting children with their families, thereby bringing them to a more permanent living situation faster.
“Michigan has once again shown its national leadership by using advanced technologies to address pressing societal issues – in this case, the protection of children,” said Shelby Solomon, executive vice president, commercial and government health plan solutions at Ingenix. “We are pleased to be part of this breakthrough initiative that facilitates collaboration between two branches of Michigan’s government to conduct the analysis necessary to improve the well-being of these children.”
Michigan began its work with Ingenix in 1994 with the creation of the nation’s first Medicaid data warehouse to monitor claims for quality of care, overpayment and fraud/abuse. Since then, Ingenix and Michigan have worked closely to expand the data warehouse to include information from most of the state’s largest programs, agencies and departments, including SCAO, MDHS, and the State’s Department of Community Health (MDCH).
About Michigan SCAO
The Michigan State Court Administrative Office (SCAO) is the administrative agency of the Michigan Supreme Court, charged with helping the trial courts operate effectively so that they can better serve the public. Among its many responsibilities are: collecting data on courts’ caseloads, including the types of cases each court hears and how long it takes to resolve cases; and overseeing courts’ involvement in various child welfare issues, and offering ways to improve courts’ handling of cases involving children who are or may become court wards.
About Michigan DHS
The Department of Human (DHS) is Michigan's public assistance, child and family welfare agency. DHS directs the operations of child protection, child welfare, public assistance and service programs through a network of over 100 county Department of Human Services offices around the state. Last year, DHS fielded more than 124,000 complaints of child abuse or neglect, and currently serves more than 16,000 children in foster care, residential, or adoptive placement.
About Ingenix
Ingenix, a UnitedHealth Group (NYSE: UNH [FREE Stock Trend Analysis]) company, is a leading provider of health information, technologies and consulting services. Organizations, institutions, businesses and government agencies that comprise the health care system depend on Ingenix solutions and insights to improve their performance. Visit www.ingenix.com for more information.


Michigan State Court Administrative Office (SCAO)
Marcia McBrien, 517-373-0129
Public Information Officer
or
Michigan Department of Human Services (DHS)
Edward Woods III, 517-373-7394
Director of Communications
or
Ingenix
Steve Puleo, 978-294-6418
Corporate Communications