July 23rd, 2012

ONE HAS TO BE SUSPICIOUS OF THE CLAIMS TO ADDRESS HEALTH CARE DISPARITIES FOR THE POOR THAT HAVE EXISTED  THROUGHOUT THE BEST OF ECONOMICS TIMES IN A SATURATED HEALTH CARE MARKET AT A TIME WHEN MEDICAID IS ESSENTIALLY BEING GUTTED.  THE HEALTH ENTERPRISE ZONES WILL IN FACT BE USING THIS 'HELPING THE UNDERSERVED/CRUMBLING COMMUNITIES' ROUTINE TO CO-OPT TAXPAYER MONEY AND SKIRT LAWS TO BRING HEALTH CARE TO THESE SAME AFFLUENT  ENTERPRISE DEVELOPMENTS WITH A FEW CENTRALIZED HEALTH COMPOUNDS FOR THE POOR.

THE NEXT QUESTIONS ASKED AT THE MEETING HIGHLIGHTED THE FACT THAT THE UNDERSERVED IN THESE COMMUNITIES WILL PLAY NO PART IN THE PROCESS.  THE FIRST WAS FROM A SEASONED GRANTWRITER WITH AN ESTABLISHED ORGANIZATION IN TOWN, THE SECOND FROM AN INDIVIDUAL LOOKING FOR FUNDING OPPORTUNITIES FOR A SMALLER COMMUNITY ORGANIZATION, AND THE LAST WAS A STRONG COMMUNITY LEADER WIITH THE NAACP WHO SPOKE OF A HIGHLY MOTIVATED COMMUNITY WITH NO FINANCIAL RESOURCES.  ALL WANTING TO PARTICIPATE IN THIS HEALTH ENTERPRISE ZONE DEVELOPMENT BUT ALL SPEAKING WITH RESERVATION AS TO THE REALITY OF THEIR CHANCES.  'IF I TAKE THE TIME AND EFFORT TO SUBMIT A GRANT FOR THIS PROGRAM DO I HAVE A CHANCE TO BE CONSIDERED'?  ANOTHER ASKS 'ALL OF THE PERKS FOR THE PROGRAM COME AS TAX BREAKS WHICH MEANS YOU HAVE TO BE A BUSINESS TO RECEIVE THEM AS A SMALL COMMUNITY ORGANIZATION CAN'T......WILL YOU HAVE OTHER INCENTIVES'?  LASTLY, 'WE HAVE A WELL-ORGANIZED COMMUNITY COMMITTED TO IMPROVEMENTS AND SMALL BUSINESSES ALREADY CONSIDERING COMING INTO OUR COMMUNITY......WOULD THAT QUALIFY AS THE PARTNERSHIP FOR WHICH YOU ARE LOOKING'?

EACH OF THESE QUESTIONS GETS TO THE FAILURE OF THE DEPARTMENT OF HEALTH IN CREATING A COMMUNITY-CENTERED SOLUTION BECAUSE AS THESE QUESTIONERS KNEW WHEN ASKING, THE ANSWER TO ALL THESE QUESTIONS IS 'NO'.  JOHNS HOPKINS IS RUNNING THIS DEVELOPMENT AND WILL USE THE PRIVATE NON-PROFITS THEY CREATED ALONG WITH THE 'GIFTING NGOs' TO DESIGN THE PROJECT.  ANY COMMUNITY PARTICIPATION WILL BE A TOKEN PERSON OR TWO WITH NO VOICE.  SO WHY DO THEY DO THESE PUBLIC MEETINGS?  THEY GOOD GOVERNANCE COMMITMENT REQUIRES THEM BUT EVERYONE SEES THEM AS WINDOW-DRESSING.  THE PEOPLE WHO KNOW ABOUT THE MEETINGS ARE STATE DEPARTMENT STAFFERS TOLD TO ATTEND THE MEETING AND POLITICIANS.  WE DID GET A GOOD SHOWING THIS TIME OF 'REAL PEOPLE' I'D LIKE TO THINK FOUND OUT THROUGH MY BLOG.  

IT DOES MAKE A DIFFERENCE TO COME OUT AND MAKE PUBLIC THE CORRUPTION AND CRIMINALITY THAT EXISTS.  IT IS LIKE A VAMPIRE AND THE FIRST DAWN OF LIGHT.....TRUTH MAKES THESE CHARACTERS LOOK AS UNSCRUPULOUS AS THEY ARE AND THEY CAN ONLY BEAR SO MUCH EXPOSURE.  BE DOROTHY THROWING WATER ON THE WICKED WITCH AND MAKE THESE SOCIOPATHS MELT AWAY!!!!!  SHOUT LOUDLY AND STRONGLY AGAINST PLANS TO FUNNEL MORE TAXPAYER MONEY AWAY FROM THE PEOPLE'S PROGRAMS AND INTO THE POCKETS OF THE RICH!

VOTE YOUR INCUMBENT OUT!!! 

FROM WIKIPEDIA:

Here is a list of ways to identify a sociopath. This list is from "Profile of a Sociopath." Is is a pretty good list of sociopathic indicators.

• Glibness/superficial charm
• Manipulative and cunning
• Grandiose sense of self
• Pathological lying
• Lack of remorse, shame or guilt
• Shallow emotions
• Incapacity for love
• Need for stimulation
• Callousness/lack of empathy
• Poor behavioral controls/impulsive nature
• Early behavior problems/juvenile delinquency
• Irresponsibility/unreliability
• Promiscuous sexual behavior/infidelity
• Lack of realistic life plan/parasitic lifestyle
• Criminal or entrepreneurial versatility
• Contemptuous of those who seek to understand them
• Does not perceive that anything is wrong with them
• Authoritarian
• Secretive
• Paranoid
• Only rarely in difficulty with the law, but seeks out situations where their tyrannical behavior will be tolerated, condoned, or admired
• Conventional appearance
• Goal of enslavement of their victim(s)
• Exercises despotic control over every aspect of the victim's life
• Has an emotional need to justify their crimes and therefore needs their victim's affirmation (respect, gratitude and love)
• Ultimate goal is the creation of a willing victim
• Incapable of real human attachment to another
• Unable to feel remorse or guilt
• Narcissism, grandiosity (self-importance not based on achievements)
• May state readily that their goal is to rule the world

(Obviously, in order to be a sociopath a person doesn't have to exhibit anything like all the above. Usually, the lack of a conscience, the manipulation of others, dishonesty and the inability to love and/or have lasting and profound personal relations and cruelty are key symptoms and often much more revealing than having been in trouble with the courts.)
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THE ARTICLE FROM LAST BLOG SHOWS NO FRAUD LAWS ON THE BOOKS TO ENFORCE....MARYLAND HAS NO OPTIONS FOR ENFORCEMENT.  THIS WEBSITE ON THE MARYLAND ATTORNEY GENERAL DOUG GANSLER'S APPEARED OVERNIGHT AND AS YOU CAN SEE BY THE 'COMING SOON' ENTRIES.....LEADS NOWHERE.
 

Maryland Medicaid Fraud Control Unit of Maryland Description Coming Soon ...

Contact Information Medicaid Fraud Control Unit of Maryland
Office of the Attorney General
200 St. Paul Place
18th Floor
Baltimore, MD   21202



Phone: (410) 576-6521 Fax: (410) 576-6314 Official Website

Statutes
Coming Soon ...


SURPRISINGLY, TEXAS HAS A STRONG PROGRAM THAT ACTS NOW AND ASKS QUESTIONS LATER.  MOST CASES PROVE TO BE GOOD CALLS.....LET THESE FRAUD MILLS GO OUT OF BUSINESS. 

The Texas Tribune | Bitter Pills The Big Push on Medicaid Fraud
By EMILY RAMSHAW Published: July 19, 2012

When it comes to finding cost savings in the state’s unwieldy Medicaid program, the Office of Inspector General at the Health and Human Services Commission gets high marks.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

The division, charged with investigating fraud among health care providers paid to treat impoverished children and the disabled, has drastically increased both its caseload and the potential monetary returns associated with it over the last fiscal year. The spike has won glowing reviews from budget-weary state lawmakers and has cast Texas’ innovative enforcement team into the national spotlight.

But O.I.G.’s dollar-recovery strategy — which includes an increased reliance on a rule that allows investigators to freeze financing for any health care provider accused of overbilling — has enraged doctors, dentists and other providers who treat Medicaid patients. They say an anonymous call to a fraud hot line or a computer-generated analysis of a handful of billing codes is enough to halt their financing without even a hearing, jeopardizing their practices and employees and leaving thousands of needy patients in a lurch while the state works to prove — or rule out — abuse.

“It’s like having an atom bomb dropped on my business,” said one doctor who asked not to be named, pending the outcome of his Medicaid fraud investigation, which has lasted months. “I’ve had to cut wages. People are worried about their jobs. We’re pariahs at this point.”

When Douglas Wilson took over as the division’s inspector general last year, he approached the job from an accounting background. Traditionally, he said, the division had operated like a law enforcement agency, performing lengthy investigations to get cases ready for criminal prosecution. Instead he wanted to halt the flow of financing to questionable providers at the first sign something was amiss.

To help execute this culture shift, Mr. Wilson hired a deputy, Jack Stick, a past municipal judge and former state legislator who in 2003 helped write one of the leanest budgets in state history, along with the bill language that created the commission’s inspector general’s office.

“The message to those providers out there who see the Medicaid program as an A.T.M., who use it to make monthly withdrawals to buy jets and $8 million houses, is that there’s a different inspector general’s office now,” Mr. Stick said.

Together, Mr. Wilson and Mr. Stick have redirected the office’s resources to put a greater focus on investigations with the biggest potential monetary returns and on Medicaid providers, not recipients. They have cut the time it takes to work a case to eight weeks from three or four years with just a slight increase in budget. In the last fiscal year, the amount of money identified for possible recovery has increased by more than 1,200 percent.

They have also increasingly used “payment holds.” In fiscal 2011, O.I.G. added 12 providers to the list of those whose financing was frozen; so far this year, they have imposed payment holds on an additional 88 providers.

The majority of those were Credible Allegation of Fraud, or C.A.F., holds — a provision in the new federal health reform law that authorizes states to suspend Medicaid payments if allegations of fraud have “indicia of reliability.” Mr. Wilson said that means fraud investigators no longer have to work their cases to “beyond a reasonable doubt”; all they need is a “preponderance of the evidence” to keep state dollars in the bank while they conduct full-scale investigations.

It is hard to quantify just how well O.I.G.’s new strategy is working. It can take months or even years to recover money in a fraud case, and the office’s goal is to prevent unnecessary spending in the first place, which is harder to tabulate. But Mr. Stick said the potential dollars associated with their increased investigations, a number they will release at the end of the fiscal year, “will be stunning.”

Rocky Wilcox, vice president and general counsel for the Texas Medical Association, said the only stunning thing is how little due process doctors targeted by Medicaid fraud investigations have. Right now, he said, the office can look at a handful of charts, turn thousands of dollars in questionable billing into millions of dollars in estimated fines and penalties, and pursue a lengthy investigation, all while the doctor’s financing and needy patients hang in the balance.

In one recent case, Mr. Wilcox said, O.I.G. cut off financing to Carousel Pediatrics — which treats 40,000 children in Central Texas, 90 percent of them on Medicaid — alleging that the clinics owed the state more than $20 million for making what investigators believed were billing errors. After the state’s H.M.O.’s and Medicaid managed-care plans came to Carousel’s defense, he said, the office allowed payments to resume.

Officials with the O.I.G. say they do not discuss continuing investigations, but that they consider all factors in a case and make “good-cause exceptions to policy when appropriate.”

Dr. Robert Anderton, a dentist and lawyer who represents health care providers in Medicaid fraud investigations, said the first C.A.F. hold he dealt with was last year, in the midst of Health and Human Services’ investigation into Medicaid reimbursement for orthodontics. (As of this month, the agency is holding $9 million in suspended payments, nearly $8 million of it to dental and orthodontic providers.)

“After that, it was just like dominoes,” said Dr. Anderton, who now has roughly 15 clients in similar situations.

Providers facing fraud investigations struggle to get even a preliminary hearing before the state, said Dr. Anderton, a past president of the American Dental Association. In the meantime, they are declaring bankruptcy, closing their doors and giving up on Medicaid, which is already facing a provider shortage because of low reimbursement rates. They are leaving thousands of patients, many of them children, without health care, he said.

“If there’s fraud, let’s take care of that. If there’s misappropriations, let’s get it settled,” he said. “It’s a totally unfair violation of due process just to stop these funds.”

Mr. Wilson and Mr. Stick say the idea that there is no due process is preposterous. Investigators do thorough reviews before halting financing and hire physicians to help with cases that require medical expertise. While they acknowledge it can take months for providers to get a state administrative hearing over allegations, they say the O.I.G. gives them the chance to come in for an informal review at any time. If the allegations are unfounded, Mr. Wilson and Mr. Stick said, the unpaid money is reimbursed and the tap is turned back on.

“To any provider who says, ‘We’re being targeted blindly,’ our message is ‘We aren’t targeting anybody.’ The data tells us who to look at,” Mr. Stick said. “There are intentional acts and there are inadvertent acts, unknowing acts. We recognize the difference.”

If anything, the budget pressures of the last session — and lawmakers’ estimation that they could save an extra $50 million over the biennium by increasing fraud investigations — have made this dollar recovery and cost prevention even more crucial. Mr. Wilson and Mr. Stick say their next strategy is to employ cutting-edge technology that could make Texas even more a national leader in such investigations.

“Last session confirmed the fact that this office needs to be aggressive about pursuing fraud, waste and abuse,” Mr. Wilson said. “We can’t be bashful about it.”

eramshaw@texastribune.org

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WHAT YOU ARE SEEING IS A CULTURE OF CRIME IN THE HIGHEST LEADERSHIP POSITIONS, WHETHER GOVERNMENT OR BUSINESS.  THE PUBLIC MUST COME OUT AND SHOUT IT DOWN AND THEY MUST USE ELECTIONS TO REVERSE THIS TAKEOVER.  YOU ARE HANDING YOUR FAMILIES FUTURE OVER TO UNSCRUPULOUS CHARACTERS IF NOT!  YOU'LL SEE HERE THAT PEOPLE'S CAREERS ARE THREATENED IF THEY DON'T FALL IN LINE WITH THIS CRIMINAL MENTALITY.
 Abandoned Main Street While Rescuing Wall Street

Author: Neil Barofsky Publisher: Free Press (2012) Binding: Hardcover, 288 pages

Jeff Horwich: The Troubled Assets Relief Program -- TARP -- you might recall that was the formal name for what we often just call "the bailout." In 2008 Congress allocated $700 billion to stabilize the U.S. financial industry.

Congress and President Bush assigned one man to build a team, and police all that spending. Until February, Neil Barofsky was the special inspector general for TARP. His book about the experience comes out tomorrow. It's called: "Bailout: An Inside Account of How Washington Abandoned Main Street While Rescuing Wall Street." Neil Barofsky, good to talk with you.

Neil Barofsky: Great to be here.

Horwich: So Neil, what was the job that you believed, in your core, that you were appointed to do?

Barofsky: Well essentially, that was set out by Congress. When they created TARP they created a special inspector general that was supposed to be the taxpayers advocate in many ways -- to look out for fraud, to make the necessary recommendations to treasury, to bring them in line, so that the banks and participants in TARP wouldn’t take advantage of loopholes or conflicts of interest and at the same time lock people up when they tried to steal from the program.

Horwich: So, when you got to the Treasury Department, from whom you were supposed to be nominally independent what was the job that they wanted you to do?

Barofsky: Well essentially, they wanted me to back down, I think. Every time I started to raising some concerns, the pushback I got was remarkable. I remember within the first couple of days, I started hearing a refrain that I heard over the course of a couple of years -- from the Bush administration to the Obama administration -- saying “Neil, we hear what you’re saying about your concerns about fraud and potential abuses in this program but really you don’t have to worry about it because these are banks, they are not going to risk their reputations by taking unfair advantage and possibly profiting off of the taxpayer.”

Horwich: You write a lot about your disillusionment with the Home Affordable Modification Program -- TARP money that was supposed to go to banks to help people stay in their homes. In your view, what happened to it?

Barofsky: Well, the program has been an abysmal failure; supposed to help up to four million people, even today it’s only 20 percent of that number and it doesn’t look like it’s going to get much better. We confronted Tim Geithner about this and his response was very telling. He wasn’t talking about how the program could be improved to help homeowners. He said the program, would help and I quote here “foam the runway for the banks.”

And by that he explained the banks could deal with a certain number of billions of foreclosures over a certain period of time but anything more than that could put the financial system and those banks in jeopardy. With that in mind, there’s little surprise that the program has been such a failure for everyone other than the large banks.

Horwich: There are a lot of folks in Washington who would probably say you didn’t play the game right and if you had you might have accomplished more. Can you look back and say you actually accomplished anything in your role?

Barofsky: I think we had a tremendous amount of accomplishments and I think when you look at the fraud losses for TARP -- which are going to be historically far, far below anything that one would imagine for a program its size and scope -- I think probably that’s going to be our most meaningful success. But you’re right I certainly didn’t play the game. At one point in 2010, I was told by the person who was running the TARP at the time, that if I didn’t change my tone, as he put it, I was going to do great harm to myself and my ability to get a job on Wall Street or a more plum appointment within the administration.

That’s a really dangerous precedent. Because of the revolving door between Washington and Wall Street, there’s that incentive for all the regulators to pull their punches, play the game and get their big payday at the end of the rainbow. And I think that’s one of the fundamental problems that we need to change if we want to avoid having another financial crisis. 

Horwich: The former special inspector general for the TARP, Neil Barofsky; his new book is “Bailout.” Thank you.

Barofsky: Thank you very much. 

 YOU REMEMBER THE ARTICLE WHERE NEW YORK'S CUOMO FIRES HIS INSPECTOR GENERAL FOR BEING TOO VIGOROUS IN HIS INVESTIGATIONS?  THIS IS THE PROBLEM AND THIRD WAY DEMOCRATS ARE LEADING THE PROTECTIONS OF WALL STREET.  THEY ARE, AFTER ALL THE ONES WHO CREATED THESE CRIMINAL CARTELS!