Watchdog Bytes

The liars, thieves and tax dodgers of Medicaid (Or how states stink at background checks and you get to pay for it)

Call us stunned: States aren’t doing so hot at checking the background of Medicaid providers.
The entitlement program for low-income and medically needy people costs $372 billion to run. Inevitably, money gets swiped thanks to slacker bureaucrats in Texas, Ohio, New York and other states.
The owner of an Ohio medical equipment company? Turns out he was convicted of receiving stolen property six months before enrolling to get state and federal cash. After he enrolled, he was convicted of Medicaid fraud.
A New York dentist was convicted of insurance fraud in 2003 for filing a claim for a dental machine that he had removed from his office. The state was ignorant of the conviction and enrolled him in 2004. Here’s the chorus: He was subsequently convicted of Medicaid fraud.
An examination of 188 Medicaid providers banned between January 2007 and June 2008 found that 24 had a history of criminal convictions, tax debts or false disclosures when they signed up to suck up the government money, according to a review by the inspector general for the U.S. Department of Health and Human Services.
Here’s some more howlers:
An Ohio pediatrician had $114,591 in federal tax liens before enrollment and received $582,421 from the Medicaid program. The inspector general excluded the provider for a program-related conviction.
An Iowa aide had a felony conviction for forgery before she enrolled in 2004. She was convicted of theft, a program-related crime, after she enrolled.
An Indiana physician convicted of illegally dispensing narcotics was enrolled in Medicaid in 1996. He operated a drug and alcohol rehabilitation clinic and was later convicted of health care fraud and insurance fraud.
A New York dentist had Federal tax liens of $9,495 and State tax liens of $10,280 during the period when he was an active provider. Medicaid paid him $709,549. The inspector general excluded the provider for insurance fraud.

The report says 48 of the 188 excluded providers had federal or state tax liens before or after they enrolled in Medicaid. Nine of the 188 excluded providers collectively had 15 liens totaling $443,100 before they enrolled as providers.
The small sample showed that Texas had about 7 percent of the 188 Medicaid bad boys slipped through enrollment screenings.

-- Darren Barbee

Blood blunders: Texas health department fines hospital $2,600 for three 'transfusion errors'

Thanks to Baptist Medical Center of San Antonio for this week’s “You’re creeping us out about hospitals” moment.
Seems BMC messed up three separate blood transfusions over a period of less than two years.
In sports terms, that is what's known as “my bad.”
To wit: Sometime after February 2009, someone discovered a labeling error in the blood bank that listed one patient’s tube of blood with another patient’s information.
Oops. 
In January 2009, the blood bank lab had another, separate incident of transfusion errors. Ditto in November 2008 with another transfusion error.
In the February case, the hospital didn’t bother to perform a “definitive transfusion reaction investigation” for the patient, according to state documents.
And the lab didn’t perform some kind of test or procedure — the Texas Department of State Health Services crossed out whatever the lab didn’t do so the identity of “Patient #1” wouldn’t be revealed. (Efforts to reach Patient #1 for comment were unsuccessful.)
Luckily, the health department cracked down, striking fear and dread into the heart of the hospital for its careless ways.
It imposed a colossal fine (if the hospital was located in Nepal instead of San Antonio). They smacked old BMC with a $2,600 penalty. (That's $100 less than the new Samsung 58-inch 3D Plasma HDTV at Best Buy.)
Take that, blood messer uppers.
Chief Medical Officer Dr. David Siegel of the Baptist Health System said in a statement that safety and quality of care are the primary objectives of the organization.
“We continually refine processes to improve the care we provide to our patients,” he said.
Siegel noted that the organization ahs been working with its accrediting agency, the Joint Commission, the College of American Pathologists and the Centers for Medicare and Medicaid Services.
“Error detection and continuous process improvement are the hallmark of a high reliability organization," he said.
The system did not address a question about what specifics steps the hospital has taken to improve blood bungles.

-- Darren Barbee

Here's the latest on identity theft

[From Star-Telegram Watchdog Columnist Dave Lieber]

If you are the victim of identity theft, expect to lose $527 for out of pocket expenses. These include postage, photocopying, childcare, travel and purchasing police and court records.

Expect to spend 68 hours repairing the damage caused by the thief.

Those are just a few of the latest stats in a new report issued by the highly-respected Identity Theft Resource Center.

 

###

You can read the full report here here.

Federal investigators find wrondoing at unidentified Texas Head Start center

[From Star-Telegram Watchdog columnist Dave Lieber]

We don't know where the alleged crime occurred yet, but the U.S. Government Accountability Office announced this week that undercover investigators found workers at a Head Start center somewhere in Texas who misrepresented the eligibility requirements of parents of children enrolled in the program.

The investigators pretended to be parents or guardians of make-believe children and offered fake pay stubs and other documents that went unchallenged.

Head Start, as you know, is a $9 billion annual program that helps families with child care and other services across the nation. But the eligibility requirements are supposed to be pretty stiff: you cannot qualify if you make too much money.

According to a report released this week and also testimony in a government hearing, a tip about the unnamed Texas center reached the feds in October that "over-income" children were being improperly enrolled. The tips came in through the FraudNet hotline.

Among the Texas findings:

- A Head Start associate disregarded more than $20,000 worth of income to qualify a child. The unnamed associate is quoted in the report as saying, "We see this, but we don't see this." The report stated, "If both parents' income were counted the family would be on a long wait list for over-income families." The report added, "Our bogus applicant was assured that the government would never come back to verify the income."

- A Head Start associate "disregarded $11,700 in nonagricultural work in order to qualify the family of three (mother, father, child) for migrant Head Start services. A requirement of migrant Head Start services is that the families income must be derived primarily from certain agricultural work."

- The income for another family of three was $2,000 more than allowed.

Meanwhile, the report notes, some Texas families who do qualify may be stuck on lengthy wait lists because other families are fraudulently admitted. One example cited: a single mother caring for two children earns $6,000 a year below the poverty level. "The mother works nights and sleeps only a few hours a day as a result of not having child care for her son during the day."

A Texas family of four lives on $290 a week, but the mother cannot work because she can't get child care.

Another Texas single mother of two children is unemployed and receives $500 per month in child support. The family receives money from two government programs (WIC and Medicaid), but the mother cannot work because she must care for the child. The report notes the mother is also the victim of domestic violence.

The GAO report suggests establishing more stringent income verification requirements and continuing  undercover tests.

You can watch some of the GAO's undercover video here.

Judge to con artist: 'You must be lying, your lips are moving'

Con artist Melissa Marie Ramon once told Watchdog, “The stories are not going to add up when (my case) goes to trial. They really are not.”
The stories may not have added up, but boy did the years.
Ramon, 34, of Bellaire, will spend 10 years in federal prison for scamming millions of dollars from investors for a fake French investment company.
Ramon, who lied about having a degree from Rice University and pretty much every thing else, will also have to pay $3,094,000 in restitution.
Prior to her sentencing, Ramon spoke for about 40 minutes, telling a federal judge how much she had changed and how much she regretted what she had done.
The judge responded by saying that Ramon must be lying because her lips were moving, according to assistant U.S. Attorney Gregg Costa.
Ramon tricked investors into giving her millions by claiming she was working for a company called JaxTrece. She hired student actors to portray company’s officials.
Ramon told investors that JaxTrece provided bridge loans to nonprofit organizations which would be repaid with interest when pending grants were funded. Ramon used the $4 million she collected from investors to buy homes in Bellaire, Texas, and in Wyoming.
Then, while out on bond, Ramon offered the properties as rentals and then defrauded people who gave her deposits.

--Darren Barbee

Slapping autistic, mentally retarded patient was 'acceptable' to head nurse

In one corner, with diagnoses of Down syndrome, autism, profound mental retardation and hypertension (and the inability to speak) was patient #9.
In the other corner, the director of nurses.
In August 2008, the patient was admitted to Cozby-Germany Hospital in Grand Saline, east of Dallas. (Never accuse the Texas Department of State Health Services of dragging their heals on a case.)
A day later Patient #9 was screaming and hitting staff. Staff injected the patient was Haldol, which is used to treat psychosis.
Enter the director of nurses, who slapped Patient #9 on the arm, according to state documents. She considered her slap acceptable behavior, the documents say.
The decision by the state's hospital regulators: The hospital does not provide staff training for providing services to patients with psychiatric disorders or aggressive behaviors. (Note: Slapping them isn’t as therapeutic as it may first sound).
The law says patients have the right to consideration and care, even if they have disorders that make them disagreeable.
The hospital paid $4,000 for the ouchy.
A call to hospital officials officials was not immediately returned.

-- Darren Barbee

Feds says they will fix broken Energy Star program

[From Star-Telegram Watchdog columnist Dave Lieber]

Weeks back we shared in a Watchdog Bytes report about how the U.S. government's EnergyStar program was broken.

Some good news has come out of this.

The feds now say they are revamping the program entirely.

The government intends to tighten its certification process. Companies won't be able to use the logo on their products until they actually receive approval.

Previously, companies could use the logo when they apply, not before getting approval.

By the end of 2010, all products approved must be checked at independent labs. Previously, the companies could "test" their own products and issue approval. (Can you believe that?)

How refreshing -- and unusual -- to see such a quick turn-around on something like this so soon after the government audit revealed these fundamental flaws in its program.

Overseas food coming to US rarely gets inspected

From Star-Telegram Watchdog columnist Dave Lieber

Recently, on this Watchdog Bytes blog, we looked at precautions U.S. consumers can take to make sure your food is clean and sanitary. Read that post here.

Now, though, the U.S. Government Accountability Office has issued a report that shows that inspections by the Food and Drug Administration of food in overseas plants hardly happens at all.

The report's highlights state:

"In in 2008, FDA inspected 153 foreign food facilities out of an estimated 189,000 such facilities registered with FDA.

"In 2007, FDA inspected 95 facilities.

"FDA estimated that it would conduct 200 inspections in 2009 and 600 in 2010."

For this year, that means that less than 1 percent of the registered overseas facilities are inspected.

Doesn't exactly inspire a lot of confidence, does it?

But Watchdog Bytes isn't done scaring you yet. There's more bad news:

"FDA has limited authority to assess penalties on importers who introduce such food products, and the lack of a unique identifier for firms exporting food products may allow contaminated food to evade FDA's review....

"FDA does not always share certain distribution-related information, such as a recalling firm's product distribution lists with states, which impedes states' efforts to quickly remove contaminated products from grocery stores and warehouses."

And more ...

The "FDA currently lacks mandatory recall authority for companies that do not voluntarily recall food products identified as unsafe. Limitations in FDA's food recall authorities heighten the risk that unsafe food will remain in the food supply."

The GAO recommends that if FDA determines that it does not have the authority to implement one or more recommendations, the agency should seek the authority from Congress."

Oh boy. Since I don't really know where my food comes from, right now, I've lost my appetite.

I think I'll skip lunch.

# # #

In case you missed it, here's a Star-Telegram report about how the FDA is falling behind on domestic food inspections, too.

U.S. nuclear weapons stockpile fact sheet

The United States is releasing newly declassified information on the U.S. nuclear weapons stockpile. Increasing the transparency of global nuclear stockpiles is important to nonproliferation efforts, and to pursuing follow-on reductions after the ratification and entry into force of the New START Treaty that cover all nuclear weapons: deployed and non-deployed, strategic and non-strategic.
The full Department of Defense fact sheet is here.

Stockpile. As of September 30, 2009, the U.S. stockpile of nuclear weapons consisted of 5,113 warheads. This number represents an 84 percent reduction from the stockpile’s maximum (31,255) at the end of fiscal year 1967, and over a 75 percent reduction from its level (22,217) when the Berlin Wall fell in late 1989.

Warhead Dismantlement. From fiscal years 1994 through 2009, the United States dismantled 8,748 nuclear warheads. Several thousand additional nuclear weapons are currently retired and awaiting dismantlement.

Non-Strategic Nuclear Weapons. The number of U.S. non-strategic nuclear weapons declined by approximately 90 percent from September 30, 1991 to September 30, 2009.

 

-- Darren Barbee

The ghosts of government healthcare: Taxpayers shell out (again) to treat the dead

 

No one can say Medicaid lets the absence of a pulse — or the lack of any vital signs — get in the way of forking over cash for a claim.
In October, Watchdog reported that pharmacies in Texas and four other states filled controlled-substance prescriptions for more than 1,800 dead Medicaid patients.
A recent audit by the U.S. Department of Health and Human Services inspector general has identified payments made to providers for patients (or corpses, as they are also known) after they had gone to that great health care plan in the sky.

 

Specifically, the Texas Health and Human Services Commission shelled out $148,598 for claims made between July 1, 2005, and June 30, 2006, according to the audit. Medicaid is a state/federal program.
The agency paid on 1,370 claims for 84 recipients who had been reported dead before or after June 2005.
Of the 84 recipients, the commission:
* Paid $18,695 for 38 recipients who were confirmed deceased as of June 30, 2005. The commission did not appropriately identify and recover these over payments through its normal review process.
* Blew $18,129 on 16 recipients who died after June 30, 2005.
* Forked over $111,774 for 30 recipients who may or may not be deceased.

The payments occurred because the commission did not have adequate controls over the prevention, identification, and recovery of payments for services purportedly provided after recipients’ deaths, the inspector general found. And monthly reviews did not include primary care case management or Medicare crossover claims.
In response to the report, the commission said it will review the claims and refund the federal government its share of the money paid after recipients deaths. 
 

-- Darren Barbee