THE AFFECT OF INSTITUTIONAL
ABUSES OF THE STATES
ON
HEALTH CARE and WELFARE
REFORM
Medicaid Fraud Complaints in N.Y.S.
January 23, 1994
Chapter 2
PROBLEM:
No Systems Exist to:
A. Track Institutional Abuse
B. Track Research Sciences Abuse
C. To INSURE STRUCTURAL INTEGRITY OF DATA.
D. Provide Data Control Checklis
E. Provide THE MEDICAL PROFESSION with INCENTIVES TO FIND COST-EFFECTIVE SOLUTIONS.
F. Protect Families from abuses by Institutions and Doctors
G. Identify Medicaid and Medicare Fraud.
BACKGROUND:
On Jan. 4, 1983 the 97th Congress enacted Public Law 97-414 cited as the "Orphan Drug Act". This Act as empowered to give incentives to drug manufacturers for developing treatment drugs for, " diseases and conditions, such as Huntington's disease, myoclonus, ALS (Lou Gehrig's disease), Tourette syndrome, and muscular dystrophy which affect such small numbers of individuals residing in the United States that the diseases and conditions are considered rare in the United States;".
There is a need for stricter definition of appropriate medical practices for physicians conducting Human Research.
1) For diseases which there is no cure and for which no single course of treatment is currently unanimously agreed upon. Research suggests a population of approximately 20,000,000 people.
2) In diseases where doctors in their judgement will use a variety of treatments in regards to an attempt to best assist their patient. This population includes approximately 43,600,000 people.
(From Data on Persons with Disabilities, 1992, Cornucopia.)
Analysis of the Diagnostic Related Groups (DRGs) in the populations above will reveal abuse by Institutional Review Boards of Human Rights as defined by THE NUREMBERG CODE (1947) Paragraph 1.
An example of Flagrant Bureaucratic abuse may be found within the State of New York Medicaid Management Information System. The system was designed to be untraceable. Examinations of the original systems design for the NYS MMIS ( See Exhibits A, B, & C ) show that all complaints of Medicaid/Medicare Fraud are reviewed by the Dept. of Social Services:
New York State (Medicaid Management Information System, Exhibit C, pg. 57)
"Types of activities which are indicators of misutilization and should be reported include:
Provider Abuse-billing for services that were not rendered; requesting payment from recipients; providing poor care; refusing to provide or make adjustments to eyeglasses, dentures or custom shoes for patients already receiving care.
Recipient Abuse-ID card forgery or alteration; "provider shopping" for drug prescription; loaning ID cards to others."
Cases come into the Baltimore Hotline and are then referred back to the State. The case driven system that currently exists in the State of New York requires HHSOIG Hotline Complaints to be forwarded to the Dept. of Social Services. The Dept. of Social Services then calls on the accused Physician/Institution to Review itself through the IRB of that facility under 45CFR46.116 (c)(1)(iii), 45CFR46.116 (d)(3), 45CFR46.116 (f), 45CFR46.117(c). Those responsible for the infractions are reviewing themselves.
The result has been a usurpation of Parental Rights making it impossible to keep families intact.
If one were to compare the instance of Legal Interventions on behalf of the minor child one would find that parents of individuals who fall into the category of Disabled Americans are much more frequently victimized through Family Court. The LOOPHOLE in the law appears when parents are accused of medical neglect and abuse. Such accusations effectively remove children from the constitutional protection guaranteed to all Americans.
Doctors and Institutions are therefore now in control of difficult to find patients who fit their Research Protocols as defined under 45CFR46.407, 45CFR46.408(c); "In addition to the provisions for waiver contained in 46.116 of Subpart A, if the IRB determines that a research protocol is designed for conditions or for a subject population for which parental or guardian permission is not a reasonable requirement to protect the subjects (for example, neglected or abused children) it may waive the consent requirements in Subpart A of this part and paragraph". This is why Abuse and Neglect Complaints are more prevalent in diseases with small populations and within our society today.
An Ad Hoc Study of living patients in a single disease with a total population of 400 people demonstrated that:
72% of Parents were not informed of childs' prognosis at time of diagnosis. 72% of Parents were not informed there was no treatment or cure for disorder. 72% of Parents were not informed of serious and permanent effects of drug treatment.
72% of Parents were threatened by Doctors/Institutions using 45CFR46.408(c)
100% of Parents who disagreed with medical treatment were disenfrancished by being required to obtain psychological assistance through the State Family Courts.
In this one study 22 million dollars of CRISP-Research Sciences funding, double billing to Private Insurers and Medicaid was identified over an 8 year period. No government entity was interested in seeking collection of improperly received funds.
Within the State of New York if one were to compare:
The NYS Child Abuse and Neglect Database (known as CCRS) to the list of medically neglected wards of the state in the following fields:
1. Identify arcas of State Intervention concerning medical neglect of minor children.
2. Identify how many minors come under specific DRG's that are funded by Federal Research Grants
3. Identify initiator of Complaint
4. Identify Doctor/Institution providing medical care.
5. Items 3. & 4. above are going to have high correspondence.
6. Compare these to CRISP-Research Funding by Doctors, Hospitals, institutions - and all permutations thereof (Drugs,Procedures, etc.) .
Complaints will cluster around individual doctors, institutions and diseases. Individual Hospital Institutional Review Boards who abuse 45CFR46.408(a) and 45CFR46.409(b). Using DRG's one would find a disproportionate number of Legal Interventions on the part of the Dept. of Social Services. Particularly those diseases for which ample Federal Funding is available through CRISP-Research Sciences. For example: check Neuropathies. Therefore it is common practice to BURY such complaints.
In systems terms, a doctor, a hospital, a school, a clinic, an insurance company, any health care related provider could seek the support of the Dept. of Social Services to disenfranchise any parent and conduct any type of medical procedure on a minor child.
What motivates them?
a) Grants and Research Funding requiring a subject population of a certain minimum size to qualify their findings under 45CFR46.408(c)
b) Lack of Appropriate Data Retention
c) Lack of Standards to identify Medical Fraud by DRGs.
An increase in the population of State Wards improves the States ability to increase their State Block Grants and raises the population of Welform Clients. The Due Process Clause of the Fifth Amendment does not apply to the New York State Dept. of Social Services, especially New York State Family Court.
As the Report to Senator Mega states, " The Legislature has given SPCCs the power to intrude into one of society's primary institutions, the family. SPCCs are private, not-for-profit corporations, with little accountability. They operate by contract and the delegation of authority from local government without much oversight." (See Exhibit D-Addendum: Report to Senator Christopher J. Mega-1987, N.Y.S.- Amy Neustein Complaint).
After the inquiry by Senator Christopher J. Mega-1987, Judge Gallet denied any further visitation to the mother. The father was awarded Full Custody. In 1988, the father placed Sherry in Foster Care. Sherry Neustein became anorexia. Today she is institutionalized and receiving all nutrition through a feeding tube.
The Sherry Neusteins have become a valuable commodity to the medical community. She now requires $100,000. a year in services (doctors, case workers, foster care, institutional care).
If even one quarter of the 442,000 Wards of the State identified by the Childrens Defense Fund Report (CNN-1/21/94) could be returned to their families this would reduce the national debt by approximately 11 Billion Dollars a year.
Costs of Social Services Investigations, court proceedings and parental defense are not included in these estimates.
This is the rational for expansion of Social Services, Contractors of all Types, Institutionalization, Provider Reimbursements, etc. All with no tracking. This structure of malfeasance extends to both Federal and State Agencies.
The original documentation from the NYS MMIS System becomes invaluable. Without which one would be unable to define necessary System Identifiers.
SYSTEMS ERROR IN DATA ACQUISITION OR RETENTION
PROVIDES
A FRUITFUL FIELD FOR FRAUD.
PROBLEM RESOLUTION
1.The children most in need of protection from Human Experimentation are removed from the protection of the law by accusing the parents of abuse and neglect. A change in the law prohibiting all experimental research on children that become wards of the state or children of parents accused of medical neglect or abuse should rapidly remedy this situation. Therefore returning Research Funding to the Legitimate Medical Community.
2. Under Proposed Health Security Act, Title V, Subtitle B, Section 5103, Electronic Data Network - Systems Audit Trails to track this abuse should be created.
3.Create the FEDERAL FAMILY PROTECTION ACT which will establish FEDERAL STANDARDS FOR MEDICAL CHILD ABUSE AND NEGLECT. This law should prohibit the use of Federal Waivers for INFORMED CONSENT.
4.Create Incentives for States to provide Constitutional Due Process in through proactive State Legislation.
5.Create A DATABASE OF ALL Federal and State Contractors so that compliance can be monitored.
6.Use Optional Field in Health Care Reform Prototype Form, Page 49, to identify individuals who medically qualify under the American with Disabilities Act. The physician can indicate the DRG Code in this field. All parents of minors would give a copy of this Form to their childs school. This would automatically qualify this minor child for evaluation for all Special Services required under IDEA.
The price of freedom is vigilance. Never before in our history has one generation worked so earnestly to secure for the next, the tools and techniques necessary for the task of Implementing Universal Health Care Reform in America....
IT IS INFORMATION THAT MOVES A NATION !
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