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Contact with the Attorney General's Office

 
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cjhelser



Joined: 24 Apr 2006
Posts: 28

PostPosted: Wed May 24, 2006 8:51 am    Post subject: Contact with the Attorney General's Office Reply with quote

Hello Waiver Watchers ~

As we all know, the 11/1/05 Annual Plan project was implemented by FSSA/DDRS WITHOUT modification and promulgation of the Indiana 460 IAC 6 rules. FSSA/DDRS only sent out "memos," which do not reverse the actual ratified rules established by the state of Indiana for the Medicaid Waiver program. This has occurred in other states across the country which 2-3 years later results in audits of providing agencies with massive paybacks due to billing/reimbursement by those agencies via unpromulgated directions of the state. In these states, the memos or bulletins submitted by the state waiver entity did not hold up.

See below our correspondence with the Indiana Attorney General's Office:

Dear Mr. Martin, Office of the Indiana Attorney General:


Thank you for taking time to talk with me earlier this morning! Though I do not agree with your conclusions, I appreciate your willingness to discuss these issues.

Below, I want to get part of our conversation on the record since these issues are critical to Indiana today and will be more critical in the next 2-3 years:


My Background -

1) Currently President of Ascend, Inc., a Case Management Company in the Medicaid Waiver program for developmental disabilities in Indiana
2) Have been continuously employed in the Medicaid program since 1976
3) Former Federal Court Liaison in Ohio for a Federal Court Order involving Medicaid services to persons with developmental disabilities


Current Medicaid Fraud Problem for my Company and the entire State of Indiana -

1) All Medicaid Providers in Indiana, including my company, have a Provider Agreement that states that they will follow Indiana rules and Medicaid rules. Since 11/1/05, we have received emails and bulletins telling us to ignore and not follow the current Indiana rules, and follow the guidelines in the emails and bulletins. To this day, the Indiana rules and the Medicaid state plan have not been amended according to Indiana law and Medicaid rule.

2) Our company is now being ordered to commit "Medicaid Fraud" by the creation of a billing and documentation process that has not been amended by Indiana rule or Medicaid rule. For example, we are paid in monthly units with no current documentation promulgated rules. Yet we are under the former Medicaid plan and audit requirements for hourly billing and hourly documentation.

3) In addition, our company is a further "party to Medicaid fraud" as a Case Manager, since we are the gatekeeper for contracts that now reimburse for days of service that have not been approved by Indiana rule or Medicaid rule. For example, a service provider can bill and be reimbursed for the time a client is away from services, even though this is not legal under the current Indiana and Medicaid rules.

4) In future audits, we are not following Indiana or Medicaid rules at this time for billing and documentation. This leaves all Indiana companies, including Ascend, open to future audit findings.


Our Course of Action to Protect our Company & the State of Indiana -

1) In October, 2005, prior to the implementation of the 11/1/05 memos that told us not to follow current Indiana and Medicaid rules, we wrote to Director Mitch Roob and Director Peter Bisbecos to ask for a "Hold Harmless Agreement" for the future audit requirements for the billing and documentation rules that were being suspended and changed without Indiana rule promulgation or Indiana State Medicaid Plan changes. We figured this was an easy solution to our legal jeopardy. This request was denied by Directors Roob and Bisbecos.

2) In meetings prior to the 11/1/05 memos, the Indiana officials promised quick action to promulgate Indiana rules and to change the Medicaid plan. This would get the State of Indiana and our Medicaid Companies out of legal jeopardy. Now nearly seven months later, no Indiana rules have been promulgated and the Indiana Medicaid State Plan has not been modified. THEREFORE, all Medicaid providers continue to commit "Medicaid Fraud" under current Indiana law.

3) Finally after seven months of Medicaid Fraud by all providers, I contacted the Office of the Indiana Attorney General to ask for assistance. Unfortunately, your response was that "if they tell you to do it, then I guess you are OK". This is not very comforting when you know you will be audited in 2-3 years under rules in billing and documentation that we are not allowed to follow As a former Federal Court Liaison, it was my job to assure State Officials followed the Medicaid rules and the Federal Court orders. My hope was that your office had the same approach to protect the citizens and businesses of the State of Indiana.


Your response was very typical of most people when you said, "no one will audit you under the rules you were told not to follow". Sir, this is very naive. As I stated to you, I was brought in as a consultant to solve the exact same situation in West Virginia a few years ago. The West Virginia State Officials changed the Medicaid reimbursement system "on the fly" without changing the rules or getting CMS approval. Two years later, West Virginia had a huge payback to the CMS since they expanded and modified Medicaid without CMS approval. The auditors in the State of West Virginia then went out to audit the individual providers for that same time period, and indeed ordered the money to be paid back to the State. The providers claimed that they were told to "do it this way" by the State Department. The auditors stated that "no one, including a State official" can order you to commit Medicaid fraud. You must follow the rules!!

I am sorry that your office has no interest in this case as a Medicaid fraud problem. However, Indiana is on the verge of very large Medicaid paybacks, and the service providers are still in audit jeopardy. This is a shame since the State rule and the Medicaid State Plan amendment processes are so easy to use. It just takes research, planning, and coordination. Actually, it can be great fun, and leads to great services for persons with disabilities and their families. And the Indiana rule process protects the citizens of Indiana and Indiana businesses from "on the fly" changes.

Thanks for considering this issue! We will agree to disagree, but I appreciate your efforts!

David Ellison
President, Ascend, Inc.
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noplacelikehome



Joined: 22 Oct 2005
Posts: 45

PostPosted: Thu May 25, 2006 11:40 am    Post subject: Reply with quote

Thanks for posting this. Very interesting. Please keep us updated.
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cjhelser



Joined: 24 Apr 2006
Posts: 28

PostPosted: Fri May 26, 2006 10:17 am    Post subject: Attorney General Reply with quote

Noplacelike home ~

Will keep everyone informed per the Attorney General's response to the Medicaid Fraud issue. We called the Attorney General's Office back and the deputy director was still cursing us for asking for an investigation into the Annual Plan project and its violation of the promulgated rules 460 IAC 6 & 7 codes. It appears the Attorney General's Office has talked to FSSA and is trying to make this all go away. Funny how on the news the other night, the Attorney General's Office is in big trouble for not investigating other shady contract deals occurring. Just another punch to the bureaucrats to keep our mission alive.
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