Friday, May 11, 2007

MH Reform update;Moseley protects unlimited stream of MH funding;NC state legislators beholden 2 BC/BS re: parity bill

Chris Fitzsimmons of NC Policy Watch has stated the following re: the insurance lobby in NC,in particular, Blue Cross / Blue Sheild(BC/BS):

".....Insurance companies have ferociously fought parity for years, claiming that the mandate would dramatically increase the cost of insurance and may result in businesses dropping coverage for their employees. The evidence from national studies and the state employee health plan proves that the claims are not true. Insurance costs do not rise significantly when mental health is covered and national studies have shown that the lack of parity costs $110 billion a year in absenteeism, lost wages, and more claims for disability and unemployment.
But it is not just a matter of economics. It is a civil rights issue. Insurance companies are allowed to discriminate against people with mental illness and it appears they want to keep discriminating against them."


Donations to NC State Legislators:

BLUE CROSS AND BLUE SHIELD OF NC PAC (Year 2006):142,600 (Year 2002): 69,250

Item 1: BCBS refuses to pull $ fm surplus account to help poor people, though it was founded on the principle of doing such:

A bill that would pull millions from the surplus account of Blue Cross and Blue Shield of North Carolina into a trust fund to provide heath coverage for low-income North Carolinians drew immediate fire from BCBSNC on Thursday.

Item 2: BCBS NC has a history and an associated lawsuit re: accumulating too much of a surplus, which is illegal in terms of statutory limits:
What does Hooker Odom have in common with Bill Frist, MD, who had to pay back Medicare re: fraud:
"Just two days before Sen. Trent Lott (R-MS) stepped down as Majority Leader in 2002, the company Frist's father started quietly settled a massive Medicare fraud lawsuit for $630 million. The eleventh-hour deal -- brokered with Justice Department attorneys after a seven-year court battle -- was made as Frist (R-TN) secured the necessary votes to assume the Senate's top post. "


SEE LETTER SUBMITTED TO ALL THE MAJOR NC NEWSPAPERS, WRITTEN TO : Mr. Les Merrittt N.C. Office of the State Auditor 2 South Salisbury St.20601 Mail Service CenterRaleigh, NC , May 3, 2007

BY: (704)633-7370 Jay Laurens Executive Director Rowan Homes, Inc.

RE: UNLIMITED STREAM OF MENTAL HEALTH FUNDING FOR PIEDMONT BEHAVIORAL HEALTH CARE managed by Hooker Odom buddy who is 'on leave' ("he's out for a couple of weeks", was the explanation when I asked if hehad taken a leave, as per his secretary when I called today, May 11, 2007) . Here is Mr. Laurens' letter to the NC State Auditor:

"If PBH looks bad, Mike Mosleye looks bad. If Mike Moseley looks bad, Secretary Hooker Odom looks bad. If Secretary Hooker Odom looks bad, Governor Easley looks bad. "

High Points of Mr. Laurens letter:

Item 1: Hooker Odom had no legislative approval to create this relationship: without legislative approval, Carmen Hooker Odom, Secretary of Health and Human Services has allocaed approximately $90 million to Piedmont Behavioral Healthcare (PBH) ......

PBH does not have to submit detail information like the Person Centered Plan, the authorization, the session notes----but the other LME's Endorsed Providers do:>Note that this session law allows for the transfer of up to only 15% from one disability category to another but does not allow for the total de-categorization of these funds. Rather thatn actually billing the state through IPRS for actual services provided like other LME's must do, PBH simply submits 'encounter data"

There is a suspicious difference between the services which are presumably being given----related to the millions of dollars being utilized----and the lack of documentation: PBH is only reporting enough total units of service to draw down federal funding since they receive all of their state funding up front." Also, in another recorded statement,a representative with the state controller's office, whose identity Iwill also reveal if necessary, has indicated that the encounter datasubmitted to his department from PBH and the Division "includes the number of units and the rate of payment per unit, but no information as to what service was actually provided or to whom."

(So, the audit of Endorsed Providers Community Support work was done at the level of eye-balling every single note, evern authorization, every piece of paper.....but these people do not even sign-off for their funds).

PBS has had a very dramatic increase in funding from NC DD/MH/SA, state funding to PBH has increased drmatically. IN fiscal year 2003-2003 PBH received $18,076,235 ..... The following year, in fiscal year 2003-2004, PBH received $36,081,977 in non-Medicaidfunding or double the amount received the previous year. ....No other LME's fund balance had grown by anywhere near that measure.

One might presume that this fast moving river of funding was associated with the loss of large mental hospitals; however, this is not true: "....BUT NO STATE HOSPITALS OR INSTITUTIONS HAD BEEN CLOSED.

A slush fund was created with the name: Fund 1590: Fund 1590--$33.716,448 (93.44% of all the total allocation. Fund 1590 was created by DHHS and DMHDDSAS for the allocation of all de-categorized, non-Medicaid dollars allocated to PBH, to be used at PBH's total discretion.

What might be the basis for this strange funding?: . One must question why the state has allowed PBH to continue to operate with a single funding stream agreement, inspite of these same concerns. Secretary Odom currently has no valid legal contract or memorandum of understanding with PBH defining this agreement.

The writer of this letter mentioned the discrepancies in the services provided and the funding being utilized and was punished by DHHS: It is important to note that shortly after PBH and DHHS entered this unusual agreement, representatives of Rowan HOmes, Inc., a provider in PBHY's network, expressed concerns that the agreement seemes to be in the best interest of PBH but not in the best interest of consumer it serves.

Hooker Odom has been caught in similar circumstances before when her husband was on the board of advisors of associated entity, Carolinas Health Care Systems: . As you know, Secretary Hooker Odom is no stranger to questionable contractual arrangements. Following an audit by your predecessor, Mr. Ralph Campbell, the state had to pay back %151.5 million to the federal government because a group of NC hospitals, led by Carolinas Medical Center (Carolinas Healthcare Systems) had overbilled Medicaid At the time this agreement was entered, Carmen Hooker Odom, who would later become the Secretary of Health and Human Services, was the Vice President for Governmental Affairs for Carolinas Healthcare Systems. Also, the Secretary's husband, T.L. "Fountain" Odom, was, and is, on the Board of Advisors for Carolinas Healthcare Systems.

Yet more suspiciousness: The Secretary selected ValueOptions even though this company's bid was $18 million more than the lowest bid and 9 million more than the next lowest bid! N.C. Representative Verla Insko, co-chair of theLegislative Oversight Committee for MH/DD/SAS even described it as a"total shock."

Easley, who appointed Hooker Odom, stood to gain: *ValueOptions has been regular contributor to the Democratic Governor's Association, including a $75,000 donation in 2006.

Dr. Michael Lancaster of NC DMA, stood to gain: . *Dr. Michael Lancaster, Chief of Clinical Policy for the NC Division of MHDDSAS was previously the Regional Medical Director for Value Options.

DHHS personel such as Tara Larson, have refused to respond: Tara Larson, Manager of Medicaid Policy at the Division of Medical Assistance (DMA) PBH has colluded has engaged in the following to increasepayments from Medicaid: * billing for services not rendered * billing for more services than actually provided * billing for more staff than are actually care providers * understaffing relative to service definition requirements and billingI can provide you with a copy of the entire letter and all relatedattachments upon request. It substantiates improprieties on the partof PBH and the provider mentioned above, with whom they have signedmultiple lucrative contracts. I firmly believe that theseimproprieties meet the definition of Medicaid fraud. Though it may bea coincidence, it worth pointing out that the Executive Director forthis contract agency also previously lived in New York.I am concerned that DMA may not investigate the matter fully. While Ms. Larson's assistant did confirm receipt of the packet, I have since left four phone messages with Ms. Larson, but have received no return calls. If PBH looks bad, Mike Mosleye looks bad. If Mike Moseley looks bad, Secretary Hooker Odom looks bad. If Secretary Hooker Odom looks bad, Governor Easley looks bad.


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