Michigan Department of Human Services Audit 2009. Auditor's reports identify a total of $834.8 million in known and likely known questionable costs and identifies significant deficiencies in internal controls.
And to think, this is just an estimate based upon sample. The part that I really enjoyed questioned all Wayne County reimbursements.
This could not have come at a worse time as the state is in the eleventh hour of budget talks.
Michigan Department of Human Services Audit 2009
Showing posts with label beverlytran. Show all posts
Showing posts with label beverlytran. Show all posts
Thursday, September 24, 2009
Sunday, September 20, 2009
Ahmed's Administrative Angst
The Michigan Department of Human Services Director, Ismeal Ahmed is out there, using social media, to lobby, oops, I mean rally the child placing agencies, drats, I mean inform the public on the potential impact of the proposed budget cuts to DHS.
In this unrehearsed, cue card reading presentation, Mr. Ahmed starts his spiel on the severe crisis families, dependent upon the state's social support system, will experience. I was somewhat shocked that there were no photos of abused and neglected kids, a long-standing traditional state technique I like to call "throwing-dead-babies." See, whenever DHS is put in the hot seat, being questioned about fulfilling its administrative duties of running an efficient agency, someone always seems to start screaming "more child protection." Here is an example of how it works:
"These cuts are too large, too deep, too damaging, and undermine the safety net needed to protect so many vulnerable children, adults and families," Ahmed said.
He is absolutely correct if the administration of DHS continues along its merry way of turning a blind eye to the pervasive fraud, waste and abuse.
Mr. Ahmed points out that the proposed cuts would also:
* Eliminate the program that helps low-income parents pay for childcare.
* Eliminate the Early Childhood Investment Corp. and its programs that foster school readiness and life success for young children.
* Make a $10 per person, per month cut in the Family Independence Program, which helps families with living expenses such as rent, utilities, clothing and personal care items.
* Reduce the State Disability Assistance program grant which helps people who are disabled and the elderly.
These are pretty compelling points of contention to not cut the the DHS budget, but this is asymmetrical in its presentation of facts.
The truth of the matter is DHS is paranoid of violating the settlement agreement with the Children's Rights class action lawsuit. One of the conditions of the settlement was to hire more CPS workers. If DHS does not hire more workers, then, I am guessing DHS is looking at exemplary damages. The price of the recovery of attorney fees cost Michigan $6.2 million.
Despite the Michigan DHS Audit of 2004 which questions over $600 million in costs and the DHS Audit of 2006 which questions another $600 million in costs nothing really has changed. DHS still refuses to initiate contractual debarment, fines or sanctions of the sub-recipient fraudfeasor. I will save you the angst in not providing a summation of all the DHS single audit program questioned costs.
And just think, the legislature is only proposing a cut of $169 million. Whatever shall Mr. Ahmed do? Reign in on the fraud, waste and abuse in DHS or close his eyes really, really tight and hold up a baby as a shield from public scrutiny. Oh, the administrative angst!
Now, here is another interesting item. Mr. Ahmed claims that the loss of DHS workers would create a barrier for individuals and families to access services. I will close this out by directing you to watch another DHS youtube creation.
Friday, September 18, 2009
An ARRA Model to stop Medicaid Fraud in Michigan Child Welfare
AN ARRA MODEL OF ACCOUNTABILITY AND TRANSPARENCY
On February 17, 2009, President Obama signed into law the American and Reinvestment Act of 2009, Public Law 111-5 (ARRA). This Act provided $787 billion of federally financed economic stimulus finding through a combination for spending programs and reductions in business and individual taxes. Michigan will receive hundreds of millions of dollars of the ARRA funds. A main component of the ARRA is to have in place an effective process to prevent and ameliorate waste, abuse, and fraud.
As Michigan has been selected as one of sixteen states that will be monitored over the next three years to provide an analysis of the use of funds under the ARRA, the opportunity exists to create new businesses and jobs by developing a model of accountability and transparency that may be implemented across the nation.
LEGISLATIVE ANALYSIS
REVISED STATUTES OF 1846 (EXCERPT) MCL 14.29 § 29, CL. 1948: The auditor general is vested with the power to request the attorney general to prosecute matters within its department.
CONSTITUTION OF MICHIGAN OF 1963, ARTICLE IV, § 53, Eff. Jan. 1, 1964: This establishes the appointment, qualifications, term, removal, post audits, and authority of the auditor general and his authority.
EXECUTIVE ORGANIZATION ACT OF 1965 (EXCERPT) Act 380 of 1965 MCL 16.182 § 82, Eff. July 23, 1965: Transfers by a type III transfer to the department of treasury and abolishes the office of the elected auditor general.
THE MANAGEMENT AND BUDGET ACT (EXCERPT) Act 431 of 1984, MCL 18.1461 § 461 Eff. March 22,1999: Established audit of federal grants awarded to state in accordance to Public Law 104-156, chapter 75 of title 31 of the United States Code, 31 U.S.C. 7501 to 7507 pertaining to audit evaluation of the internal controls of this state and the state's compliance with material features of laws and regulations related to major federal assistance programs.
EXECUTIVE REORGANIZATION ORDER (EXCERPT) E.R.O. No. 2007-22, Off. October 1, 2007: MCL 18.46 Transfer of powers and duties of internal auditors of principal departments under MCL 18.1486 and 18.1487 to office of the state budget director; transfer of powers and duties of principal departments to appoint and supervise internal auditor under MCL 18.1486 to state budget director.
COST BENEFIT ANALYSIS
Costs:
There are no costs associated with this bill, as its purpose is to reduce and ameliorate waste, abuse, and fraud.
Benefits:
1. The reduction and amelioration of waste, abuse, and fraud in federally funded grants will provide for the opportunity to more efficiently utilize funding and resources by targeting and capturing the recoupment of funding from fraudulent activities.
2. In turn, this will allow the state to receive 10 percent of the recoupment of the federal share of fraudulent claims.
3.
There will be a decrease in the state percentage of the formula match of its federal grants, further improving resources and operations of the state
4. Public image of the state as an ARRA accountability and transparency demonstration improves, encouraging new economic development.
IMPACT ANALYSIS
The impact of this bill will increase efficiency of state operations in the reduction and amelioration of waste, abuse, and fraud of federal funding and will demonstrate compliance with the ARRA and the U.S. Office of Management
Budget Circular A-133.
HOUSE BILL No.______
______________, 2009, Introduced by Reps. ___________ and _________ and referred to the Committee on __________________.
A bill to amend 2003 PA 1, entitled
"AUDITS AND EXAMINATIONS"
(MCL 13.101) by adding the term “annual” in section 1 and by adding sections 1a, 1b, 2a, 2b and 2c to chapter 13.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
CHAPTER 13
13.101 Auditor general; duties; powers; employment and compensation; influencing action of examiner as misdemeanor; definitions.
Sec. 1.
(1) The auditor general shall conduct ANNUAL audits and examinations of all branches, departments, offices, boards, commissions, agencies, authorities, and institutions of this state.
(a) THE AUDITOR GENERAL SHALL IMMEDIATELY REPORT ALL FINDINGS OF AUDITS AND EXAMINATIONS OF ALL BRANCHES, AGENCIES, AUTHORITIES, BOARDS, COMMISSIONS, DEPARTMENTS, INSTITUTIONS AND OFFICES OF THIS STATE TO THE LEGISLATURE.
(b) THE AUDITOR GENERAL SHALL IMMEDIATELY REFER VIOLATIONS OF STATE AND FEDERAL LAW TO THE ATTORNEY GENERAL.
(2) In connection with the audits and examinations described in this act, the auditor general may examine, or cause to be examined, the books, accounts, documents, records, performance activities, and financial affairs of each branch, department, office, board, commission, agency, authority, and institution of this state.
(3) Upon demand of the auditor general, deputy auditor general, or any person appointed by the auditor general to make the audits and examinations provided in this act, the officers and employees of all branches, departments, offices, boards, commissions, agencies, authorities, and institutions of this state shall produce for examination all books, accounts, documents, and records of their respective branch, department, office, board, commission, agency, authority, and institution and truthfully answer all questions relating to their books, accounts, documents, and records of their respective activities and affairs.
(4) In connection with audits and examinations described in this act, the auditor general, deputy auditor general, or any person appointed to make audits and examinations may issue subpoenas, direct the service of the subpoena by any police officer, and compel the attendance and testimony of witnesses; may administer oaths and examine any person as may be necessary; and may compel the production of books, accounts, papers, documents, and records. The orders and subpoenas issued by the auditor general, deputy auditor general, or any person appointed with the duty of making the examinations provided in this subsection may be enforced upon application to any circuit court as provided by law.
(5) The auditor general may employ and compensate auditors, examiners, and assistants as he or she considers necessary. In addition, the auditors, examiners, and assistants shall be paid their necessary traveling expenses while engaging in the duties provided under this act. Compensation and expenses shall be paid out of the funds appropriated for that purpose. The auditor general and the deputy auditor general shall receive their actual traveling expenses incurred while engaging in the duties provided under this act, which shall be paid out of the funds appropriated for that purpose.
(6) Any person who gives or offers to any examiner, accountant, clerk, or other employee of the auditor general, any money, gift, emolument, or thing of value for the purpose of influencing the action of the examiner or other employee, in any matter relating to the examination of any public account authorized by this act, or for the purpose of preventing or delaying the examination of any public account, or for the purpose of influencing the action of the examiner or other employee, in framing, changing, withholding, or delaying any report of any examination of any public account, is guilty of a misdemeanor, punishable by a fine of not more than $1,000.00 nor less than $200.00, or imprisonment for not more than 6 months and not less than 30 days, or both.
(7) Any person appointed by the auditor general to make the examinations provided for under this act, or any officer, clerk, or other employee of the auditor general, who receives or solicits any money, gift, emolument, or anything of value for the purpose of being influenced in the matter of the examination of any public account authorized by this act, or for the purpose of being influenced to prevent or delay the examination of any public account, is guilty of a misdemeanor, punishable by a fine of not more than $1,000.00 and not less than $200.00, or imprisonment for not more than 6 months and not less than 30 days, or both.
(8) As used in this act:
(a) “Audit” means a post audit of financial transactions and accounts or performance audit as described in section 53 of article IV of the state constitution of 1963.
(b) “Auditor general” means the individual appointed auditor general under section 53 of article IV of the state constitution of 1963.
(c) “Examination” means an inquiry, compilation, or review within the scope of the auditor general's authority under section 53 of article IV of the state constitution of 1963.
SEC. 2. SPECIAL ASSISTANT AUDITORS.
(a) THE AUDITOR GENERAL MAY CONTRACT WITH THE FOLLOWING STATE LICENSED ENTITIES: CERTIFIED PUBLIC ACCOUNTANS; QUALIFIED MANAGEMENT CONSULTANTS; ATTORNEYS; AND OTHER PERSONS OR FIRMS NECESSARY TO CARRY OUT THE DUTIES OF THE OFFICE. FOR THE PURPOSE OF ASSISTING IN PERFORMAANCE AUDITS, THE AUDITOR GENERAL MAY CONTRACT WITH ANY STATE AGENCY. THE AUDITOR GENERAL MAY CONTRACT WITH OTHER GOVERNMENTAL AGENCIES FOR THE CONDUCT OF JOINT AUDITS OF A STATE AGENCY OR A PORTION THEREOF.
(b) THE AUDITOR GENERAL SHALL ADOPT RULES ESTABLISHING QUALIFICATIONS FOR NON-LICENSED PERSONS WITH WHOM HE MAY CONTRACT.
(c) THE AUDITOR GENERAL MAY DESIGNATE ANY PERSON WITH WHOM HE CONTRACTS AS A SPECIAL ASSISTANT AUDITOR FOR THE PURPOSE OF CONDUCTING A POST AUDIT OR INVESTIGATION UNDER HIS SUPERVISION. THE AUDITOR GENERAL MAY DELEGATE HIS POWERS AND AUTHORITY RESPECTING POST AUDITS AND INVESTIGATIONS TO SPECIAL ASSISTANT AUDITORS OTHER THAN THE POWER OF SUBPOENA, BUT ANY DELEGATION OF AUTHORITY TO ADMINISTER OATHS OR TAKE DEPOSITIONS MUST BE MADE IN WRITING AND LIMITED TO A PARTICULAR AUDIT OR INVESTIGATION.
Tuesday, September 15, 2009
U.S. House Ways and Means Testimony on the revisiting of implementation for the Fostering Connections to Success and Increasing Adoptions Act of 2008
September 15, 2009
To the Honorable Members of the Ways and Means Committee:
Greetings and Salutations
My name is Beverly Tran and I rise to this occasion to thank you for listening to the voice of the people, for it has been silenced for far too long. I share with you my sole concern with the implementation of the Fostering Connections to Success and Increasing Adoptions Act of 2008 (P.L. 110-351), and that is a lack of checks and balances.
Understanding the failure of implementation
Since 2001, I have been seeking the explanation of parental rights. More than just a statutory definition, I sought to understand its epistemology beyond the general consensus of social theory.
Why had there yet to be demonstrated a logically constructed, conceptual and operational formula for the determining factor of parental rights? My only recourse was to deconstruct the policies of child welfare. What I found was the existence of a well-founded methodology in determining parental rights, including its clear and concise evidentiary standard. The foundation of parental rights had been laid many centuries ago in property law, theorized through microeconomics.
The reason child welfare, specifically child protective services, foster care and adoption, in its current state, will never meet its end goal of functioning in the best interest of the child with the current implementation of this Act, is because no one understands what it is that is being protected. It is not the child, per say, but the future of the child to mature to be a tax-paying contributor to society.
No one understands that checks and balances of the child welfare system do not exist.
Child welfare as a frontier industry
Child welfare must not be understood as an industry that was constructed to maximize the profits of society through the best interests of the child, but it must be understood as a profit-maximizing industry that has schemes to increase its inputs, throughputs and outputs to ensure the economic sustainability of the public and private contractual arms of the states. Inputs are children who enter child welfare; throughputs are foster children; and, outputs are those children that exit the system, whether through reunification, adoption, maturation or attrition.
The Fostering Connections Act can be properly implemented, but only if this Congress understands that there needs to be a substantial change in its current operations by implementing checks and balances.
A lack of market regulation
Since foster care and adoption statutorily became a fully, publicly funded industry in 1974, it has operated strictly with federal funding and regulations, only in the form of financial penalties if the market shows signs of weakness, as states must meet and exceed the previous year’s federally mandated benchmark of the number of children under the auspices of the state to avoid financial penalties. The market is devoid of competition as the government is monopolistic with its statutory control and possesses sufficient authority to acquire the goods and procure the services, through the removal of the child by and through the removal of the legal rights to the grant of custody and guardianship.
Upon further examination, it will be demonstrated that it is the right of the state to grant the custody and guardianship, for it is the state that is the possessor of parental rights to the acquisition of goods.
Due to the lack of this understanding, federal and state policies have been improperly formatted and implemented. We, as a nation have witnessed the residual effects of a system devoid of oversight, and that is our financial system. Now, we are experiencing the second wave of fraud as our national leadership is fast asleep at the helm of the ship named health care.
Child welfare operates in a risk aversive market, as it intentionally never included the oversight mechanism of accountability and transparency; there are no checks and balances, hence, no incurred liabilities from error.
The mechanical error that I have identified is the systemic deficiency of checks and balances, embedded deep within the ethos of foster care and adoption. Checks and balances, essential elements in tripartite governments, must be readily recognized as accountability and transparency.
No accountability
If it has been determined that law and policy has been violated within the mechanical procedures of foster care and adoption, it is considered as an acceptable mistake, with a federally acceptable range of error of 0.10. This acceptable error is the destruction of a family.
Nothing is publicly reported, not even for the purposes of ameliorating future material and provisional violations of law and policy, particularly those committed under the color of law. This phenomenon is largely due to an inherent conflict of interest breed within the philosophical edifice of the child welfare system. Under the doctrine of parens patriae, the states attorney general have been granted the powers of parental rights through statutory declarations of commerce.
It thus becomes a contentious issue of intervention: “Do the states attorney general advocate to further a compelling governmental interest in the representation of the state and its contractual arms of child welfare, or do the states attorney general advocate for the citizen individuals who have been granted the gift of custody and guardianship? The child welfare system, in whole, incorporating all facets of the industry, functions on the fallacy of affirming the disjunct, that is, the government operates in good faith and there is no need to advocate for the citizen individuals who allegedly violated the granted gift of custody and guardianship.
Simply put, it is in the best interests of the child for government to invest in the profitable return of a future tax-paying, productive citizen, and not to advocate for the non-productive individual citizen, for that individual has violated the social compact in failing to contribute to the society as a whole, whether it be morally, intellectually, financially, or economically. Because of the belief government functions in good faith, there is no need to construct and implement a congruent system of checks and balances in child welfare. The crime of poverty has been justified.
Public disenfranchisement
Where public access and voter participation into the mechanical process of this market are the checks, the general public is disenfranchised because child welfare law and policies are neither put up for public discussion nor full disclosure. Even more so, a targeted population is specifically disenfranchised because children are not allowed the right to vote.
Child welfare protects and preserves itself by importing policies to obviate transparency and accountability, whereby, it has manufactured obfuscatory policies to terminate parental rights of the granted gift of custody and guardianship to “cloak” the industry of abuse and neglect.
That "cloak", for which I reference, is laced with public policies to create the tapestry of public perceptions, to conceal the inner workings of the industry of child welfare. This cloak is impenetrable to empirical analysis, as it is hermetically sealed by the Freedom of Information Act, and the institutionalized belief that sealed information of child welfare policies furthers a compelling governmental interest. That compelling governmental interest is the general welfare of the public, now and in the future.
When the 1974 Child Abuse Prevention Treatment Act was designed, a fatal flaw was inculcated into 1997 Adoption Safe Families Act, and its subsequent legislative actions. I speak again of the lack of checks and balances. This philosophical tenet is embedded deep within core of public belief, woven into the historical fabric of society and engrained into the academic discipline of policy analysis, where nothing could be of the contrary. Initial funding streams from Social Security Title I, Title II, Title IV-A, B, D and E, Title V and Medicaid Targeted Case Management (TCM), as well as others, were created to flow down to the states to care for abused and neglected children who were qualified as impoverished under the means test of Title IV-A under the Temporary Aid to Needy Families (TANF). Simply put, poverty is codified as abuse and neglect and the discipline of Social Work has generated the only literature of analysis, which has been mostly qualitative.
No transparency
Under the Eleventh Amendment of the United States Constitution, states possess sovereign immunity from prosecution of wrongdoing by the federal government. Immunity is then draped to circumvent accountability and transparency in non-reporting/non-disclosure through Freedom Of Information Act exceptions. Basically, anything dealing with errors in child welfare cases, more intuitively recognized as fraud, waste and abuse, is kept from the public for the protection of the child, justifying the lack of need for exclusionary databases and reporting protocol.
Due to the lack of transparency, federal and state policies have been improperly formatted and implemented. We, as a nation have witnessed the residual effects of a system devoid of oversight, and that is our financial system. Now, we are experiencing the second wave of attack on our nation’s economic security as our national leadership have been fast asleep at the helm of the ship named health care. The monster named Medicaid fraud has victoriously raised its ugly head, with no one to battle, until now.
Sunshine initiatives
I take this time to honor a great man, former U.S. Attorney General Michael B. Mukasey, for personally inspiring me to continue my work to end Medicaid fraud in child welfare. He is the first leader to listen and speak out on the need for investigation on the levels of political corruption, fraud, waste and abuse in the U.S. Administration for Children and Families through the early initiatives of the Health Care Fraud Enforcement Task Force (H.E.A.T.)
I take this time to thank the dedication of U.S. Attorney Eric H. Holder, Jr., U.S. DHHS Secretary Kathleen Sebelius, U.S. DHHS Inspector General Daniel R. Levinson for listening to the people and developing the Strike Forces to end Medicare fraud in child welfare.
As it stands, there is no system of “checks and balances” to maintain the integrity of operations and best interests for all stakeholders involved in the implementation of this Act. The amount of power and money involved in child welfare is massive, involving multiple funding streams of Social Security and Medicaid, yet pails to the levels of fraud, waste and abuse of taxpayer dollars. Poverty is codified as the crime of abuse and neglect for eligibility of a child entering foster care is strictly based on being impoverished. Hence, as poverty increases so shall the number of child removals to foster care. Billions of dollars of federal fraud were found through only cursory audits conducted by the U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG) and U.S. Department of Justice, but this shall be no longer for the people have been heard.
The OIG has identified a number of state financing arrangements and other revenue-maximization tactics that inappropriately increase Federal Medicaid payments to States. Children are being double-billed, provided for unnecessary medical services and phantom programs are funded that bill fictitious children and services. This is what is called fraud, or more intuitively, federal false claims. Every year, lawyers across the nation are settling an increased number of lawsuits against states, child placing agencies and foster parents to the tune of tens of billions of taxpayer dollars, all because the nation has not had the opportunity to be exposed to the child welfare industry for what it is: a market.
U.S. DHHS funded organization, Council On Accreditation, has nothing to do with children and families as they only lobby for their due-paying, state contracted, private agencies. An accreditation organization is not supposed to be established to advocate for transgressors of law, but it does.
It is time to hold these privatized child placing agencies to the same standards they hold the guardians of children. If the agencies possess the empowering authority to remove children and advocate termination of parental rights, then, in the same wielding of justice, the state should possess the empowering authority to remove licenses and terminate contractual relationships, and effectuate contractual debarment with these child placing agencies. The regulatory mechanism of the OIG exclusion database is in place but is not utilized.
Implementation recommendations
Improve regulation
As these child welfare programs function devoid of any accountability, the first instance of oversight would be to effectuate financial sanctions and contractual debarment with privatized agencies through the state licensing agencies. Privatized agencies operate as not-for-profit, therefore excluding them from external audits. Typically, child placing agencies self-report on an honor system because it is too costly for a state to retain the manpower and resources to properly ensure that each entity is in compliance with the requirements or receiving federal funds pursuant to the Office of Management and Budget Circular A-133. It becomes more cost-effective for a state to turn its head and allow fraudulent billing to occur than to enforce regulation.
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 and Optional Targeted Case Management. States need to decrease its percentage in the federal formula for Medicaid funding. Right now it is approximately 50%. It becomes more cost effective for a 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. Assumption may be formulated that some states use a portion of the Federal Funding Percentage to meet its State Funding Percentage. This can only be disproved with regulation.
Encourage State Medicaid Fraud Units to prosecute and recover
State Medicaid Fraud Units need 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 and demonstrating exemplary standards to deter future fraudulent transgressions.
These state units can be encouraged to work with its citizens, as they may be the eyes and ears of regulation through public awareness campaigns, whistleblower litigations, and state Medicaid False Claims statutes. As many abuse and neglect programs are riddled with fraudulent billing and poor or falsely generated performance reports, the only way of verifying this is to listen to the people.
Promote the funding of public legal defense and grievance databases
Unfortunately, one of the few ways a family can access medical, social, psychological services for children today is through a court classification of abuse and neglect. Social welfare assistance programs have been cut, but the only federal funding streams that has opened up to provide for those who need help has been foster care. It has come to the point where there are no other options.
A blueprint for accountability and transparency was never conceived in child welfare. When a social system has a zero error rating in decisions to remove children and/or terminate parental rights, no databases of grievances, sanctions, fines, contractual debarment, including violations of material provisions of law and policy, a red flag should immediately be raised. There is a greater possibility of being not found of murder than it is being not found guilty of child abuse and neglect, as the jurisprudence of dependency courts are unparallel to traditional courts, the adjudication standard being guilty, until proven innocent.
It is my hope that this Congress will direct a portion of this funding to legal defense and for the construction of a grievance database, similar to what is called for in the U.N. Intercountry Adoption Treaty to foster connections between the people, the U.S. DHHS OIG and U.S. DOJ AG to stop Medicaid fraud in child welfare.
Reinstatement of parental rights
If a system is to be viewed as balanced, there is always a counter-balance. This would be the reinstatement of parental rights. Currently, there are four states, which have some form of limited exceptions to reinstatements. Technology has removed the barrier of contact and time. In light of the crux of my position on Medicaid fraud, there does exist improper and unnecessary removals of children and termination of parental rights, by what is considered as being legally kidnapped. There are times where it may take an individual more than 12 months to obtain the help needed to succeed in life. We must understand the severance of a legacy has not proven to be the best means in dealing with the hardships of others. Let us take the time to reunite these children with the degrees of consanguinity and affinity so they may have a chance to connect to a profitable and successful future for their own best interests.
With sincerity and serenity,
Beverly Tran
To the Honorable Members of the Ways and Means Committee:
Greetings and Salutations
My name is Beverly Tran and I rise to this occasion to thank you for listening to the voice of the people, for it has been silenced for far too long. I share with you my sole concern with the implementation of the Fostering Connections to Success and Increasing Adoptions Act of 2008 (P.L. 110-351), and that is a lack of checks and balances.
Understanding the failure of implementation
Since 2001, I have been seeking the explanation of parental rights. More than just a statutory definition, I sought to understand its epistemology beyond the general consensus of social theory.
Why had there yet to be demonstrated a logically constructed, conceptual and operational formula for the determining factor of parental rights? My only recourse was to deconstruct the policies of child welfare. What I found was the existence of a well-founded methodology in determining parental rights, including its clear and concise evidentiary standard. The foundation of parental rights had been laid many centuries ago in property law, theorized through microeconomics.
The reason child welfare, specifically child protective services, foster care and adoption, in its current state, will never meet its end goal of functioning in the best interest of the child with the current implementation of this Act, is because no one understands what it is that is being protected. It is not the child, per say, but the future of the child to mature to be a tax-paying contributor to society.
No one understands that checks and balances of the child welfare system do not exist.
Child welfare as a frontier industry
Child welfare must not be understood as an industry that was constructed to maximize the profits of society through the best interests of the child, but it must be understood as a profit-maximizing industry that has schemes to increase its inputs, throughputs and outputs to ensure the economic sustainability of the public and private contractual arms of the states. Inputs are children who enter child welfare; throughputs are foster children; and, outputs are those children that exit the system, whether through reunification, adoption, maturation or attrition.
The Fostering Connections Act can be properly implemented, but only if this Congress understands that there needs to be a substantial change in its current operations by implementing checks and balances.
A lack of market regulation
Since foster care and adoption statutorily became a fully, publicly funded industry in 1974, it has operated strictly with federal funding and regulations, only in the form of financial penalties if the market shows signs of weakness, as states must meet and exceed the previous year’s federally mandated benchmark of the number of children under the auspices of the state to avoid financial penalties. The market is devoid of competition as the government is monopolistic with its statutory control and possesses sufficient authority to acquire the goods and procure the services, through the removal of the child by and through the removal of the legal rights to the grant of custody and guardianship.
Upon further examination, it will be demonstrated that it is the right of the state to grant the custody and guardianship, for it is the state that is the possessor of parental rights to the acquisition of goods.
Due to the lack of this understanding, federal and state policies have been improperly formatted and implemented. We, as a nation have witnessed the residual effects of a system devoid of oversight, and that is our financial system. Now, we are experiencing the second wave of fraud as our national leadership is fast asleep at the helm of the ship named health care.
Child welfare operates in a risk aversive market, as it intentionally never included the oversight mechanism of accountability and transparency; there are no checks and balances, hence, no incurred liabilities from error.
The mechanical error that I have identified is the systemic deficiency of checks and balances, embedded deep within the ethos of foster care and adoption. Checks and balances, essential elements in tripartite governments, must be readily recognized as accountability and transparency.
No accountability
If it has been determined that law and policy has been violated within the mechanical procedures of foster care and adoption, it is considered as an acceptable mistake, with a federally acceptable range of error of 0.10. This acceptable error is the destruction of a family.
Nothing is publicly reported, not even for the purposes of ameliorating future material and provisional violations of law and policy, particularly those committed under the color of law. This phenomenon is largely due to an inherent conflict of interest breed within the philosophical edifice of the child welfare system. Under the doctrine of parens patriae, the states attorney general have been granted the powers of parental rights through statutory declarations of commerce.
It thus becomes a contentious issue of intervention: “Do the states attorney general advocate to further a compelling governmental interest in the representation of the state and its contractual arms of child welfare, or do the states attorney general advocate for the citizen individuals who have been granted the gift of custody and guardianship? The child welfare system, in whole, incorporating all facets of the industry, functions on the fallacy of affirming the disjunct, that is, the government operates in good faith and there is no need to advocate for the citizen individuals who allegedly violated the granted gift of custody and guardianship.
Simply put, it is in the best interests of the child for government to invest in the profitable return of a future tax-paying, productive citizen, and not to advocate for the non-productive individual citizen, for that individual has violated the social compact in failing to contribute to the society as a whole, whether it be morally, intellectually, financially, or economically. Because of the belief government functions in good faith, there is no need to construct and implement a congruent system of checks and balances in child welfare. The crime of poverty has been justified.
Public disenfranchisement
Where public access and voter participation into the mechanical process of this market are the checks, the general public is disenfranchised because child welfare law and policies are neither put up for public discussion nor full disclosure. Even more so, a targeted population is specifically disenfranchised because children are not allowed the right to vote.
Child welfare protects and preserves itself by importing policies to obviate transparency and accountability, whereby, it has manufactured obfuscatory policies to terminate parental rights of the granted gift of custody and guardianship to “cloak” the industry of abuse and neglect.
That "cloak", for which I reference, is laced with public policies to create the tapestry of public perceptions, to conceal the inner workings of the industry of child welfare. This cloak is impenetrable to empirical analysis, as it is hermetically sealed by the Freedom of Information Act, and the institutionalized belief that sealed information of child welfare policies furthers a compelling governmental interest. That compelling governmental interest is the general welfare of the public, now and in the future.
When the 1974 Child Abuse Prevention Treatment Act was designed, a fatal flaw was inculcated into 1997 Adoption Safe Families Act, and its subsequent legislative actions. I speak again of the lack of checks and balances. This philosophical tenet is embedded deep within core of public belief, woven into the historical fabric of society and engrained into the academic discipline of policy analysis, where nothing could be of the contrary. Initial funding streams from Social Security Title I, Title II, Title IV-A, B, D and E, Title V and Medicaid Targeted Case Management (TCM), as well as others, were created to flow down to the states to care for abused and neglected children who were qualified as impoverished under the means test of Title IV-A under the Temporary Aid to Needy Families (TANF). Simply put, poverty is codified as abuse and neglect and the discipline of Social Work has generated the only literature of analysis, which has been mostly qualitative.
No transparency
Under the Eleventh Amendment of the United States Constitution, states possess sovereign immunity from prosecution of wrongdoing by the federal government. Immunity is then draped to circumvent accountability and transparency in non-reporting/non-disclosure through Freedom Of Information Act exceptions. Basically, anything dealing with errors in child welfare cases, more intuitively recognized as fraud, waste and abuse, is kept from the public for the protection of the child, justifying the lack of need for exclusionary databases and reporting protocol.
Due to the lack of transparency, federal and state policies have been improperly formatted and implemented. We, as a nation have witnessed the residual effects of a system devoid of oversight, and that is our financial system. Now, we are experiencing the second wave of attack on our nation’s economic security as our national leadership have been fast asleep at the helm of the ship named health care. The monster named Medicaid fraud has victoriously raised its ugly head, with no one to battle, until now.
Sunshine initiatives
I take this time to honor a great man, former U.S. Attorney General Michael B. Mukasey, for personally inspiring me to continue my work to end Medicaid fraud in child welfare. He is the first leader to listen and speak out on the need for investigation on the levels of political corruption, fraud, waste and abuse in the U.S. Administration for Children and Families through the early initiatives of the Health Care Fraud Enforcement Task Force (H.E.A.T.)
I take this time to thank the dedication of U.S. Attorney Eric H. Holder, Jr., U.S. DHHS Secretary Kathleen Sebelius, U.S. DHHS Inspector General Daniel R. Levinson for listening to the people and developing the Strike Forces to end Medicare fraud in child welfare.
As it stands, there is no system of “checks and balances” to maintain the integrity of operations and best interests for all stakeholders involved in the implementation of this Act. The amount of power and money involved in child welfare is massive, involving multiple funding streams of Social Security and Medicaid, yet pails to the levels of fraud, waste and abuse of taxpayer dollars. Poverty is codified as the crime of abuse and neglect for eligibility of a child entering foster care is strictly based on being impoverished. Hence, as poverty increases so shall the number of child removals to foster care. Billions of dollars of federal fraud were found through only cursory audits conducted by the U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG) and U.S. Department of Justice, but this shall be no longer for the people have been heard.
The OIG has identified a number of state financing arrangements and other revenue-maximization tactics that inappropriately increase Federal Medicaid payments to States. Children are being double-billed, provided for unnecessary medical services and phantom programs are funded that bill fictitious children and services. This is what is called fraud, or more intuitively, federal false claims. Every year, lawyers across the nation are settling an increased number of lawsuits against states, child placing agencies and foster parents to the tune of tens of billions of taxpayer dollars, all because the nation has not had the opportunity to be exposed to the child welfare industry for what it is: a market.
U.S. DHHS funded organization, Council On Accreditation, has nothing to do with children and families as they only lobby for their due-paying, state contracted, private agencies. An accreditation organization is not supposed to be established to advocate for transgressors of law, but it does.
It is time to hold these privatized child placing agencies to the same standards they hold the guardians of children. If the agencies possess the empowering authority to remove children and advocate termination of parental rights, then, in the same wielding of justice, the state should possess the empowering authority to remove licenses and terminate contractual relationships, and effectuate contractual debarment with these child placing agencies. The regulatory mechanism of the OIG exclusion database is in place but is not utilized.
Implementation recommendations
Improve regulation
As these child welfare programs function devoid of any accountability, the first instance of oversight would be to effectuate financial sanctions and contractual debarment with privatized agencies through the state licensing agencies. Privatized agencies operate as not-for-profit, therefore excluding them from external audits. Typically, child placing agencies self-report on an honor system because it is too costly for a state to retain the manpower and resources to properly ensure that each entity is in compliance with the requirements or receiving federal funds pursuant to the Office of Management and Budget Circular A-133. It becomes more cost-effective for a state to turn its head and allow fraudulent billing to occur than to enforce regulation.
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 and Optional Targeted Case Management. States need to decrease its percentage in the federal formula for Medicaid funding. Right now it is approximately 50%. It becomes more cost effective for a 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. Assumption may be formulated that some states use a portion of the Federal Funding Percentage to meet its State Funding Percentage. This can only be disproved with regulation.
Encourage State Medicaid Fraud Units to prosecute and recover
State Medicaid Fraud Units need 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 and demonstrating exemplary standards to deter future fraudulent transgressions.
These state units can be encouraged to work with its citizens, as they may be the eyes and ears of regulation through public awareness campaigns, whistleblower litigations, and state Medicaid False Claims statutes. As many abuse and neglect programs are riddled with fraudulent billing and poor or falsely generated performance reports, the only way of verifying this is to listen to the people.
Promote the funding of public legal defense and grievance databases
Unfortunately, one of the few ways a family can access medical, social, psychological services for children today is through a court classification of abuse and neglect. Social welfare assistance programs have been cut, but the only federal funding streams that has opened up to provide for those who need help has been foster care. It has come to the point where there are no other options.
A blueprint for accountability and transparency was never conceived in child welfare. When a social system has a zero error rating in decisions to remove children and/or terminate parental rights, no databases of grievances, sanctions, fines, contractual debarment, including violations of material provisions of law and policy, a red flag should immediately be raised. There is a greater possibility of being not found of murder than it is being not found guilty of child abuse and neglect, as the jurisprudence of dependency courts are unparallel to traditional courts, the adjudication standard being guilty, until proven innocent.
It is my hope that this Congress will direct a portion of this funding to legal defense and for the construction of a grievance database, similar to what is called for in the U.N. Intercountry Adoption Treaty to foster connections between the people, the U.S. DHHS OIG and U.S. DOJ AG to stop Medicaid fraud in child welfare.
Reinstatement of parental rights
If a system is to be viewed as balanced, there is always a counter-balance. This would be the reinstatement of parental rights. Currently, there are four states, which have some form of limited exceptions to reinstatements. Technology has removed the barrier of contact and time. In light of the crux of my position on Medicaid fraud, there does exist improper and unnecessary removals of children and termination of parental rights, by what is considered as being legally kidnapped. There are times where it may take an individual more than 12 months to obtain the help needed to succeed in life. We must understand the severance of a legacy has not proven to be the best means in dealing with the hardships of others. Let us take the time to reunite these children with the degrees of consanguinity and affinity so they may have a chance to connect to a profitable and successful future for their own best interests.
With sincerity and serenity,
Beverly Tran
Friday, September 11, 2009
Another classic example of Medicaid Fraud in child welfare
After I sit back down from another round of standing ovation to the FBI, I have to take the time to let everyone know that this ongoing investigation should be focusing on Kiddy Kickbacks in Medicaid fraud funding of this jail for kids scheme in Pennsylvania.
Two Former Luzerne County Court of Common Pleas Judges Indicted on Racketeering, Fraud, Money Laundering, Tax, and Related Charges
Dennis C. Pfannenschmidt, United States Attorney for the Middle District of Pennsylvania; Janice Fedaryck, Special Agent in Charge, Federal Bureau of Investigation; and Don Fort, Special Agent in Charge, Internal Revenue Service-Criminal Investigation Division, announced today that a federal grand jury sitting in Harrisburg has returned a 48-count indictment charging former Luzerne County Court of Common Pleas judges Michael T. Conahan and Mark A. Ciavarella, Jr. with racketeering and related charges in connection with alleged improper actions of the former judges to facilitate the construction and operation of juvenile detention facilities owned by PA Child Care, LLC and Western PA Child Care, LLC.
The indictment alleges that the defendants engaged in racketeering, fraud, money laundering, extortion, bribery, and federal tax violations and that they received millions of dollars in illegal payments. Along with the criminal charges, the indictment seeks the forfeiture of at least $2,819,500 which is alleged to be the proceeds of the charged criminal activity.
This investigation is being conducted by the Federal Bureau of Investigation and by criminal investigators of the Internal Revenue Service.
On April 8, the FBI issued a statement requesting the public’s assistance in this ongoing investigation. Anyone with information is asked to call the public corruption task force toll free at 1-866-996-4320.
This case is part of an on-going investigation by the Federal Bureau of Investigation and the Internal Revenue Service and is being prosecuted by a team of federal prosecutors led by Senior Litigation Counsel Gordon Zubrod and includes Assistant U.S. Attorneys William Houser, Michael Consiglio, Amy Phillips, and Criminal Division Chief Christian Fisanick. Pfannenschmidt praised this team of investigators and prosecutors for their tireless efforts on behalf of the people of Luzerne County.
An indictment or information is not evidence of guilt but simply a description of the charge made by the Grand Jury and/or United States Attorney against a defendant. A charged defendant is presumed innocent until a jury returns a unanimous finding that the United States has proven the defendant’s guilt beyond a reasonable doubt or until the defendant has pled guilty to the charges.
Two Former Luzerne County Court of Common Pleas Judges Indicted on Racketeering, Fraud, Money Laundering, Tax, and Related Charges
Dennis C. Pfannenschmidt, United States Attorney for the Middle District of Pennsylvania; Janice Fedaryck, Special Agent in Charge, Federal Bureau of Investigation; and Don Fort, Special Agent in Charge, Internal Revenue Service-Criminal Investigation Division, announced today that a federal grand jury sitting in Harrisburg has returned a 48-count indictment charging former Luzerne County Court of Common Pleas judges Michael T. Conahan and Mark A. Ciavarella, Jr. with racketeering and related charges in connection with alleged improper actions of the former judges to facilitate the construction and operation of juvenile detention facilities owned by PA Child Care, LLC and Western PA Child Care, LLC.
The indictment alleges that the defendants engaged in racketeering, fraud, money laundering, extortion, bribery, and federal tax violations and that they received millions of dollars in illegal payments. Along with the criminal charges, the indictment seeks the forfeiture of at least $2,819,500 which is alleged to be the proceeds of the charged criminal activity.
This investigation is being conducted by the Federal Bureau of Investigation and by criminal investigators of the Internal Revenue Service.
On April 8, the FBI issued a statement requesting the public’s assistance in this ongoing investigation. Anyone with information is asked to call the public corruption task force toll free at 1-866-996-4320.
This case is part of an on-going investigation by the Federal Bureau of Investigation and the Internal Revenue Service and is being prosecuted by a team of federal prosecutors led by Senior Litigation Counsel Gordon Zubrod and includes Assistant U.S. Attorneys William Houser, Michael Consiglio, Amy Phillips, and Criminal Division Chief Christian Fisanick. Pfannenschmidt praised this team of investigators and prosecutors for their tireless efforts on behalf of the people of Luzerne County.
An indictment or information is not evidence of guilt but simply a description of the charge made by the Grand Jury and/or United States Attorney against a defendant. A charged defendant is presumed innocent until a jury returns a unanimous finding that the United States has proven the defendant’s guilt beyond a reasonable doubt or until the defendant has pled guilty to the charges.
Sunday, September 6, 2009
Kiddy Kickbacks
Before diving into the world of what I call "kiddy kickbacks", let's begin by understanding the term,Kickback.
A kickback, under the theories of fraud, is generally when when a person provides false information to benefit from federal funds.
Recently, the U.S. DHHS OIG and U.S. DOJ AG partnership to end health care fraud, Detroit H.E.A.T. identified another multi-million dollar Medicare Fraud scheme. This is an excellent example to apply to Medicaid Fraud profit-maximizing schemes in child welfare.
In this particular setup, the clinic routinely billed the Medicare program for services that were medically unnecessary or were never provided. Patients were prescribed medications at the clinic based not on medical need, but on what medications were likely to generate Medicare reimbursements. Falsified medical files were maintained by the clinic to make the treatments purportedly being given there appear legitimate, when in fact they were not.
Medicare beneficiaries were not referred to the clinic by their primary care physicians, or for any other legitimate medical purpose, but rather were recruited to come to the clinic through the payment of kickbacks. In exchange for those kickbacks, the Medicare beneficiaries would visit the clinic and sign documents indicating that they had received the services billed to Medicare. Kickbacks came in the form of cash and prescriptions for narcotic drugs.
Now, here is how it works in child welfare:
Targeted Case Management is a Medicaid funding source in foster care and adoption. Child Placing Agencies (CPA) routinely bill the Medicaid program for services that were unnecessary or were never provided. These services could range from individual therapy for the child to MRIs. Children referred to mental health clinics by a CPA are prescribed medications at the clinics, not based on medical need, but on what medications were likely to generate Medicaid reimbursements. Falsified medical files are maintained by the clinic, the CPA and the courts to make the treatments purportedly being given there appear legitimate, when in fact they were not. The higher the dosage of medication, the higher level of payment. This scheme was explained in the court transcripts of the adoptive father of Ricky Holland that was murdered in Michigan.
The next question on everyone's mind is, "Why haven't I heard about this before?"
The answer is quite simple: Freedom of Information Act (FOIA).
Quite simply, under FOIA, anything dealing with a child, especially a child under the auspices of the state in foster care are protected from review and disclosure. The best part is when a child in foster care is adopted out, those records are not just sequestered from public scrutiny, they are shredded forever. There is no possible way for a federal audit to detect the blatant false claims and fraud...until now.
Kiddy Kickbacks go deeper than the FBI Medicare investigation I presented. In foster care, the entire system operates on kiddy kickbacks. It is relatively easy to find the connections, just look at the board of directors.
Let's start with the Archdiocese of Detroit.
For example, Robert Asmussen, is Vice President of Strategic Planning at St. John Health and is the Chairman, Board of Directors, St. Vincent and Sarah Fisher Center, a residential institution for foster care youth, I shut down. (I dare anyone to challenge me on that one.) Children who were physically harmed while at St. Vincent and Sarah Fisher Center were taken to Providence, a health care facility of St. John Health. As mandatory reporters, the doctors would never, ever, ever file incident reports to the state of children who were harmed.
St. John would shoot the kids back to St. Vincent Sarah Fisher Center to be diagnosed by Psychiatrist Howard Weiner, M.D., to be in need of higher dosages of medication, generating more reason for the children to remain in care and opening the door to increases in funding for higher levels of special needs.
Services were never provided to the children in St. Vincent Sarah Fisher Center but they were documented, signed by Dr. Weiner and submitted into court.
It gets better.
Patricia M. Moylan, Ph.D. would conduct physicals for the children at St. Vincent Sarah Fisher and submit for billing. Dr. Moylan was signing physicals for children she had never seen because on one document, she conducted a physical for a 12 year old girl, who was a boy. (Yes, I have the documents stored in various locations.)
But wait, there is more.
Judge Michael J. Talbot sits on the Michigan Judicial Tenure Commission. This is the place where one would file a complaint against a Referee or Judge challenge conduct and procedure in a child protection case. Needless to say, the Commission has never found any fraud, wrong doing, or any transgressions by the those presiding over cases. The reason why is most judges sit on the boards of these CPAs.
Just look at Michigan Supreme Court Justice Maura Corrigan. She is a Director of Vista Maria, a Commissioner of the Pew Commission on Children in Foster Care, and participates in various child welfare task forces. In fact, she focuses on funding, or rather the construction of federal funding-maximizing schemes for foster care, because we all know, the Chief Justice of the Supreme Court is the overseer of the State Court Administration Office, which is in charge of child welfare funding. Justice Corrigan is the former Chief Justice who ran her campaign telling the public to thank her for everything she has done for foster care and adoption in Michigan.
Then there is Nancy J. Diehl who has worked as a prosecutor for over 24 years and currently heads the Felony Trial Division in the Wayne County Prosecutor's Office overseeing the Child and Family Abuse Bureau. She lectures extensively throughout the state and nationally on domestic violence and child abuse investigation, prosecution and related issues. Diehl is the coauthor of four booklets pertaining to children and the legal system.
Not one CPA has ever been prosecuted in Wayne County. Even more interesting, it is the Attorney General who prosecutes abuse and neglect in Wayne County and not the county prosecutor.
In the end, Kiddy Kickbacks are a great way of keeping a system functioning at peak performance, never giving any cause for alarm of fraud. CPAs refer children to contracted psychological service providers. In turn, the service providers known as therapists and psychologists, generate court reports that will have the child medicated for higher levels of billing and longer stays in the system. As the end goal is termination of parental rights, the service providers guarantee court reports that will support the CPA activities. The more the service providers support the CPA activities, the more clients are referred to them. And that is what is called a Kiddy Kickback.
A kickback, under the theories of fraud, is generally when when a person provides false information to benefit from federal funds.
Recently, the U.S. DHHS OIG and U.S. DOJ AG partnership to end health care fraud, Detroit H.E.A.T. identified another multi-million dollar Medicare Fraud scheme. This is an excellent example to apply to Medicaid Fraud profit-maximizing schemes in child welfare.
In this particular setup, the clinic routinely billed the Medicare program for services that were medically unnecessary or were never provided. Patients were prescribed medications at the clinic based not on medical need, but on what medications were likely to generate Medicare reimbursements. Falsified medical files were maintained by the clinic to make the treatments purportedly being given there appear legitimate, when in fact they were not.
Medicare beneficiaries were not referred to the clinic by their primary care physicians, or for any other legitimate medical purpose, but rather were recruited to come to the clinic through the payment of kickbacks. In exchange for those kickbacks, the Medicare beneficiaries would visit the clinic and sign documents indicating that they had received the services billed to Medicare. Kickbacks came in the form of cash and prescriptions for narcotic drugs.
Now, here is how it works in child welfare:
Targeted Case Management is a Medicaid funding source in foster care and adoption. Child Placing Agencies (CPA) routinely bill the Medicaid program for services that were unnecessary or were never provided. These services could range from individual therapy for the child to MRIs. Children referred to mental health clinics by a CPA are prescribed medications at the clinics, not based on medical need, but on what medications were likely to generate Medicaid reimbursements. Falsified medical files are maintained by the clinic, the CPA and the courts to make the treatments purportedly being given there appear legitimate, when in fact they were not. The higher the dosage of medication, the higher level of payment. This scheme was explained in the court transcripts of the adoptive father of Ricky Holland that was murdered in Michigan.
The next question on everyone's mind is, "Why haven't I heard about this before?"
The answer is quite simple: Freedom of Information Act (FOIA).
Quite simply, under FOIA, anything dealing with a child, especially a child under the auspices of the state in foster care are protected from review and disclosure. The best part is when a child in foster care is adopted out, those records are not just sequestered from public scrutiny, they are shredded forever. There is no possible way for a federal audit to detect the blatant false claims and fraud...until now.
Kiddy Kickbacks go deeper than the FBI Medicare investigation I presented. In foster care, the entire system operates on kiddy kickbacks. It is relatively easy to find the connections, just look at the board of directors.
Let's start with the Archdiocese of Detroit.
For example, Robert Asmussen, is Vice President of Strategic Planning at St. John Health and is the Chairman, Board of Directors, St. Vincent and Sarah Fisher Center, a residential institution for foster care youth, I shut down. (I dare anyone to challenge me on that one.) Children who were physically harmed while at St. Vincent and Sarah Fisher Center were taken to Providence, a health care facility of St. John Health. As mandatory reporters, the doctors would never, ever, ever file incident reports to the state of children who were harmed.
St. John would shoot the kids back to St. Vincent Sarah Fisher Center to be diagnosed by Psychiatrist Howard Weiner, M.D., to be in need of higher dosages of medication, generating more reason for the children to remain in care and opening the door to increases in funding for higher levels of special needs.
Services were never provided to the children in St. Vincent Sarah Fisher Center but they were documented, signed by Dr. Weiner and submitted into court.
It gets better.
Patricia M. Moylan, Ph.D. would conduct physicals for the children at St. Vincent Sarah Fisher and submit for billing. Dr. Moylan was signing physicals for children she had never seen because on one document, she conducted a physical for a 12 year old girl, who was a boy. (Yes, I have the documents stored in various locations.)
But wait, there is more.
Judge Michael J. Talbot sits on the Michigan Judicial Tenure Commission. This is the place where one would file a complaint against a Referee or Judge challenge conduct and procedure in a child protection case. Needless to say, the Commission has never found any fraud, wrong doing, or any transgressions by the those presiding over cases. The reason why is most judges sit on the boards of these CPAs.
Just look at Michigan Supreme Court Justice Maura Corrigan. She is a Director of Vista Maria, a Commissioner of the Pew Commission on Children in Foster Care, and participates in various child welfare task forces. In fact, she focuses on funding, or rather the construction of federal funding-maximizing schemes for foster care, because we all know, the Chief Justice of the Supreme Court is the overseer of the State Court Administration Office, which is in charge of child welfare funding. Justice Corrigan is the former Chief Justice who ran her campaign telling the public to thank her for everything she has done for foster care and adoption in Michigan.
Then there is Nancy J. Diehl who has worked as a prosecutor for over 24 years and currently heads the Felony Trial Division in the Wayne County Prosecutor's Office overseeing the Child and Family Abuse Bureau. She lectures extensively throughout the state and nationally on domestic violence and child abuse investigation, prosecution and related issues. Diehl is the coauthor of four booklets pertaining to children and the legal system.
Not one CPA has ever been prosecuted in Wayne County. Even more interesting, it is the Attorney General who prosecutes abuse and neglect in Wayne County and not the county prosecutor.
In the end, Kiddy Kickbacks are a great way of keeping a system functioning at peak performance, never giving any cause for alarm of fraud. CPAs refer children to contracted psychological service providers. In turn, the service providers known as therapists and psychologists, generate court reports that will have the child medicated for higher levels of billing and longer stays in the system. As the end goal is termination of parental rights, the service providers guarantee court reports that will support the CPA activities. The more the service providers support the CPA activities, the more clients are referred to them. And that is what is called a Kiddy Kickback.
Sunday, August 30, 2009
How states pull the wool over the feds' eyes
The following string of excerpts from federal and Michigan audits and evaluations is a working example of Medicaid Fraud in Child Welfare:
"Michigan staff, both at the Central Office and county level, did an excellent job of preparing for the review. Records were extremely well organized with necessary documentation of eligibility requirement readily located. The State provided a “reviewer friendly” environment for the review to take place. Of note was the willingness and untiring efforts made by the Program Office in leading this effort. DHS licensing and field staff, in partnership with personnel from the SCAO and the Wayne County Department of Children and Family Services, were most efficient in obtaining additional information or acting as resources during the onsite review. Additionally, DHS’ fiscal unit is recognized for the thorough and updated payment histories.
Michigan staff actively and enthusiastically participated in reviewing the cases.
(That's because they successfully covered up the Medicaid Fraud.)
Exemplary is the collaborative relationship between DHS and the State Court. This was evident not only in the presence of either the current or former Chief Justices of the Supreme Court at the entrance or exit conference, but also in the excellent quality of court orders observed during the review. In particular, the involvement of SCAO is noted for conveying title IV-E requirements to the court, instituting revisions to court orders and garnering greater consistency in the use of those revisions among the county courts. The ongoing collaboration between DHS and SCAO is a strong mechanism to foster an understanding of the need for and timely occurrence of appropriate and meaningful judicial determinations for children within both the child welfare and legal communities."
U.S. Department of Health and Human Services, Administration for Children and Families, Michigan Title IV-E Foster Care, Secondary Eligibility Review, April 1, 2006 through September 30, 2006, Conducted the week of March 26 through 29, 2007
“The state averted the loss of nearly $40 million in child welfare funding, thanks in part to the work of judicial branch staff.”
Clifford W. Taylor, Michigan Supreme Court Chief Justice, Annual Report 2007
“If DHS did not improve, it faced a possible penalty of $22 million”…. “The U.S. Department of Health and Human Services conducted the second eligibility review of DHS’s case files for foster care maintenance payments issued between April 1, 2006 and September 30, 2006. Prior to the review, DHS conducted an extensive case file review to identify cases that did not meet Foster Care: Title IV-E Program eligibility requirements. For cases that DHS determined did not meet the Foster Care: Title IV-E Program eligibility requirements, DHS changed the funding source on the cases to a funding source other than Foster Care: Title IV-E Program before April 1, 2006… As a result, those cases were not in the population reviewed during the federal review…The federal review concluded that DHS was in substantial compliance with federal eligibility requirements for the period April 1, 2006 through September 30, 2006.
We issued a qualified opinion on the Foster Care: Title IV-E Program. Our conclusion is different from the federal review because our sample included cases from the entire audit period.
Michigan Auditor General, 2007
Licensing
During the (Michigan) onsite review, (federal) reviewers determined that criminal background checks were in evidence for all foster home files that were examined. In instances where children were placed in child caring institutions, reviewers determined that law enforcement checks had been done on administrators. Particularly noteworthy is Michigan’s practice of screening all licensed foster homes against its child abuse register on a weekly basis.
U.S. Department of Health and Human Services, Administration for Children and Families, Michigan Title IV-E Foster Care, Secondary Eligibility Review, April 1, 2006 through September 30, 2006, Conducted the week of March 26 through 29, 2007
DHS had not developed a formal policy that defined when and for what service types criminal background checks and educational qualifications should be required as a part of a human service contract (includes foster care).
Michigan Office of the Auditor General, Performance Audit of Human Service Contracting, Department of Human Services, April 2008, Report No.: 431-0110-05
"Michigan staff, both at the Central Office and county level, did an excellent job of preparing for the review. Records were extremely well organized with necessary documentation of eligibility requirement readily located. The State provided a “reviewer friendly” environment for the review to take place. Of note was the willingness and untiring efforts made by the Program Office in leading this effort. DHS licensing and field staff, in partnership with personnel from the SCAO and the Wayne County Department of Children and Family Services, were most efficient in obtaining additional information or acting as resources during the onsite review. Additionally, DHS’ fiscal unit is recognized for the thorough and updated payment histories.
Michigan staff actively and enthusiastically participated in reviewing the cases.
(That's because they successfully covered up the Medicaid Fraud.)
Exemplary is the collaborative relationship between DHS and the State Court. This was evident not only in the presence of either the current or former Chief Justices of the Supreme Court at the entrance or exit conference, but also in the excellent quality of court orders observed during the review. In particular, the involvement of SCAO is noted for conveying title IV-E requirements to the court, instituting revisions to court orders and garnering greater consistency in the use of those revisions among the county courts. The ongoing collaboration between DHS and SCAO is a strong mechanism to foster an understanding of the need for and timely occurrence of appropriate and meaningful judicial determinations for children within both the child welfare and legal communities."
U.S. Department of Health and Human Services, Administration for Children and Families, Michigan Title IV-E Foster Care, Secondary Eligibility Review, April 1, 2006 through September 30, 2006, Conducted the week of March 26 through 29, 2007
“The state averted the loss of nearly $40 million in child welfare funding, thanks in part to the work of judicial branch staff.”
Clifford W. Taylor, Michigan Supreme Court Chief Justice, Annual Report 2007
“If DHS did not improve, it faced a possible penalty of $22 million”…. “The U.S. Department of Health and Human Services conducted the second eligibility review of DHS’s case files for foster care maintenance payments issued between April 1, 2006 and September 30, 2006. Prior to the review, DHS conducted an extensive case file review to identify cases that did not meet Foster Care: Title IV-E Program eligibility requirements. For cases that DHS determined did not meet the Foster Care: Title IV-E Program eligibility requirements, DHS changed the funding source on the cases to a funding source other than Foster Care: Title IV-E Program before April 1, 2006… As a result, those cases were not in the population reviewed during the federal review…The federal review concluded that DHS was in substantial compliance with federal eligibility requirements for the period April 1, 2006 through September 30, 2006.
We issued a qualified opinion on the Foster Care: Title IV-E Program. Our conclusion is different from the federal review because our sample included cases from the entire audit period.
Michigan Auditor General, 2007
Licensing
During the (Michigan) onsite review, (federal) reviewers determined that criminal background checks were in evidence for all foster home files that were examined. In instances where children were placed in child caring institutions, reviewers determined that law enforcement checks had been done on administrators. Particularly noteworthy is Michigan’s practice of screening all licensed foster homes against its child abuse register on a weekly basis.
U.S. Department of Health and Human Services, Administration for Children and Families, Michigan Title IV-E Foster Care, Secondary Eligibility Review, April 1, 2006 through September 30, 2006, Conducted the week of March 26 through 29, 2007
DHS had not developed a formal policy that defined when and for what service types criminal background checks and educational qualifications should be required as a part of a human service contract (includes foster care).
Michigan Office of the Auditor General, Performance Audit of Human Service Contracting, Department of Human Services, April 2008, Report No.: 431-0110-05
Saturday, August 29, 2009
A Round of Applause for Detroit H.E.A.T.
Ladies and Gentlemen,
Let's stand up and give a round of applause to our new friends at the U.S. Department of Health and Human Services Office of Inspector General and the U.S. Department of Justice Attorney General for catching a Medicare Fraudfeasor!
This same, exact scheme is a mirror image of what is done in Medicaid. Instead of the area of physical therapy, you have it in foster care and adoption because children do not sign nor review the documents, and, parents are not privileged to even know what is going on with their own children.
Free reign on fraud, straight-up bilking tax dollars. No accountability, no transparency, no oversight.
Here is a real life example. I know because I talked to the people who were actually doing it, and I have the documents to prove it. And yes, the documents are cyber-filed protected.
In Wayne County, Michigan, there are no bids on state child placing agency (CPA) contracts. These 5 agencies provide services to abused and neglected children. Each year, the big 5 CPAs submit letters of renewal, that include an increase in the contractual fees.
Then, the big 5 submit billing to Wayne County for certain services provided to children. There is no human way possible to verify if the services were actually rendered. It is relatively economically impossible to even go through each and every billing statement to even see if the clients meet eligibility criteria. Here is an example:
In Wayne County foster care, they will use referrals to the Juvenile Assessment Center for adults. Yes, that is correct, adults. The majority of the time the services rendered to these "adults" are only on paper, the same paper that is submitted for billing reimbursements.
Then in Wayne County, you have employment services for children. Yes, employment services for children, where the county will conduct employment background checks to make sure these children are eligible for employment, sometimes 5 days a week. I would reveal who the check was made out to, but I do value my life.
But the fraud in foster care only gets better.
In Wayne County you have what is called the Will Smith/Bill Smith billing system. Basically, a child is taken into foster care and billed as a foster care child. Then, with a cut and a paste of the same Social Security number, Will becomes Bill, who is now a juvenile delinquent. And there you have it, double-billing.
Yes, there is a legitimate form of double-billing called "dual jackets". This is when a child is in one system and needs services from the other but a review of the records will show that the name remains the same.
I will be providing the Medicaid Fraud Strike Force with as much instruction as possible to assist in the detection, identification, and recovery. I want Michigan to be the model state.
I will also be coming out soon with my book to better understand how the industry functions.
Until then, bravissimo H.E.A.T., encore!
Department of Justice Press Release
For Immediate Release
August 26, 2009 United States Attorney's Office
Eastern District of Michigan
Contact: (313) 226-9100
Detroit Area Physical Therapist Pleads Guilty to Causing More Than $1.6 Million in Fraudulent Medicare Billing
Detroit area physical therapist Jay Jha, 45, pleaded guilty today to participating in a conspiracy to defraud the Medicare program of approximately $18.3 million. Jha, of Troy, Mich., pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Gerald Rosen. At sentencing, scheduled for Dec. 16, 2009, Jha faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to information contained in plea documents, Jha, a physical therapist licensed in the state of Michigan, began working in approximately February 2003 as a contract therapist for a co-conspirator. The co-conspirator owned and controlled several companies operating in the Detroit area that purported to provide physical and occupational therapy services to Medicare beneficiaries. Jha admitted that he, the co-conspirator, and others created fictitious therapy files appearing to document physical and occupational therapy services provided to Medicare beneficiaries, when in fact no such services had been provided. According to court documents, the fictitious services reflected in the files were billed to Medicare through sham Medicare providers controlled by co-conspirators.
In order to create the fictitious therapy files, Jha acknowledged that his co-conspirators paid cash kickbacks and other inducements to Medicare beneficiaries, in exchange for the beneficiaries’ Medicare numbers and signatures on documents falsely indicating that they had received physical or occupational therapy. Jha admitted that he was one of the licensed physical or occupational therapists from whom the co-conspirator obtained signatures on fictitious "progress notes" and other documents in the therapy files, falsely indicating that the therapists had provided therapy services to the Medicare beneficiaries on those dates.
During the course of the scheme, Jha admitted he signed approximately 336 fictitious physical therapy files indicating that he had provided physical therapy services to Medicare beneficiaries, when in fact he had not. Jha admitted that he was paid between $90 and $110 for each file that he falsified. Between approximately February 2003 and December 2005, Jha admitted that he falsified physical therapy files that supported claims to the Medicare program totaling approximately $1,680,000. Medicare actually paid approximately $772,800 on those claims. Jha admitted that, throughout the conspiracy, he was fully aware that Medicare was being billed for physical therapy services that he falsely indicated he had performed.
The case is being prosecuted by Trial Attorneys John K. Neal and Benjamin D. Singer of the Criminal Division’s Fraud Section and by Special Assistant U.S. Attorney Thomas W. Beimers of the Eastern District of Michigan. The FBI and the HHS Office of Inspector General (HHS-OIG) conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.
Since the inception of Strike Force operations in March 2007—Miami (Phase One), Los Angeles (Phase Two), Detroit (Phase Three), and Houston (Phase Four)—the Strike Force has obtained indictments of more than 293 individuals and organizations that collectively have billed the Medicare program for more than $680 million. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
Each of the Strike Force teams across the separate phases are led by a federal prosecutor from the Criminal Division’s Fraud Section or the U.S. Attorney’s Office. Each team has an agent from the FBI and HHS-OIG.
To learn more about the HEAT team, go to: www.stopmedicarefraud.gov
Let's stand up and give a round of applause to our new friends at the U.S. Department of Health and Human Services Office of Inspector General and the U.S. Department of Justice Attorney General for catching a Medicare Fraudfeasor!
This same, exact scheme is a mirror image of what is done in Medicaid. Instead of the area of physical therapy, you have it in foster care and adoption because children do not sign nor review the documents, and, parents are not privileged to even know what is going on with their own children.
Free reign on fraud, straight-up bilking tax dollars. No accountability, no transparency, no oversight.
Here is a real life example. I know because I talked to the people who were actually doing it, and I have the documents to prove it. And yes, the documents are cyber-filed protected.
In Wayne County, Michigan, there are no bids on state child placing agency (CPA) contracts. These 5 agencies provide services to abused and neglected children. Each year, the big 5 CPAs submit letters of renewal, that include an increase in the contractual fees.
Then, the big 5 submit billing to Wayne County for certain services provided to children. There is no human way possible to verify if the services were actually rendered. It is relatively economically impossible to even go through each and every billing statement to even see if the clients meet eligibility criteria. Here is an example:
In Wayne County foster care, they will use referrals to the Juvenile Assessment Center for adults. Yes, that is correct, adults. The majority of the time the services rendered to these "adults" are only on paper, the same paper that is submitted for billing reimbursements.
Then in Wayne County, you have employment services for children. Yes, employment services for children, where the county will conduct employment background checks to make sure these children are eligible for employment, sometimes 5 days a week. I would reveal who the check was made out to, but I do value my life.
But the fraud in foster care only gets better.
In Wayne County you have what is called the Will Smith/Bill Smith billing system. Basically, a child is taken into foster care and billed as a foster care child. Then, with a cut and a paste of the same Social Security number, Will becomes Bill, who is now a juvenile delinquent. And there you have it, double-billing.
Yes, there is a legitimate form of double-billing called "dual jackets". This is when a child is in one system and needs services from the other but a review of the records will show that the name remains the same.
I will be providing the Medicaid Fraud Strike Force with as much instruction as possible to assist in the detection, identification, and recovery. I want Michigan to be the model state.
I will also be coming out soon with my book to better understand how the industry functions.
Until then, bravissimo H.E.A.T., encore!
Department of Justice Press Release
For Immediate Release
August 26, 2009 United States Attorney's Office
Eastern District of Michigan
Contact: (313) 226-9100
Detroit Area Physical Therapist Pleads Guilty to Causing More Than $1.6 Million in Fraudulent Medicare Billing
Detroit area physical therapist Jay Jha, 45, pleaded guilty today to participating in a conspiracy to defraud the Medicare program of approximately $18.3 million. Jha, of Troy, Mich., pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Gerald Rosen. At sentencing, scheduled for Dec. 16, 2009, Jha faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to information contained in plea documents, Jha, a physical therapist licensed in the state of Michigan, began working in approximately February 2003 as a contract therapist for a co-conspirator. The co-conspirator owned and controlled several companies operating in the Detroit area that purported to provide physical and occupational therapy services to Medicare beneficiaries. Jha admitted that he, the co-conspirator, and others created fictitious therapy files appearing to document physical and occupational therapy services provided to Medicare beneficiaries, when in fact no such services had been provided. According to court documents, the fictitious services reflected in the files were billed to Medicare through sham Medicare providers controlled by co-conspirators.
In order to create the fictitious therapy files, Jha acknowledged that his co-conspirators paid cash kickbacks and other inducements to Medicare beneficiaries, in exchange for the beneficiaries’ Medicare numbers and signatures on documents falsely indicating that they had received physical or occupational therapy. Jha admitted that he was one of the licensed physical or occupational therapists from whom the co-conspirator obtained signatures on fictitious "progress notes" and other documents in the therapy files, falsely indicating that the therapists had provided therapy services to the Medicare beneficiaries on those dates.
During the course of the scheme, Jha admitted he signed approximately 336 fictitious physical therapy files indicating that he had provided physical therapy services to Medicare beneficiaries, when in fact he had not. Jha admitted that he was paid between $90 and $110 for each file that he falsified. Between approximately February 2003 and December 2005, Jha admitted that he falsified physical therapy files that supported claims to the Medicare program totaling approximately $1,680,000. Medicare actually paid approximately $772,800 on those claims. Jha admitted that, throughout the conspiracy, he was fully aware that Medicare was being billed for physical therapy services that he falsely indicated he had performed.
The case is being prosecuted by Trial Attorneys John K. Neal and Benjamin D. Singer of the Criminal Division’s Fraud Section and by Special Assistant U.S. Attorney Thomas W. Beimers of the Eastern District of Michigan. The FBI and the HHS Office of Inspector General (HHS-OIG) conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.
Since the inception of Strike Force operations in March 2007—Miami (Phase One), Los Angeles (Phase Two), Detroit (Phase Three), and Houston (Phase Four)—the Strike Force has obtained indictments of more than 293 individuals and organizations that collectively have billed the Medicare program for more than $680 million. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
Each of the Strike Force teams across the separate phases are led by a federal prosecutor from the Criminal Division’s Fraud Section or the U.S. Attorney’s Office. Each team has an agent from the FBI and HHS-OIG.
To learn more about the HEAT team, go to: www.stopmedicarefraud.gov
Friday, August 28, 2009
From the ashes of education comes cyber-learning
Published in the examiner.com August 28, 2009
In the wake of declining enrollment, possible bankruptcy, and the worst high school drop-out rates in the nation, Detroit Public Schools, along with rest of the nation’s public school systems, educators and lawmakers are in for a rude awakening: the factory school model of education has died.
What has arisen from the ashes is Westwood Cyber High School of Westwood Community Schools of Dearborn Heights, Michigan.
The visionary pioneer of this cyber-learning inititative is Executive Director, Glen Taylor, who has proudly partnered with Inclusion Trust out of the United Kindgdom. The U.K. “Not School” program, a 100% virtual learning experience, has been operational for about 9 years with a 97% completion rate.
The Inclusion Trust of the U.K. works directly with Westwood Cyber High School, the only project-based learning online in the United States. Inclusion Trust has formed other partnerships in Ireland, Sweden, and Australia, to name a few, demonstrating a successful alternative to traditional education in the Not School program.
Inclusion Trust came twice, the last time in July 2009, to Westwood Cyber High School to train staff on how to execute the duties and responsibilities of being research mentors. The Cyber High School was originally slated to have Westwood Cyber High Schools implemented the Models of Demonstration Proficiency format in February 2009. The format is a learning effect to standard, meaning the rubrics are tailored to the learning agenda and measurement expectations to the State of Michigan educational high school requirements.
Originally targeted for a goal of 182 students with its current retention rate at 93%, expansion to capacity of 540 was authorized by the state. Staff of Westwood Cyber recently traveled to the U.K. for enhanced training to transpose the model to an increased researcher population of 1,000, authorized by the state waivers under Title I funding by the State Director of Instructional Technology, Barb Fardel (email: FardellB@michigan.gov) and Bruce Umpsted (email: umpsteadb@michigan.gov).
There are no students because they are considered “researchers”, as stipulated by Technology Mentor, Wanda Hudson. Each researcher is given projects to be completed. Projects range from generating newletters to film production. The most innovative part of the learning experience is that the research managers, referred to as Mentors (as there are no teachers in the Not School) work directly with each researcher. The mentor, then, integrates mathematics, economics, physics, history and the rest of the social and physical sciences into each research project (as there is no homework in the Not School) for the researcher to present for publication.
It is quite expected that one will ask how this is all funded and how all this technological teaching can be achieved during the academic school year.
You have to remember, this is Not School, meaning, the research year is all year long, 24 hours a day. Researchers work at their own pace, finding their optimal time to complete each research project at home. According to the U.K. program description, the Not School is crafted for youth who disengaged with traditional learning because of illness or phobia, pregnancy, bullying or disaffection, travelling, reluctance to learn, exclusion, or in care. These descriptives fall under the classification of “at-risk” youth, the target population of Westwood Cyber High School.
A unique component to the Not School format is that the research mentors have designed a system of encouragement to keep the researchers on task by having them log on everyday, and even come to the home when there is a need for greater assistance in research and personal management of their lives.
Researchers are provided the tools of IMac desktop 20 inch screen computers, HP Digital Camera, and HP 5-in-1 printer to document work offline, as expected to do, and to put online. Once the researchers have completed their first 12-month cycle of research, the “researching tools” are given to the research to personally own.
One component, I believe, that has yet to be explored is the fact that the Westwood Cyber High School has chosen keywords to describe their target population, meaning “at-risk” youth. This label of “at-risk” youth has traditionally been applied with the negative connotations of foster care, better known as a ward of the state, but now, at with Director Glen Taylor at the helm of this educational phoenix, these “at-risk” youth are greatly prepared for college, not just because they own state-of-the-art computer equipment, or the idea that they have mastered technological abilities to achieve a college degree, but for the simple idea that these “at-risk” youth may qualify for expanded opportunities for grants and scholarships.
The benefits of this social and technological learning greatly outweigh the sunken costs of the factory school model. Faith in the future potential of our children in the Detroit Metropolitan Area has reemerged through the reimagining of education through Westwood Cyber High Schools.
It’s time our leaders listen to our children.
For more information, contact:
Westwood Cyber High School, 3335 South Beech Daly Road, Dearborn Heights, MI 48125.
Phone: 313-565-0288, or email: taylorg@wwschools.net
website: http://www.westwood.k12.mi.us/buildingwebs/cyberhighschool/index.html
In the wake of declining enrollment, possible bankruptcy, and the worst high school drop-out rates in the nation, Detroit Public Schools, along with rest of the nation’s public school systems, educators and lawmakers are in for a rude awakening: the factory school model of education has died.
What has arisen from the ashes is Westwood Cyber High School of Westwood Community Schools of Dearborn Heights, Michigan.
The visionary pioneer of this cyber-learning inititative is Executive Director, Glen Taylor, who has proudly partnered with Inclusion Trust out of the United Kindgdom. The U.K. “Not School” program, a 100% virtual learning experience, has been operational for about 9 years with a 97% completion rate.
The Inclusion Trust of the U.K. works directly with Westwood Cyber High School, the only project-based learning online in the United States. Inclusion Trust has formed other partnerships in Ireland, Sweden, and Australia, to name a few, demonstrating a successful alternative to traditional education in the Not School program.
Inclusion Trust came twice, the last time in July 2009, to Westwood Cyber High School to train staff on how to execute the duties and responsibilities of being research mentors. The Cyber High School was originally slated to have Westwood Cyber High Schools implemented the Models of Demonstration Proficiency format in February 2009. The format is a learning effect to standard, meaning the rubrics are tailored to the learning agenda and measurement expectations to the State of Michigan educational high school requirements.
Originally targeted for a goal of 182 students with its current retention rate at 93%, expansion to capacity of 540 was authorized by the state. Staff of Westwood Cyber recently traveled to the U.K. for enhanced training to transpose the model to an increased researcher population of 1,000, authorized by the state waivers under Title I funding by the State Director of Instructional Technology, Barb Fardel (email: FardellB@michigan.gov) and Bruce Umpsted (email: umpsteadb@michigan.gov).
There are no students because they are considered “researchers”, as stipulated by Technology Mentor, Wanda Hudson. Each researcher is given projects to be completed. Projects range from generating newletters to film production. The most innovative part of the learning experience is that the research managers, referred to as Mentors (as there are no teachers in the Not School) work directly with each researcher. The mentor, then, integrates mathematics, economics, physics, history and the rest of the social and physical sciences into each research project (as there is no homework in the Not School) for the researcher to present for publication.
It is quite expected that one will ask how this is all funded and how all this technological teaching can be achieved during the academic school year.
You have to remember, this is Not School, meaning, the research year is all year long, 24 hours a day. Researchers work at their own pace, finding their optimal time to complete each research project at home. According to the U.K. program description, the Not School is crafted for youth who disengaged with traditional learning because of illness or phobia, pregnancy, bullying or disaffection, travelling, reluctance to learn, exclusion, or in care. These descriptives fall under the classification of “at-risk” youth, the target population of Westwood Cyber High School.
A unique component to the Not School format is that the research mentors have designed a system of encouragement to keep the researchers on task by having them log on everyday, and even come to the home when there is a need for greater assistance in research and personal management of their lives.
Researchers are provided the tools of IMac desktop 20 inch screen computers, HP Digital Camera, and HP 5-in-1 printer to document work offline, as expected to do, and to put online. Once the researchers have completed their first 12-month cycle of research, the “researching tools” are given to the research to personally own.
One component, I believe, that has yet to be explored is the fact that the Westwood Cyber High School has chosen keywords to describe their target population, meaning “at-risk” youth. This label of “at-risk” youth has traditionally been applied with the negative connotations of foster care, better known as a ward of the state, but now, at with Director Glen Taylor at the helm of this educational phoenix, these “at-risk” youth are greatly prepared for college, not just because they own state-of-the-art computer equipment, or the idea that they have mastered technological abilities to achieve a college degree, but for the simple idea that these “at-risk” youth may qualify for expanded opportunities for grants and scholarships.
The benefits of this social and technological learning greatly outweigh the sunken costs of the factory school model. Faith in the future potential of our children in the Detroit Metropolitan Area has reemerged through the reimagining of education through Westwood Cyber High Schools.
It’s time our leaders listen to our children.
For more information, contact:
Westwood Cyber High School, 3335 South Beech Daly Road, Dearborn Heights, MI 48125.
Phone: 313-565-0288, or email: taylorg@wwschools.net
website: http://www.westwood.k12.mi.us/buildingwebs/cyberhighschool/index.html
Sunday, August 16, 2009
How To Catch A Medicaid Fraudfeasor: A Primer
As those of you loyal followers who may already know, and for those who wish to learn,
The U.S. Department of Health and Human Services Office of Inspector General (DHHS OIG) in partnership with the U.S. Department of Justice Attorney General (DOJ AG) has created the Health Care Fraud Enforcement Task Force (H.E.A.T.) to stop Medicare and Medicaid Fraud.
The purpose of H.E.A.T. is to end the annual billions of dollars in fraud, waste and abuse of taxpayer dollars, because, obviously, the states Medicaid Fraud Control Units just were not doing what they were suppose to be doing, and that is stopping Medicare and Medicaid Fraud.
In addition, it seems that the DHHS OIG and the DOJ AG have publicly confessed, with its creation of H.E.A.T., to have been snoring and drooling at the helm as the overseeing admirals of the states Medicaid Fraud Control Units.
But now, since the act of contrition, we need to move forward and get these Strike Forces up and operating, quickly!
Below, is the precursor of my primer on "How To Catch a Medicaid Fraudfeasor."
(Fraudfeasor means simply, "One who commits fraud.")
The following is taken directly from the National Association of Medicaid Fraud Control Units Frequently Asked Questions:
1. What is a Medicaid Fraud Control Unit?
A Medicaid Fraud Control Unit (“Unit” or “MFCU”) is a single identifiable entity of state government, annually certified by the Secretary of the U.S. Department of Health and Human Services. The Unit has either statewide criminal prosecution authority or formal procedures for referring cases to local prosecutorial authorities with respect to the detection, investigation and prosecution of suspected criminal violations of the Medicaid program. See 42 U.S.C. §1396b(q). There are 50 state MFCUs. 43 are currently located in the office of the state Attorney General. Connecticut, D.C., Georgia, Illinois, Iowa, Tennessee and West Virginia have Units which are in other departments of state government. North Dakota received a waiver from the federal government and does not have a Unit.
Since I enjoy using Michigan as my case study, let us begin to examine the deficiencies in this description.
Michigan has a Medicaid Fraud Unit located in the Office of Attorney General, Child and Family Services Bureau, called the Health Care Fraud Division. The duties and responsibilities are to the Department of Human Services through "Medicaid fraud and patient abuse investigations, prosecutions, civil Medicaid recoveries, and vulnerable adult matters."
What is wrong with this picture? The Health Care Fraud Division does not touch "child matters." So, why is this?
Well, the proper response is that the Michigan Office of Attorney General does deal with "child matters." As a matter of fact, there is an entire division dedicated to "child matters" called the Children and Youth Services Division. Oddly enough, the Division only deals with child matters in Wayne County by making the county the only one in the state whereby the Attorney General prosecutes child abuse and neglect matters.
So, how is it that the Attorney General can investigate fraud and protect vulnerable children when the Attorney General is the one advocating for the ones who are the fraudfeasors?
The answer may not be a clear as one would imagine.
At first glance, you see an inherent conflict of interest; this being the Attorney General would have to investigate and advocate, prosecute and defend, or basically, snitch on himself. This is only the first layer.
The next layer is a question of an independent and autonomous authority to investigate and refer Medicaid Fraud for prosecution and recovery. This would be the co-location of authority of the Office of Children's Ombudsman (OCO). The office is, or was, situated in the Department of Management of Budget. Targeted Case Management is a Medicaid funded program for foster care, adoption and juvenile justice. The OCO has the formal authority, through statute and autonomy, to investigate complaints dealing with children in these Medicaid programs, and to make referrals to the counties prosecutors or Attorney General when Medicaid Fraud is suspected. OCO has never made one referral of suspected Medicaid Fraud for prosecution and recovery.
Unfortunately, the DHHS Secretary has certified Michigan's Medicaid Fraud Unit, even though its functions of controlling Medicaid Fraud in child welfare programs are non-existent.
2. Must each state have a MFCU?
Under federal law, each state must have a Unit unless the state demonstrates to the satisfaction of the Secretary of the Department of Health and Human Services that a Unit would not be cost effective because minimal fraud exists in the state's Medicaid program and Medicaid beneficiaries will be protected from abuse and neglect.
3. What is the jurisdiction of a MFCU?
A Unit's function is to conduct a statewide program for the investigation and prosecution of health care providers who defraud the Medicaid program. In addition, a Unit reviews complaints of abuse or neglect against patients in health care facilities receiving Medicaid funding and may review complaints of the misappropriation of patients' private funds in these facilities. The Unit is also charged with investigating fraud in the administration of the Medicaid program. The Ticket to Work and Work Incentives Improvement Act of 1999 authorizes the Units, with the approval of the Inspector General of the relevant federal agency, to investigate fraud in other federally-funded health care programs, if the case is primarily related to Medicaid. This section also authorizes the Units, on an optional basis, to investigate and prosecute resident abuse or neglect in non-Medicaid board and care facilities.
In Michigan, investigations of child resident abuse or neglect falls under the jurisdiction of the Department of Human Services (DHS), the same entity that is procures contracts of residential programs. The Bureau of Children and Adult Licensing (f.k.a. Office of Children and Adult Licensing and was located, independenty, in the Department of Energy, Labor and Growth) has the statutory authority to investigate and protect vulnerable children in receiving care from a licensed facility, particularly under the auspices of the state. This small group of investigators generate findings reports, but are not obligated to refer suspected and substantiated matters of Medicaid Fraud to any law enforcement authority.
4. How are MFCUs funded?
MFCUs receive annual grants (Federal Financial Participation or "FFP") from the U.S. Department of Health and Human Services. Grant amounts must be matched with state funding. Initially, a Unit receives federal funding at a 90 percent level. After its first three years, the FFP is reduced to 75 percent.
The FFP is reduced because the states MFCU are to become sustainable in the prosecution and recovery of Medicaid Fraud. Michigan has finally effectuated (rather semi-effective because there is very little civil incentive for individual referrals of Medicaid Fraud) and enhanced Medicaid False Claims Act. The point of this being the state will aggressively target and capture the recovery funds of Medicaid Fraud. By doing so, the state is allowed to recovery %10 of the FFP.
Alas, in the realms of child welfare, this has never been done.
5. What are the limitations on federal financial participation?
Federal financial participation is authorized for full-time attorneys, investigators and auditors involved in the investigation and prosecution of matters within the jurisdiction of a Unit. Full-time employees are required to be hired to perform full-time duty intended to last at least a year. Federal grant money may also be used for part-time support staff but only to the extent that these part-time employees participate in work activities that further the jurisdictional duties of the Unit. Finally, FFP is available to the Unit's parent agency to cover all indirect costs associated with the operation of the Unit.
Here is a really fun little item: "If the OCO is the co-location of authority to investigate Medicaid Fraud, matters well within the jurisdiction of the Medicaid Fraud Unit, and it never refers suspected and/or substantiated Medicaid Fraud, is FFP being used, and if it is, is being used to cover the state share of the percentage formula?
6. What are MFCU minimal staffing levels?
A Unit is intended to operate using a "strike force" concept of investigators, auditors and attorneys working together full-time to develop Medicaid fraud investigations and prosecutions. The staff of the Unit must include attorneys experienced in the investigation and prosecution of civil fraud or criminal cases, auditors capable of supervising the review of financial records, and investigators with substantial experience in commercial or financial investigations. If a Unit lacks direct prosecutorial authority, it must have a formalized procedure in place for referring cases to the appropriate prosecutorial authority.
Due to the fact that Michigan Medicaid Fraud Unit has never engaged in "strike force" operations, especially in child welfare, H.E.A.T. has stepped up to the plate.
7. What is the extent of federal oversight over a MFCU?
Each Unit operates under the administrative oversight of the Inspector General of the U.S. Department of Health and Human Services and must be recertified annually. As part of the recertification process, the Inspector General reviews a Unit's application for recertification and may conduct on-site visits. Additionally, the MFCUs are required to submit annual reports to the Inspector General. These reports include specific statistical data required by federal legislation on the number and type of cases under investigation, the number of convictions obtained and the number of dollar recoveries to the Medicaid program. The day-to-day supervision of a Unit rests with the parent agency.
8. How do Medicaid fraud cases typically arise?
While specifics may vary from state to state, a primary source of referrals is the agency responsible for auditing and reviewing Medicaid provider claims, the Medicaid agency. Other significant sources of referrals are the MFCUs in other states as well as other law enforcement agencies.
In Michigan, there are multiple "co-locations" to make primary referrals, but nobody does it. The investigative reports fade into the shadows of internet archives, and rather quickly, I must say!
This is one of my favorite examples of the non-existence of referrals in Michigan:
Michigan Office of the Auditor General, Audit Report, Financial Audit Including the Provisions of the Single Audit Act of the Department of Human Services, October 1, 2004 through September 30, 2006, Report #: 431-0100-07, (Pages 101-102). Thomas H. McTavish, C.P.A., Auditor General. (Released August 2007).
“DHS is primarily responsible for the expenditure of Foster Care: Title IV-E Program funds.
DHS has a contract with Wayne County to provide funding to Wayne County for eligible juvenile justice children. DHS considers Wayne County to be a subrecipient.
In order to be reimbursed, Wayne County submits a billing, which lists the Wayne County juvenile justice children for whom they are requesting reimbursement. DHS does not verify the eligibility of the children for whom they are paying. We were informed by DHS that the documentation would be retained by Wayne County because it was Wayne County that was responsible for continued eligibility determination. However, in our discussions with Wayne County, we were informed that it was DHS who was responsible for the continued eligibility determinations. The contract between Wayne County and DHS was silent on who was responsible for the continued determination.
As the grantor of the federal funds, OMB Circular A-133 requires DHS to monitor the program to ensure that the funds are expended for only eligible children. Because of the lack of understanding between the two parties and the lack of documentation for the items we reviewed, we have questioned all of the amounts provided to Wayne County for the two years ended September 30, 2006.” (Emphasis added)
The Audit Report continues to say in part:
“If DHS did not improve, it faced a possible penalty of $22 million”…. “The U.S. Department of Health and Human Services conducted the second eligibility review of DHS’s case files for foster care maintenance payments issued between April 1, 2006 and September 30, 2006. Prior to the review, DHS conducted an extensive case file review to identify cases that did not meet Foster Care: Title IV-E Program eligibility requirements. For cases that DHS determined did not meet the Foster Care: Title IV-E Program eligibility requirements, DHS changed the funding source on the cases to a funding source other than Foster Care: Title IV-E Program before April 1, 2006… As a result, those cases were not in the population reviewed during the federal review…The federal review concluded that DHS was in substantial compliance with federal eligibility requirements for the period April 1, 2006 through September 30, 2006.
We issued a qualified opinion on the Foster Care: Title IV-E Program. Our conclusion is different from the federal review because our sample included cases from the entire audit period.
RECOMMENDAITONS
FOR THE THIRD CONSECUTIVE AUDIT, WE RECOMMEND THAT DHS IMPROVE ITS INTERNAL CONTROL OVER THE FOSTER CARE: TITLE IV-E PROGRAM TO ENSURE ITS COMPLIANCE WITH FEDERAL LAWS AND REGULATIONS REGARDING ACTIVITIES ALLOWED OR UNALLOWED, ALLOWABLE COSTS/COST PRINCIPLES, AND ELIGIBILITY.
We also recommend that DHS improve its internal control to ensure compliance with federal laws and regulations regarding subrecipient monitoring.”
TRANSLATION: "TAG, YOU'RE IT!"
9. How do the multi-state/federal global settlements arise and how are they handled?
Medicaid fraud global settlements generally arise in connection with a U.S. Department of Justice investigation against a Medicare provider. When resolving these Medicare cases, the federal government, often at the request of defense counsel, turns to the state MFCUs because it cannot settle the Medicaid portion of the case without the Units. Moreover, defense attorneys are unlikely to settle the case without the affected states because each state has the authority to exclude a convicted provider from its health care programs. The Department of Justice typically contacts the National Association of Medicaid Fraud Control Units about a potential settlement, and the President of the Association appoints a settlement team which usually consists of three to four members.
Michigan has no exclusionary database because Medicaid Fraud in child welfare programming is never referred for prosecution. In the Michigan Auditor General Annual Report 2008, the imperative was revisited for a fourth time, for Department of Human Services to engage in contractual debarment and assessing sanctions for questionable and improper payments, and lack of internal controls.
10. What federal consequences follow a felony conviction for Medicaid fraud?
Under federal regulations, providers who are convicted of a program related offense are excluded for a minimum of five years from receiving funds from any federally funded health care program, either as a health care provider or employee. Often, this sanction has a greater impact on the convicted individual and the provider community at large than the criminal penalties assessed in the case.
The world eagerly awaits the first felony conviction in Michigan.
11. What is the National Association of Medicaid Fraud Control Units (NAMFCU)?
The National Association of Medicaid Fraud Control Units (NAMFCU) was founded in 1978 to provide a forum for a nationwide sharing of information concerning the problems of Medicaid fraud, to improve the quality of Medicaid prosecutions by conducting training programs, to provide technical assistance to Association members and to provide the public with information about the MFCU program. All 50 MFCUs are members of the Association. NAMFCU is headquartered in Washington, D.C. and is staffed by a Counsel, an Association Administrator and a part-time Association Assistant.
Here is my take on the National Association of Medicaid Fraud Control Units:
SQUAMULOUS LAGS.
I submit that NAMFCU needs to be put on the H.E.A.T. "laundry list."
The U.S. Department of Health and Human Services Office of Inspector General (DHHS OIG) in partnership with the U.S. Department of Justice Attorney General (DOJ AG) has created the Health Care Fraud Enforcement Task Force (H.E.A.T.) to stop Medicare and Medicaid Fraud.
The purpose of H.E.A.T. is to end the annual billions of dollars in fraud, waste and abuse of taxpayer dollars, because, obviously, the states Medicaid Fraud Control Units just were not doing what they were suppose to be doing, and that is stopping Medicare and Medicaid Fraud.
In addition, it seems that the DHHS OIG and the DOJ AG have publicly confessed, with its creation of H.E.A.T., to have been snoring and drooling at the helm as the overseeing admirals of the states Medicaid Fraud Control Units.
But now, since the act of contrition, we need to move forward and get these Strike Forces up and operating, quickly!
Below, is the precursor of my primer on "How To Catch a Medicaid Fraudfeasor."
(Fraudfeasor means simply, "One who commits fraud.")
The following is taken directly from the National Association of Medicaid Fraud Control Units Frequently Asked Questions:
1. What is a Medicaid Fraud Control Unit?
A Medicaid Fraud Control Unit (“Unit” or “MFCU”) is a single identifiable entity of state government, annually certified by the Secretary of the U.S. Department of Health and Human Services. The Unit has either statewide criminal prosecution authority or formal procedures for referring cases to local prosecutorial authorities with respect to the detection, investigation and prosecution of suspected criminal violations of the Medicaid program. See 42 U.S.C. §1396b(q). There are 50 state MFCUs. 43 are currently located in the office of the state Attorney General. Connecticut, D.C., Georgia, Illinois, Iowa, Tennessee and West Virginia have Units which are in other departments of state government. North Dakota received a waiver from the federal government and does not have a Unit.
Since I enjoy using Michigan as my case study, let us begin to examine the deficiencies in this description.
Michigan has a Medicaid Fraud Unit located in the Office of Attorney General, Child and Family Services Bureau, called the Health Care Fraud Division. The duties and responsibilities are to the Department of Human Services through "Medicaid fraud and patient abuse investigations, prosecutions, civil Medicaid recoveries, and vulnerable adult matters."
What is wrong with this picture? The Health Care Fraud Division does not touch "child matters." So, why is this?
Well, the proper response is that the Michigan Office of Attorney General does deal with "child matters." As a matter of fact, there is an entire division dedicated to "child matters" called the Children and Youth Services Division. Oddly enough, the Division only deals with child matters in Wayne County by making the county the only one in the state whereby the Attorney General prosecutes child abuse and neglect matters.
So, how is it that the Attorney General can investigate fraud and protect vulnerable children when the Attorney General is the one advocating for the ones who are the fraudfeasors?
The answer may not be a clear as one would imagine.
At first glance, you see an inherent conflict of interest; this being the Attorney General would have to investigate and advocate, prosecute and defend, or basically, snitch on himself. This is only the first layer.
The next layer is a question of an independent and autonomous authority to investigate and refer Medicaid Fraud for prosecution and recovery. This would be the co-location of authority of the Office of Children's Ombudsman (OCO). The office is, or was, situated in the Department of Management of Budget. Targeted Case Management is a Medicaid funded program for foster care, adoption and juvenile justice. The OCO has the formal authority, through statute and autonomy, to investigate complaints dealing with children in these Medicaid programs, and to make referrals to the counties prosecutors or Attorney General when Medicaid Fraud is suspected. OCO has never made one referral of suspected Medicaid Fraud for prosecution and recovery.
Unfortunately, the DHHS Secretary has certified Michigan's Medicaid Fraud Unit, even though its functions of controlling Medicaid Fraud in child welfare programs are non-existent.
2. Must each state have a MFCU?
Under federal law, each state must have a Unit unless the state demonstrates to the satisfaction of the Secretary of the Department of Health and Human Services that a Unit would not be cost effective because minimal fraud exists in the state's Medicaid program and Medicaid beneficiaries will be protected from abuse and neglect.
3. What is the jurisdiction of a MFCU?
A Unit's function is to conduct a statewide program for the investigation and prosecution of health care providers who defraud the Medicaid program. In addition, a Unit reviews complaints of abuse or neglect against patients in health care facilities receiving Medicaid funding and may review complaints of the misappropriation of patients' private funds in these facilities. The Unit is also charged with investigating fraud in the administration of the Medicaid program. The Ticket to Work and Work Incentives Improvement Act of 1999 authorizes the Units, with the approval of the Inspector General of the relevant federal agency, to investigate fraud in other federally-funded health care programs, if the case is primarily related to Medicaid. This section also authorizes the Units, on an optional basis, to investigate and prosecute resident abuse or neglect in non-Medicaid board and care facilities.
In Michigan, investigations of child resident abuse or neglect falls under the jurisdiction of the Department of Human Services (DHS), the same entity that is procures contracts of residential programs. The Bureau of Children and Adult Licensing (f.k.a. Office of Children and Adult Licensing and was located, independenty, in the Department of Energy, Labor and Growth) has the statutory authority to investigate and protect vulnerable children in receiving care from a licensed facility, particularly under the auspices of the state. This small group of investigators generate findings reports, but are not obligated to refer suspected and substantiated matters of Medicaid Fraud to any law enforcement authority.
4. How are MFCUs funded?
MFCUs receive annual grants (Federal Financial Participation or "FFP") from the U.S. Department of Health and Human Services. Grant amounts must be matched with state funding. Initially, a Unit receives federal funding at a 90 percent level. After its first three years, the FFP is reduced to 75 percent.
The FFP is reduced because the states MFCU are to become sustainable in the prosecution and recovery of Medicaid Fraud. Michigan has finally effectuated (rather semi-effective because there is very little civil incentive for individual referrals of Medicaid Fraud) and enhanced Medicaid False Claims Act. The point of this being the state will aggressively target and capture the recovery funds of Medicaid Fraud. By doing so, the state is allowed to recovery %10 of the FFP.
Alas, in the realms of child welfare, this has never been done.
5. What are the limitations on federal financial participation?
Federal financial participation is authorized for full-time attorneys, investigators and auditors involved in the investigation and prosecution of matters within the jurisdiction of a Unit. Full-time employees are required to be hired to perform full-time duty intended to last at least a year. Federal grant money may also be used for part-time support staff but only to the extent that these part-time employees participate in work activities that further the jurisdictional duties of the Unit. Finally, FFP is available to the Unit's parent agency to cover all indirect costs associated with the operation of the Unit.
Here is a really fun little item: "If the OCO is the co-location of authority to investigate Medicaid Fraud, matters well within the jurisdiction of the Medicaid Fraud Unit, and it never refers suspected and/or substantiated Medicaid Fraud, is FFP being used, and if it is, is being used to cover the state share of the percentage formula?
6. What are MFCU minimal staffing levels?
A Unit is intended to operate using a "strike force" concept of investigators, auditors and attorneys working together full-time to develop Medicaid fraud investigations and prosecutions. The staff of the Unit must include attorneys experienced in the investigation and prosecution of civil fraud or criminal cases, auditors capable of supervising the review of financial records, and investigators with substantial experience in commercial or financial investigations. If a Unit lacks direct prosecutorial authority, it must have a formalized procedure in place for referring cases to the appropriate prosecutorial authority.
Due to the fact that Michigan Medicaid Fraud Unit has never engaged in "strike force" operations, especially in child welfare, H.E.A.T. has stepped up to the plate.
7. What is the extent of federal oversight over a MFCU?
Each Unit operates under the administrative oversight of the Inspector General of the U.S. Department of Health and Human Services and must be recertified annually. As part of the recertification process, the Inspector General reviews a Unit's application for recertification and may conduct on-site visits. Additionally, the MFCUs are required to submit annual reports to the Inspector General. These reports include specific statistical data required by federal legislation on the number and type of cases under investigation, the number of convictions obtained and the number of dollar recoveries to the Medicaid program. The day-to-day supervision of a Unit rests with the parent agency.
8. How do Medicaid fraud cases typically arise?
While specifics may vary from state to state, a primary source of referrals is the agency responsible for auditing and reviewing Medicaid provider claims, the Medicaid agency. Other significant sources of referrals are the MFCUs in other states as well as other law enforcement agencies.
In Michigan, there are multiple "co-locations" to make primary referrals, but nobody does it. The investigative reports fade into the shadows of internet archives, and rather quickly, I must say!
This is one of my favorite examples of the non-existence of referrals in Michigan:
Michigan Office of the Auditor General, Audit Report, Financial Audit Including the Provisions of the Single Audit Act of the Department of Human Services, October 1, 2004 through September 30, 2006, Report #: 431-0100-07, (Pages 101-102). Thomas H. McTavish, C.P.A., Auditor General. (Released August 2007).
“DHS is primarily responsible for the expenditure of Foster Care: Title IV-E Program funds.
DHS has a contract with Wayne County to provide funding to Wayne County for eligible juvenile justice children. DHS considers Wayne County to be a subrecipient.
In order to be reimbursed, Wayne County submits a billing, which lists the Wayne County juvenile justice children for whom they are requesting reimbursement. DHS does not verify the eligibility of the children for whom they are paying. We were informed by DHS that the documentation would be retained by Wayne County because it was Wayne County that was responsible for continued eligibility determination. However, in our discussions with Wayne County, we were informed that it was DHS who was responsible for the continued eligibility determinations. The contract between Wayne County and DHS was silent on who was responsible for the continued determination.
As the grantor of the federal funds, OMB Circular A-133 requires DHS to monitor the program to ensure that the funds are expended for only eligible children. Because of the lack of understanding between the two parties and the lack of documentation for the items we reviewed, we have questioned all of the amounts provided to Wayne County for the two years ended September 30, 2006.” (Emphasis added)
The Audit Report continues to say in part:
“If DHS did not improve, it faced a possible penalty of $22 million”…. “The U.S. Department of Health and Human Services conducted the second eligibility review of DHS’s case files for foster care maintenance payments issued between April 1, 2006 and September 30, 2006. Prior to the review, DHS conducted an extensive case file review to identify cases that did not meet Foster Care: Title IV-E Program eligibility requirements. For cases that DHS determined did not meet the Foster Care: Title IV-E Program eligibility requirements, DHS changed the funding source on the cases to a funding source other than Foster Care: Title IV-E Program before April 1, 2006… As a result, those cases were not in the population reviewed during the federal review…The federal review concluded that DHS was in substantial compliance with federal eligibility requirements for the period April 1, 2006 through September 30, 2006.
We issued a qualified opinion on the Foster Care: Title IV-E Program. Our conclusion is different from the federal review because our sample included cases from the entire audit period.
RECOMMENDAITONS
FOR THE THIRD CONSECUTIVE AUDIT, WE RECOMMEND THAT DHS IMPROVE ITS INTERNAL CONTROL OVER THE FOSTER CARE: TITLE IV-E PROGRAM TO ENSURE ITS COMPLIANCE WITH FEDERAL LAWS AND REGULATIONS REGARDING ACTIVITIES ALLOWED OR UNALLOWED, ALLOWABLE COSTS/COST PRINCIPLES, AND ELIGIBILITY.
We also recommend that DHS improve its internal control to ensure compliance with federal laws and regulations regarding subrecipient monitoring.”
TRANSLATION: "TAG, YOU'RE IT!"
9. How do the multi-state/federal global settlements arise and how are they handled?
Medicaid fraud global settlements generally arise in connection with a U.S. Department of Justice investigation against a Medicare provider. When resolving these Medicare cases, the federal government, often at the request of defense counsel, turns to the state MFCUs because it cannot settle the Medicaid portion of the case without the Units. Moreover, defense attorneys are unlikely to settle the case without the affected states because each state has the authority to exclude a convicted provider from its health care programs. The Department of Justice typically contacts the National Association of Medicaid Fraud Control Units about a potential settlement, and the President of the Association appoints a settlement team which usually consists of three to four members.
Michigan has no exclusionary database because Medicaid Fraud in child welfare programming is never referred for prosecution. In the Michigan Auditor General Annual Report 2008, the imperative was revisited for a fourth time, for Department of Human Services to engage in contractual debarment and assessing sanctions for questionable and improper payments, and lack of internal controls.
10. What federal consequences follow a felony conviction for Medicaid fraud?
Under federal regulations, providers who are convicted of a program related offense are excluded for a minimum of five years from receiving funds from any federally funded health care program, either as a health care provider or employee. Often, this sanction has a greater impact on the convicted individual and the provider community at large than the criminal penalties assessed in the case.
The world eagerly awaits the first felony conviction in Michigan.
11. What is the National Association of Medicaid Fraud Control Units (NAMFCU)?
The National Association of Medicaid Fraud Control Units (NAMFCU) was founded in 1978 to provide a forum for a nationwide sharing of information concerning the problems of Medicaid fraud, to improve the quality of Medicaid prosecutions by conducting training programs, to provide technical assistance to Association members and to provide the public with information about the MFCU program. All 50 MFCUs are members of the Association. NAMFCU is headquartered in Washington, D.C. and is staffed by a Counsel, an Association Administrator and a part-time Association Assistant.
Here is my take on the National Association of Medicaid Fraud Control Units:
SQUAMULOUS LAGS.
I submit that NAMFCU needs to be put on the H.E.A.T. "laundry list."
Tuesday, August 4, 2009
Inspiration
Inspire to be.
Inspire to do.
Inspire to think.
Inspire to create.
Inspire to learn.
Inspire to love.
Inspire to leave a legacy.
Inspiration for Peace.
Inspiration for Hamtramck.
(Actually, it is part of a public relations strategy, but I will make you wait until I publish the book. Notice how I did not include the words VOTE or ELECT in this.)
Monday, August 3, 2009
Part One of My Campaign Strategy
Well, it seems the time is here. The election has begun.
I am sure some of you are saying to yourselves:
"What do you mean the election has begun?"
As I have decided to run the first of its kind, "low-budget, technological top-down transference of information, engage the public, encourage civic participation, recycled, green" campaign.
I have adopted a Karl Rove type of political strategy. It seems none of the candidates really approached the absentee voters. I did, well, at least I tried. Absentee voting began last week and everyone seemed to forget about the strongest and most reliable voting population, those confined to the assisted living.
Next, there is another segment of the population that will vote absentee: women who have recently been granted citizenship. These women, so strong and vibrant, are excited to participate in the political process.
And, lest not we forget the mothers with small children. It is quite difficult to stand in line to vote with small children. I know because I did it before.
Of course, everyone should have already guessed that I have all intentions of writing a book, and an academic journal article, on the entire political process; hence, the description of my blog.
I am even drafting a House Bill on my discoveries.
Life is beautiful, share it with the world.
I am sure some of you are saying to yourselves:
"What do you mean the election has begun?"
As I have decided to run the first of its kind, "low-budget, technological top-down transference of information, engage the public, encourage civic participation, recycled, green" campaign.
I have adopted a Karl Rove type of political strategy. It seems none of the candidates really approached the absentee voters. I did, well, at least I tried. Absentee voting began last week and everyone seemed to forget about the strongest and most reliable voting population, those confined to the assisted living.
Next, there is another segment of the population that will vote absentee: women who have recently been granted citizenship. These women, so strong and vibrant, are excited to participate in the political process.
And, lest not we forget the mothers with small children. It is quite difficult to stand in line to vote with small children. I know because I did it before.
Of course, everyone should have already guessed that I have all intentions of writing a book, and an academic journal article, on the entire political process; hence, the description of my blog.
I am even drafting a House Bill on my discoveries.
Life is beautiful, share it with the world.
Monday, July 27, 2009
Lawsuit Alleges Medicaid Fraud In Michigan Child Welfare System
The Michigan Citizen
July 27, 2009
HAMTRAMCK, MICHIGAN — Michigan Children’s Ombudsman Verlie Ruffin has failed to report violations of state and federal law to the state Attorney General in order to “cover-up” Medicaid fraud committed by individual state agents, and privately contracted agencies of the state, according to a lawsuit filed in April.
Questions surround Targeted Case Management, a Medicaid-funded program for state foster care, adoption, and juvenile delinquency.
The lawsuit, filed in the state Court of Appeals, further alleges that Michigan Attorney General Mike Cox, defending the state Ombudsman, has failed to intervene in prosecuting Medicaid fraud in child welfare. Beverly Tran, who filed this action, is one of the candidates seeking the Hamtramck, Mich. office of city council.
Tran says that there has not been a single referral to the Attorney General since the office was created. She goes on to say that the state Auditor General has documented an estimated $1.8 billion in questionable and improper payments. “That’s why the U.S. Department of Health and Human Services Office of Inspector General has partnered with the U.S. Department of Justice Attorney General to create the Health Care Fraud Enforcement Prevention Team (H.E.A.T.) and is now in Michigan.”
UPDATE: The Michigan Senate has announced that "there is evidence of ongoing and large scale Medicaid fraud.
July 27, 2009
HAMTRAMCK, MICHIGAN — Michigan Children’s Ombudsman Verlie Ruffin has failed to report violations of state and federal law to the state Attorney General in order to “cover-up” Medicaid fraud committed by individual state agents, and privately contracted agencies of the state, according to a lawsuit filed in April.
Questions surround Targeted Case Management, a Medicaid-funded program for state foster care, adoption, and juvenile delinquency.
The lawsuit, filed in the state Court of Appeals, further alleges that Michigan Attorney General Mike Cox, defending the state Ombudsman, has failed to intervene in prosecuting Medicaid fraud in child welfare. Beverly Tran, who filed this action, is one of the candidates seeking the Hamtramck, Mich. office of city council.
Tran says that there has not been a single referral to the Attorney General since the office was created. She goes on to say that the state Auditor General has documented an estimated $1.8 billion in questionable and improper payments. “That’s why the U.S. Department of Health and Human Services Office of Inspector General has partnered with the U.S. Department of Justice Attorney General to create the Health Care Fraud Enforcement Prevention Team (H.E.A.T.) and is now in Michigan.”
UPDATE: The Michigan Senate has announced that "there is evidence of ongoing and large scale Medicaid fraud.
Official Endorsement From Former Wayne County Auditor General
To my greatest honor, I have been formally endorsed by a man I consider as my inspiration for public office and a personal hero. Former Auditor General of Wayne County for 13 years, Brendan Dunleavy, has delivered his support of my candidacy with the greatest of enthusiasm.
With sincerity and serenity, I thank you, sir.
With sincerity and serenity, I thank you, sir.
Saturday, July 25, 2009
The League of Gloom and Doom
Wednesday evening was the first Candidate Forum graciously sponsored by the Hamtramck Block Club Association at the People's Community Center on Joseph Campau.
I had an absolute ball, even though I forgot to properly prepare catchy opening remarks; I will admit, I am a bit rusty at public speaking. I enjoyed the event because I was allowed my first opportunity to personally engage a gathering of people by handing out my perfume scented personal campaign fliers. Along with the name TRAN, the voters have a redolent recall of a scent for election day. Just call it my own little way of applying my years of study to the campaign. We shall see if I can get a journal article out of it.
Anyway, I had more fun listening to what I have labeled as The League of Gloom and Doom. If anyone can remember the DC Comics Superheroes Justice League, this is my spin on the rhetoric of the other candidates.
Everything was about how horrible the city is. I just do not understand why, I was the only one who saw the beauty and potential of this unique municipal enclave. The scowling faces of each candidate keep a glowing smile on my face knowing what the city needs more than ever is the inspiration of happiness and success. Beauty of the spirit and the body of the city is a powerful tool, one I shall be promoting daily, even after the election.
Now, I can lead you into the heart of my campaign.
My son and I made a few campaign signs with some gathered material hiding around the house. I want to see if it is possible to run a primary campaign on no-cost or low-cost. So far so good as I am well under $100.00.
The League of Gloom and Doom has, on multiple occasions, pulled me over to side to chastise and ridicule me for not having thousands of dollars worth of fundraising to buy big signs. Big signs to post all over the city, most on homes they did not even ask for permission. This whole campaign seems to be fueled on who can get the most signs out. I somewhat take this mentality as an insult to the intelligence of the voters.
Why you may ask, well, let me tell you.
On my trusty Brother's black and white printer (I should get some campaign support from the company for mentioning this), I printed out fliers. Then, wherever I go, I hand them out, perfumed and all, to just about every person who crosses my path on the street. But what I include with the ceremonious handing of my flier is the personal invitation for each person who is in receipt of my scented campaign literature, to participate in the political process of my election to tell their friends, family, and neighbors about my run for office. So many people have opened their hearts to my request that they take a few extra fliers and pass them out for me.
The League of Gloom and Doom continuously harps on the premise that "85%" (notice how I put it in quotations) of the people of Hamtramck are computer illiterate.
My response to this is, "What are we going to do about it?" Silence abounds from the League of Gloom and Doom.
Here is my position: I want to bring the city into the 21st century with technology.
If anyone has ever noticed, the Hamtramck website, according to a certain official, is, "Woefully inadequate." Check it out: City of Hamtramck
Hamtramck is going to eventually provide internet accessibility throughout the entire city. Well, no time like the present to start utilizing the power of internet by empowering that "85%" to use computers. Simple programs to be put together to bring in free computers or discounted computers for residents, the same way one can purchase a club lock for your car at a discounted rate from the city. Simple workshops that could be put on by local organizations, with the potential to be funded through the solicitation of grants, to educate those interested in how to access the internet.
In addition, there will be a substantial reduction in cost:
(1) When it comes to the transmission of information to the citizens of the city. With a simple click, you have what I love to call The Art of TAO: Transparency, Accountability, and Oversight. (Book coming out soon, very soon.)
(2) The responsibilities of the City Manager are now streamlined in conducting cost/benefit analyses, with real-time, open participation with other city officials and citizens.
(3) With a functionally efficient and effective internet presence, Hamtramck is able to promote itself on a global level, inviting new and even more diverse economic presence.
I actually set up, yes, another social experiment, just to see the potential of internet accessibility of city documents. As a one-stop-shop for those entities interested in exploring the possibility of investing in the city, I put all the pertinent information for initial investigation all in one place. So far, the results are wonderful! You can check it out by clicking the white "scribd" button to the left on this site.
(4) My campaign is virtual and this is the reason why: I have a powerful following of my activities which is in no way strictly exclusive to Hamtramck. As an elected official, one of the roles is to represent to people. Nobody ever said that representation had to be mutually exclusive to the city limits. I represent, or rather will formally represent the city as an elected official, throughout the Wayne County, throughout the State of Michigan, throughout the United States of America, throughout North America, throughout the Western Hemisphere, and throughout the World.
(5) If you have not taken the time to notice, in the upper right hand corner of this site, there is a little "chicklet" called google translate. With a click of the "badge", you can find one of the 34 offered languages and translate the entire page. Try it, its lots of fun.
(By the way for those who did not know, the words in quotations are sample of internet terminology. Just taught you something new, ha!)
(6) With an internet presence, Hamtramck will possess the ability to "target and capture" existing federal funding and new stimulus federal funding. The abilities are not centralized in the databases that will and should be created, but with the paving of cyber-avenues (yes, I just coined that term) to engage in collaborative partnerships, consortia, and network with other public agencies, (i.e. universities, think tanks, local, state, federal, international governments).
(7) Last, but not least, the ones who are able to access the internet and find their way to this blog will be able, by word of mouth and the sharing of a computer screen, plant the seeds of interest to want to learn more about computers and the internet.
I am re-writing the order of operations for a campaign and the role of an elected official, and having a ball doing it!
The citizenry stands together, many in body, yet one in the beautiful spirit of Hamtramck, and that, my dears, is why I am running for City Council.
So, as for The League of Gloom and Doom, get over it! I am here to stay!
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