Michigan Needs To Take A Lesson From North Carolina Attorney General Office

A few years ago I posted on the North Carolina Medicaid SWAT Team and the fabulous work of Attorney General Roy Cooper.  Yes, I am shamelessly a Roy Cooper fan.

What is of great interest to me in this particular article is the warm relationship between the the N.C. Department of Health and Human Services and the state's Medicaid Fraud Control Unit.  

What I see is a partnership, far beyond a funded, mandated Medicaid Integrity Program.  I see referrals.  I see communication.  I see partnership in accountability and transparency.  I see innovation. I see program improvement, increased efficiency and improved delivery of services.  I see reduction in health care costs.  I see Electronic Health Records and functional information technology infrastructure of the state.

What I do not see is any of what I have just mentioned in the State of Michigan.  Michigan is so bad with Medicaid fraud it had to have DOJ/HHS HEAT Task Force come in and set up shop.  Detroit was one of 5 cities picked to set up shop because the Attorney General, Mike Cox, was too busy having fun.  Still, nothing has changed except Attorney Generals.

Mr. Schuette, I am so disappointed with you.  We shall do lunch, soon.

DHHS investigating dozens of alleged billing fraud cases

The N.C. Department of Health and Human Services has investigated 75 cases for potential Medicaid billing fraud and has already referred 35 cases to the N.C. Attorney General’s office.

Using data analytics software from IBM, DHHS combed through 75 cases that showed what it called “questionable billing practices by Medicaid outpatient behavioral health providers.” Of those, 35 cases totaling $21 million were referred to the special Medicaid Investigations Unit of the Attorney General’s office.

The practices were not listed by name, though 13 were in Wake County and four were in Durham County. DHHS spokeswoman Chrissy Pearson said the names of the practices were confidential because they have been referred for a criminal investigation. If charges are filed, the names of those being investigated would then be public record.

More referrals could be forthcoming if DHHS finds more suspicious billings.

Voting is beautiful, be beautiful ~ vote.©

North Carolina Medicaid Fraud Reporting Campaign

State warns against Medicaid fraud

DHHS Secretary Lanier Cansler is requesting that the posters be displayed in prominent locations inside more than 70,000 provider offices and state/county agencies.

Part of DHHS’ new “Medicaid fraud and abuse cost YOU!” campaign, the posters encourage citizens to report Medicaid fraud, waste and abuse to the Division of Medical Assistance (DMA) via a toll-free hotline, 1-877-DMA-TIP1 (1-877-362-4871).

Or report an online complaint.

And do not forget to thank Attorney General Roy Cooper for this groundbreaking initiative to end Medicaid fraud in child welfare.

Love ya, Roy! Send me a poster!

North Carolina Medicaid Swat Team

Governor Beverly Perdue of North Carolina has teamed up with her Attorney General to create a Medicaid Swat Team.

North Carolina began the creation of this action by including TRICARE in an investigation of child welfare fraud. This, still to this day, is the only instance where child welfare fraud was examined from the direction of military health care.

I can only speculate (until I call the Attorney General) that is this Medicaid Swat Team is a product of the Medicaid Fraud Control Unit.

Since North Carolina is being such a progressive state in attacking Medicaid fraud (unlike Michigan), I am willing to put some money down that the state will develop the very first model to approach child welfare fraud from inside the structures of government. (I have the other models.)

All I can say is, thank you Governor Perdue, but I am still in love with Roy Cooper.

Gov. Perdue Kicks Off Campaign to Crack Down on Medicaid Fraud, Waste and Abuse

Posted on April 14, 2010. Filed under: North Carolina Medicaid | Tags: Medical practice insurance audit, NC Medicaid, NC Medicaid Audits, NC Medicaid MIC, North Carolina Medicaid Integrity Contractor |

Gov. Bev Perdue today announced a series of aggressive measures to set government straight by cracking down on Medicaid fraud, waste and abuse that costs taxpayers millions of dollars each year. The steps include stronger investigation and prosecution of potential abusers, including new Medicaid SWAT teams, better use of technology to detect and prevent abuse, and a campaign to encourage the public and providers to report suspected abuse.

“In these tough times, when Medicaid enrollment is growing even as we face deep budget shortfalls, we must do more to root out waste and crack down on folks who are abusing or defrauding Medicaid,” said Perdue. “Tens of millions of taxpayer dollars each year are wasted on Medicaid fraud, waste and abuse. It’s got to stop and we will not allow it to continue.”

A new software system in DHHS will bring the detection of potential Medicaid fraud into the 21st century, by quickly analyzing thousands of Medicaid claims and flagging suspicious cases. Once identified, the most egregious cases will go to newly created Medicaid SWAT teams, specially trained investigators who will quickly deploy to investigate providers or consumers identified as potential abusers of the system.

Gov. Perdue also called for toughening North Carolina’s anti-fraud laws by stopping kickbacks to providers that refer patients for Medicaid services and ending the practice of soliciting patients for services they don’t need.

Gov. Perdue announced these new initiatives at a press conference at Rex Hospital in Raleigh. She also called for doubling the staff size of the Attorney General’s Medicaid Investigations Unit and an aggressive awareness campaign to encourage individuals and providers to report Medicaid fraud, waste and abuse when they suspect it.

“Medicaid fraud hurts our state’s most vulnerable residents and robs taxpayers,” said Attorney General Roy Cooper, whose Medicaid Investigations Unit handles criminal and civil cases. “Adding more investigators and ways to detect fraud is the right direction to go to stop those who abuse the system.”

The Attorney General’s Medicaid Investigations Unit is composed of investigators, auditors, attorneys and State Bureau of Investigation agents who look into cases of fraud, abuse and neglect of residents in medical facilities that receive Medicaid funding. Proceeds from civil settlements typically reimburse Medicaid and penalties go to North Carolina public schools. Last year, the unit recovered $52 million, with a 10-year total of more than $300 million recovered.

North Carolina Begins the End of Child Welfare Fraud

It looks like we have the beginnings of federal action to end Medicaid fraud in child welfare.

Owner of Fayetteville childcare centers pleads guilty to fraud

The owner of a chain of Fayetteville childcare centers pleaded guilty Friday to bilking money from government programs.

Sandra Elliot, 47, pleaded guilty before U.S. District Judge Terrence W. Boyle to federal charges of health care fraud and aiding and abetting, according to U.S. Attorney George E.B. Holding's office.

Elliot was charged in December after a joint federal and state investigation into Learning Links Educational Network Services Center Inc., which Elliot opened in 2006.
According to a news release, Learning Links claimed to provide early intervention treatment for children with developmental delays or anger management problems.
The company, which eventually operated three locations in Fayetteville, one in Dunn and had plans to open others, also claimed to provide tutoring for children enrolled at the center.

To pay for the services, Learning Links primarily billed and received payments from Medicaid and Tricare, both of which are government-run benefit programs.
Although the exact amount of money fraudulently received still is being calculated, the release said, Elliot stipulated that the fraud exceeded $1million and forfeited two automobiles, a recreational vehicle and $201,791.

A sentencing date has not been announced. Elliot could face as many as 10 years in federal prison followed by three years of supervised release and a fine of $250,000.
The case was investigated by the Defense Criminal Investigative Service, the North Carolina Department of Justice Medicaid Fraud Investigations Unit, the Tricare Program Integrity Office and the Health Net Federal Services Office of Program Integrity.

A search of Learning Links locations in 2009 allowed law enforcement to confirm that the centers employed non-licensed personnel, provided unwarranted therapy and billed for services not rendered, according to the release.

Investigators said that in some instances, children who allegedly received the services weren't even in the state on the billed date of service.
In other instances, the company billed for services to children several months after the children stopped treatment, and practitioners no longer working for the company still were being listed as the provider of services.

In a 2007 interview with The Fayetteville Observer, Elliot said she had taught in inner-city schools in Washington, D.C., for 12 years. Later, she taught in North Carolina schools and worked in special education programs in Wake, Cumberland and Durham counties, she said.

Tricare is the military equivalent to Medicaid and Medicare.

Thank you North Carolina and U.S. Attorney Office for officially kicking off the national campaign to end Medicaid fraud in child welfare!

Roy Cooper, I love you!