I'm an American Citizen who has been reporting a crime - OPM FEHBP Hospital Insurance Fraud since 1999.....my Criminal Complaint has been placed in the OPM & DHHS HMO Government Grievance Procedures, whereas when Judicial Review was requested, it was denied sua sponte, just as quickly as the OPM FEHBP Hospital Insurance. I've been reporting OPM FEHBP health insurance kickback fraud resulting in death of a Retired Federal Employee - Air National Guard Base Technician.
.
Office of Inspector general's are and have been in violation of the US Patroit Act sect 1001 Civil Rights and Civil liberties Violations against the Public: by allowing and concealing mass OPM FEHBP Hospital Insurance Fraud ( anti dumping / anti kikcback violations ) against Retired Federal Employees forced into Medicaid by criminal termination of OPM FEHBP Hospital Insurance Service Contracts.
.
[CITE: 5CFR890.105] & Medicaid False Claims Act - OPM FEHBP Supersedes Medicaid.
.
The Retired OPM FEHBP Beneficiaries are being automatically denied Hospital Insurance Benefits ( criminal enactment of DHHS HMO grievance / appeals procedures - hospital discharge procedures ) for posthospital care, for criminal conversions into Medicaid. Felony kickback fraud.
.
[CITE: 42CFR409.33] HOSPITAL INSURANCE BENEFITS --Table of Contents Subpart D--Requirements for Coverage of Posthospital SNF Care Sec. 409.33
.
OPM Federal Employee Health Benefits Insurance Policy and Information Division:
.
Subj: RE: more details
Date: 3/3/00 12:23:10 PM Eastern Standard Time
From:
FEHB@opm.gov (FEHB Internet Mailbox)
To:
Kstbylite1@aol.com ('
Kstbylite1@aol.com')
.
I am sorry about what happened to your mother. It's so hard to watch
someone we love suffer, and if we feel the person isn't getting the proper
medical care, it makes it so much worse.
You have a couple options for addressing your concerns.
The first option is to go through the health plan. As you know, benefits
for extended care/skilled nursing facilities are limited. But if you feel
that the care your mother was receiving should have been covered, based on
the description in the plan's brochure, you can file a disputed claim. The
process is spelled out in the brochure. You must first request a
reconsideration from the plan; they may overturn their decision on appeal.
If they uphold their decision, your next level of appeal is OPM.
The second option, if you really believe that fraud is involved, is to file
a complaint with our Inspector General's offi ) for posthospital care, for criminal conversions into Medicaid. Felony kickback fraud.
.
[CITE: 42CFR409.33] HOSPITAL INSURANCE BENEFITS --Table of Contents Subpart D--Requirements for Coverage of Posthospital SNF Care Sec. 409.33
.
OPM Federal Employee Health Benefits Insurance Policy and Information Division:
.
Subj: RE: more details
Date: 3/3/00 12:23:10 PM Eastern Standard Time
From:
FEHB@opm.gov (FEHB Internet Mailbox)
To:
Kstbylite1@aol.com ('
Kstbylite1@aol.com')
.
I am sorry about what happened to your mother. It's so hard to watch
someone we love suffer, and if we feel the person isn't getting the proper
medical care, it makes it so much worse.
You have a couple options for addressing your concerns.
The first option is to go through the health plan. As you know, benefits
for extended care/skilled nursing facilities are limited. But if you feel
that the care your mother was receiving should have been covered, based on
the description in the plan's brochure, you can file a disputed claim. The
process is spelled out in the brochure. You must first request a
reconsideration from the plan; they may overturn their decision on appeal.
If they uphold their decision, your next level of appeal is OPM.
The second option, if you really believe that fraud is involved, is to file
a complaint with our Inspector General's office. They investigate fraud
complaints. You may either call the health care fraud hotline
(202-418-3300) or write to:
U.S. Office of Personnel Management
Office of the Inspector General Fraud Hotline
1900 E Street, NW, Room 6400
Washington, DC 20415
.
Again, I'm sorry to hear about your mother's death.
Karen Leibach
Insurance Policy and Information Division
.
[CITE: 5CFR890.105 ] If the carrier ( OPM FEHBP HMO -Hospital affiliate ) denies a claim (or a portion of a claim - [ posthospital extended care SERVICES ] ), the covered individual may ask the carrier ( FEHBP HMO affiliate ) to reconsider its denial.
A covered individual * must exhaust both * the carrier ( DHHS - HMO- service-grievance procedure ) and OPM review processes specified in this section before seeking judicial review of the denied ( Covered ) claim.
.
Elderly Victims of Hospital Insurance Fraud ( anti dumping / anti kickback violations ) die without posthospital care / SERVICES.
A Hospitalized Elderly Victim of Hospital Insurance Fraud are Not able - mentally or physically - to conduct OPM & DHHS Government Grievance Procedures to Fight for DENIED Covered posthospital services.
Grievance & appeals procedures are used to conduct, conceal and allow fraudulent insurance acts against public programs and american citizens. Denial of Civil and Criminal Rights - Obstruction of Justice.
.
According to the Detroit News, Between 1999 & 2001 Michigan's Medicaid clientele ballooned to 1.25 million from 1 million, at a cost of approximately $6,000 on each Medicaid Reciepent. Criminal ( kickback ) Conversions of OPM Retired FEHBP.
,
According to Vernon Smith, " a health care expert " who attended - Previous Attorney General MI, ( now ) Governor Jennifer Granholms Summit, he stated the Biggest Factor responsible for raising Medicaid spending is Enrollment. <~ HMO Hospital DHHS / OPM Dumping. Felony.
.
Section 1001 of the USA Patriot Act, signed into law by the President on October 26, 2001, directs the Inspector General to review information and receive complaints alleging abuses of civil rights and civil liberties by Department of Justice employees.
The OIG has created a special section in its Investigations Division to process these complaints. This section will **** identify the more serious ***** civil rights and civil liberties allegations and assign them to OIG employees for investigation.
The OIG will refer other complaints to Department components for their review and handling.
How to Report a Complaint about Waste, Fraud, Abuse, or Misconduct in the Department of Justice:
The Office of the Inspector General (OIG) investigates allegations of fraud, waste, abuse, and misconduct by Department of Justice employees, contractors, and grantees.
.
The OIG is an independent entity within the Department of Justice that reports to both the Attorney General and Congress on issues that affect the Department's personnel or operations.
.
.
You may report waste, fraud, abuse, or misconduct to the OIG by mail:
.
Office of the Inspector General
U.S. Department of Justice
Investigations Division
950 Pennsylvania Avenue, NW
Room 4706
Washington, DC 20530
e-mail:
oig.hotline@usdoj.gov .
Public Official Criminal Misconduct OIG Fraud - RICO
.
OIG SSA Allegation Management Division Quote: " If we were to provide information pertaining to the subject of the allegation, he or she might then have grounds to seek possible criminal and civil sanctions against OIG and its employees".
.
Title 18 US Code: OIG's violating HIPAA Laws - 1518 - reads - obstruction of criminal investigations of health care offences - Hospital Insurance Fraud -anti dumping, Retired OPM FEHBP- anti kickback, into Medicaid. Obstruction of Justice Region V CMS.
.
IAIP redacted 8Jun04 .indd S.C. Section 552, as amended. Preface The Department of Homeland Security (DHS) Office of Inspector General (OIG) was established by the Homeland Security Act of 2002 (Public Law 107-296) by amendment to the Inspector General Act of 1978.
.
Subj: RE: abuse of civil rights by justice employees
Date: 12/13/2002 8:54:30 AM Eastern Standard Time
From:
Inspector.General@usdoj.gov (General, Inspector)
To:
Kstbylite1@aol.com ('
Kstbylite1@aol.com')
.
Dear Ms. Kimball:
.
The purpose of this letter is to acknowledge receipt of your Internet submission dated October 31, 2002. The matters that you raised have been reviewed by the staff of the Investigations Division, Office of the Inspector General.
.
The primary investigative responsibilities of this office are:
.
· Allegations of criminal, as well as non-criminal, misconduct committed by U.S. Department of Justice employees and contractors; and
· Waste and abuse by high ranking Department officials, or that affects major programs and operations.
.
This Office does not have jurisdiction in the matter you described.
.
Section 1001 of the USA Patriot Act, signed into law October 26, 2001......
.
Therefore, your complaint has been forwarded to:
.
Office of Personnel Management
Office of the Inspector General
1900 E Street NW
Washington, D.C. 20415
.
Allegations of criminal misconduct committed by- OIG OPM J. Frech - U.S. Department of Justice employees and contractors - OPM FEHBP Health Insurance Contracting Divisions.
Stop Health Care Fraud!
.
Office of Inspector General
Office of Personnel Management
Joseph Frech investigator
dtd: 9 may 2002
.
" The matters discribed in your letter are not within the jurisdiction of this office. The OIG had also recieved information regarding your case in September 2000. At that time we determined that the ( OPM FEHBP ) Health Benefits Contracts Division has sole jurisdiction over your complaint. The decision made by the contracts division is final and the OIG will NOT Investigate ( OPM FEHBP Contracting Divisions assisting, allowing & concealing felony federal health care offences against Retired FEHBP ). "
.
I hope this answers any questions regarding this matter.
.
Sincerely,
.
The Office of the Inspector General
Department of Justice
--------------------------------------
.
MASS DUMPING OF RETIRED FEHBP WILL BEGIN IN 2006 - FELONY FRAUD
.
Subj: Re: Health Alliance Insurance Fraud
Date: 2/21/2003 5:07:41 PM Eastern Standard Time
From:
senator@stabenow.senate.gov (Senator Debbie Stabenow)
To:
kstbylite1@aol.com February 21, 2003
.
Thank you . . .
. . for contacting me about ( OPM FEHBP ) insurance & Medicaid ( kickback ) fraud committed by Health Alliance Plan. I appreciate that you have taken the time to communicate your views and concerns with me.
I understand your concern about this issue. Should related legislation
come before the U.S. Senate for a vote, I will keep your views in mind,
and share your thoughts on this issue with my colleagues who serve on the
Health, Education, Labor and Pensions Committee.
Thank you again for contacting me. Please feel free to contact me
whenever I can be of assistance to you or your family.
Sincerely,
Debbie Stabenow
United States Senator
.
=============== RELATED LEGISLATION - Medicare Drug Plan
.
Carrier OPM - HCFA - DHHS & OIG counterparts - subject to prosecution under section 1001, title 18, United States Code.
.
1999 RULES & REGULATIONS Part IV DHHS OIG 42 CFR Part 1001 . Federal Health care Programs: ( OPM FEHBP ) . Fraud & Abuse Anti Kickback Statutes Sect 1128B(b) of the Social Security Act provides criminal penalties for individuals or entities that knowingly & willfully offer, pay, solicit, or recieve renumeration to induce ( inducing forfiture OPM FEHBP for criminal Medicaid kickback conversions ) the referral of business reimbursable under a Federal Health Care Program ( including Medicare & HCFA Medicaid ). Section 2 of the Medicare and Medicaid Patient & PROGRAM PROTECTION ACT of 1987 ( MMPPPA )
.
OPM JANUARY 2003 <~ befor Medicare Drug Bill was given to congress
.
[Code of Federal Regulations][Title 5, Volume 2][Revised as of January 1, 2003]From the U.S. Government Printing Office via GPO Access[CITE: 5CFR890.304] [Page 439-441] TITLE 5--ADMINISTRATIVE PERSONNEL CHAPTER I--OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM--Table of Contents Subpart C--Enrollment
.
To Conceal past & Future OPM Hospital DHHS dumping & kickbacks with HCFA/CMS - making the Medicare -Drug- Plan - a criminal kickback solisitation. TARGETING Retired FEHBP.
.
Sec. 890.304 When do enrollments terminate, cancel or suspend ? .
.
(2) An annuitant or survivor annuitant may suspend enrollment in FEHB for the purpose of enrolling in a Medicare-sponsored plan under sections 1833, 1876, or 1851 of the Social Security [[Page 441]] Act , or to enroll in the Medicaid program or a similar State-sponsored program of medical assistance for the needy, or to use CHAMPVA or TRICARE (including coverage provided by the Uniformed Services Family Health Plan) or TRICARE-for-Life instead of FEHB coverage.
To suspend FEHB coverage, documentation of eligibility for coverage under the non- FEHB program must be submitted to THE RETIREMENT SYSTEM.
If the documentation is received within the period beginning 31 days before and ending 31 days after the effective date of the enrollment in the Medicare-sponsored plan, or the Medicaid or similar program, or within 31 days before or after the day designated by the annuitant or survivor annuitant as the day he or she wants to suspend FEHB coverage to use CHAMPVA or TRICARE (including the Uniformed Services Family Health Plan) or TRICARE-for-Life instead of FEHB coverage, then suspension will be effective at the end of the day before the effective date of the enrollment or the end of the day before the day designated. Otherwise, the suspension is effective the first day of the first pay period that begins after the date THE RETIREMENT SYSTEM recieves the documentation.
(3) The enrollee and covered family members are not entitled to the temporary extension of coverage for conversion or to convert to an individual contract for health benefits.
( OPM HOSPITAL DHHS HMO DUMPING - PostHospital Facilities ( Hospital contracted Affiliates ) Bill/SUE Victims for criminally terminated OPM HMO Hospital Insurance - forcing Medicaid Application - kickback fraud ).
(e) Temporary continuation of coverage. Employees and family members are entitled to temporary continuation of coverage only as provided under subpart K of this part.
.
TITLE 5 > PART III > Subpart G > CHAPTER 89
Sec. 8903. - Health benefits plans
.
The Office of Personnel Management may contract for or approve the following health benefits plans:
(1) Service Benefit Plan. - One Government-wide plan, which may be underwritten by participating affiliates licensed in any number of States, offering two levels of benefits, under which payment is made by a carrier under contracts with physicians, hospitals, or other providers of health services for benefits of the types described by section 8904(1) of this title given to employees, annuitants, members of their families, former spouses, or persons having continued coverage under section 8905a of this title, or, under certain conditions, payment is made by a carrier to the employee, annuitant, family member, former spouse, or person having continued coverage under section 8905a of this title.
.
Affiliate: Health Alliance Plan - OPM FEHB HMO Federal Hospital Insurance Service Contractor/Provider.
.
HAP offers 2,596 personal care physicians (PCP) and 4,901 specialists. HAP’s delivery system includes 45 hospitals in southeast Michigan and the Flint area, including 23 major hospital networks, 65 urgent care centers and 765 ancillary providers: nursing homes, mental health facilities, optical providers, laboratories, durable medical equipment providers,ambulance services and pharmacy chains.
.
Public Official Criminal Misconduct by Government Employees. " Color of Law "
Michigan is involved in allowing and concealing Hospital dumping by OPM FEHBP & DHHS into Medicaid.
DHHS made my Governor Vice Chairperson for DHHS National Governor's Committee.
.
The Department of Health & Human Services - Office of Inspector General
( DHHS/OIG ) continues to work with the Administration on Aging ( AOA ), Health Care Finance Administration ( HCFA ), and the American Association of Retired Persons ( AARP ) to develop an outreach campaign to educate beneficiaries and those who work with the elderly to recognize fraud and abuse and to report it appropriately. <~ grievance / appeals procedures used to deny due process of law and conceal felony fraud against the Elderly.
This campaign will be fully "launched" in 1999.
The Region V office had a record high 940 new MSP cases filed in 1998. Contributing to this were partnership arrangements with contractors and U.S. Attorneys in Michigan and Ohio..................
.
Title 18 U.S.C. § 4. Misprision of felony. Whoever, having knowledge of the actual commission of a felony cognizable by a court of the United States, conceals and does not as soon as possible make known the same to some judge or other person in civil or military authority under the United States, shall be fined under this title or imprisoned not more than three years, or both.
.
THE MEDICAID FALSE CLAIM ACT (EXCERPT)Act 72 of 1977
400.603 Application for, or determining rights to, medicaid benefits; false statement or false representation of material facts; concealing or failing to disclose certain events; felony; penalty. [M.S.A. 16.614(3) ]
(3) A person, ( Kimberly Kimball ) who having knowledge of the occurrence of an event ( OPM contracted Hospital DHHS Workers inducing forfiture of FEHBP Insurance by criminal enactment of HMO Grievance Procedures ) affecting his initial or continued right to receive a medicaid benefit or the initial or continued right of any other person on whose behalf he has applied for or is receiving a benefit, shall not conceal or fail to disclose that event ( OPM Hospital DHHS conducting anti dumping / anti kickback violations against HMO COVERED Federal Employee Health Beneficiaries ) with intent to obtain a benefit to which the person or any other person is not entitled or in an amount greater than that to which the person or any other person is entitled.
(4) A person who violates this section is guilty of a felony, punishable by imprisonment of not more than 4 years, or a fine of not more than $50,000.00, or both.
.
OPM FEHBP Insurance Supersedes Medicaid - OPM FEHBP are Not 'entitled' to Medicaid Services 'Allready covered' by OPM FEHBP ( kickback fraud ).
.
Michigan Consumer & Industry Services-concealing Medicaid kicback fraud for DHHS/HCFA region V now called CMS- Center for Medicaid Services.
.
John Engler, Governor / Attorney General Jennifer Granholm <~ now Governor and also Natnl Governors cmte Vice Chair for DHHS
Department of Consumer & Industry Services
P.O.Box 30664
Lansing MI 48909
.
August 17,1999
.
RE: 990759 BonSecours Hospital
.
Dear Ms Kimball
.
This communication is a follow-up to our letter to you regarding your complaint against BonSecours Hospital.
.
As you are aware, your complaint was forwarded to the Department of Health & Human Services, Health Care Financing Administration ( HCFA ), in Chicago for thier evaluation and direction to the State. HCFA has advised us that they are NOT authorizing an Investigation of the alledged allegation in your letter. Based on HCFA Decision, we have closed our file.
.
If you should have any questions, please call Mary Duncan at ( 517 ) 334-7442, between 8:00 am and 4:30 pm, Monday through Friday.
Sincerely,
signature : Mary Duncan
James L Buchanan, Chief
Detroit Field Services/Special Services Section
.
MI
Attorney General - health care fraud division # 2002-04-0925 .......... Mike Cox / Jennifer Granholm
original Complaint #'s filed with State Law Enforcement Offices & dates filed:
a. Health Care Fraud Division # 99-05-1034
January 2000 ........................ Linda Damer
b. Insurance Bureau # 31302-001
March 2000 .......................................... Cindy Mielock , Kristie Tabor
c. Liscensing Division # 68-99-3073-00
April 1999 ....................Victim still living.................. Cynthia Samuel
d. Bureau of Health Systems # 990759
April 1999 ....................Victim still living ................... Mary Duncan
.
MI
.
From : Jeanette Girty Health Alliance Plan -
DHHS HMO Grievance - Quote in writting on June 20, 2000 -
To Taber,Kristie - Michigan Insurance Bureau -
.
HAP Quote: " After a two week stay, the ( Covered OPM FEHBP ) husband STILL refused to apply for ( HCFA ) Medicaid ".
.
HCFA Health Care Finance Administration - Handles Medicaid
.
Subj: update, letter sent to State Fraud & Insurance Bureaus -Reply
Date: 8/3/00 11:06:34 AM Eastern Daylight Time
From:
SHahnReizner@hcfa.gov To:
Kstbylite1@aol.com CC:
DSchmidt@hcfa.gov,
JTolian@hcfa.gov,
PMiner@hcfa.gov Ms. Kimball,
While we appreciate your efforts to keep this office informed of your communication with the Michigan Department of Insurance, please note that the matter that Department has taken up in response to your inquiry concerns a coverage decision made by a Federal Employee Health Benefit Plan.
As you know, the Federal agency that handles inquiries about FEHB plan coverage issues is not HCFA, but the Office of Personnel Management, which has already been in communication with you about this matter.
It is therefore not necessary or for you to copy me on your ongoing
communications with the Michigan Department of Insurance.
Susan Hahn Reizner
Medicaid Fraud and Abuse Coordinator
HCFA Region V - Chicago
.
OPM FEHBP
Subj: Alexandra Rupert
Date: 9/6/00 2:45:32 PM Eastern Daylight Time
From:
IETHOMAS@opm.gov (Thomas, Imogene E)
To:
SpiritDancerMita@aol.com ('
SpiritDancerMita@aol.com')
CC:
kstbylite1@aol.com ('
kstbylite1@aol.com')
Hello Ms. Kimball
I received a response from Jeanette Girty at Health Alliance Plan regarding
your mother Alexandra Rupert's denied claim. Ms. Girty informed me that
they resolved this case long ago. HAP paid the additonal days and sent the
approval letter to you in Marysville, MI on May 21, 1999. You also sent in
a complaint letter to the Michigan Insurance Bureau in March of this year
regarding the same thing as well as some alleged quality issues. They also
investigated the QA issues and responded to you. Ms. Girty said HAP had not
received an itemized bill for the additional three days so they sent you
another letter reminding you of the approval and asked you to forward the
itemized bill to them. As of today, they have not received this
information. HAP need the information (the itemized bill) for proof of
payment. HAP considers this case resolved and closed. Any questions let me
know.
Regards,
Imogene E. Thomas
.
Michigan Insurance Bureau
.
Subj: Health Alliance Plan
Date: 12/21/2000 4:34:13 PM Eastern Standard Time
From:
Kristie.Taber@cis.mi.us ( Taber,Kristie @ INSFS@CIS)
To:
Kstbylite1@aol.com (
Kstbylite1@aol.com)
Cindy Mielock forwarded to me your recent e-mail. I have reviewed our file
and your concerns. Our previous review consisted of a review of Health
Alliance Plans handling of the submitted claims, and their payment of
benefits pursuant to the terms of the contract. At the time that the
dispute arose, the process to review your concerns was through the plans
grievance procedures. As a result of your grievance, further benefits were
paid on behalf of your mother, Mrs.Rupert. As such, it appears that the
HMO has paid all the claims submitted, and there are no outstanding bills.
Also, pursuent to our previous telephone conversations, we obtained a copy
of the HMO's established guidelines used for making the determination that
your mother's condition 'no longer' required skilled care. This was provided
to you in our October 16th, 2000 corraspondence. Our file was closed at this time.
It appears that the remaining issues concern matters outside of our
authority, such as the quality of care your mother recieved. You have
contacted other governmental agencies regarding these concerns.
Unfortunately, those issues are not issues we are able to address on your
behalf.
I hope this explains the status of your file with our office. If you have
further questions, please feel free to contact me directly at 517-373-2080,
or toll free at 1-877-999-6442.
<>
Center for Regulatory Effectiveness Michigan
Whom to contact: Michigan Office of Financial and Insurance Services (OFIS) ( Taber,Kristie @ INSFS@CIS)
What you can appeal: The availability, delivery, or quality of health care services, including a complaint regarding an adverse determination, as well as issues concerning the contract between you and your health plan.
.
Subj: MI Civil Rights Dept. 285032
Date: 12/2/2003 10:42:57 AM Eastern Standard Time
From:
BlairJ@michigan.gov To:
manifestdreams@aol.com Sent from the Internet (Details)
Dear Ms. Kimball,
Thank you for your e-mail correspondence on November 18, 2003.
As you were notified in April and August 2002, this department is unable
to assist you with your concern. If you have not already done so, I
encourage you to contact the Michigan Insurance Bureau.
Sincerely, Joan Blair, Reconsideration Team Manager 313/456-3827
.
Subject: FBI Response
Date: 5/26/2004 10:26:33 AM Eastern Daylight Time
From:
tips11@fbi.gov Reply To:
To:
LawISAmootIssue@aol.com CC:
BCC:
Sent on:
Sent from the Internet (Details)
.
Dear Ms. Kimball,
.
THIS IS NOT AN AUTOMATED RESPONSE
Thank you for your submission to the FBI Internet
Tip Line. After a careful evaluation of your
information, it is our determination that your
complaint should be reported to your local law
enforcement authorities or District Attorney's
office. If you wish pursue legal matters against
the hospital you should contact an attorney.
Post-Hospital Extended Care Services
.
(i) The term "post-hospital extended care services" means extended care services furnished an individual after transfer from a hospital in which he was an inpatient for not less than 3 consecutive days before his discharge from the hospital in connection with such transfer.
.
........concealing patient skill care needs to criminally terminate OPM FEHBP hospital insurance services for criminal conversion into HCFA Medicaid.
.
Subj: Skilled Nursing Facility Coverage <~ ' Hospital Extended Care Benefits '
Date: 4/23/99 8:19:16 PM !!!First Boot!!!
From:
MSWEB1@hapcorp.org (Member Services Web)
To:
Kstbylite1@AOL.com .
Ms. Kimball,
Thank you once again for contacting the <~ DHHS/OPM HMO Grievance 'Service'
Member Services Web. Upon review of the
referral to Nightengale East Nursing Center, <--- deception: Hospital transfer
we have found that Mrs.Rupert will be
referred to Nightengale for a total of two <---illegal threat to force Medicaid Application
weeks for family training for maintenance of
her feeding tube. This family training is
considered to be basic care according to <--42PHC 409.32 & 33 Hospital Requirements
HAP criteria. Although the skilled nursing
facility benefit is for up to 730 days, HAP <---Hospital Extended Care Benefit,
criteria require that the care must be skilled. <----Mattie of HAP, approved skilled nursing with hospital SW prior to Hospital discharge on 20 April 1999 in medical records released to law enforcement on 21 april 99 when family was finally allowed to see them After victim was Off Hospital Property ( dumped ).
Because Mrs.Rupert is recieving basic and
NOT skilled care, she does not meet the <---- false claim fraud ( intent to harm )
criteria for the maxium benefit.
If you would like to speak to someone
directly regarding Mrs.Rupert's care, you
are more than welcome to call HAP at
1-800-422-4641 and ask for Mattie Ogburn. <~ was communicating with Hospital DHHS.
Ms.Ogburn has spoken with Mr.Rupert and
is handling your Mother's case.
Member Services Web
.
18 USC Sec. 24 01/02/01-EXPCITE- TITLE 18 - CRIMES AND CRIMINAL PROCEDURE PART I - CRIMES CHAPTER 1 - GENERAL PROVISIONS-HEAD- Sec. 24. Definitions relating to Federal health care offense-STATUTE-
(a) As used in this title, the term ''Federal health care offense'' means a violation of, or a criminal conspiracy to violate- (1) section 669, 1035 - reads - False statements relating to health care matters, 1347, or 1518 - reads - obstruction of criminal investigations of health care offences, of this title; ( 2) section 287, 371, 664, 666, 1001- anti kickback violations, 1027, 1341, 1343, or 1954 of this title, if the violation or conspiracy relates to a health care benefit program.
(b) As used in this title, the term ''health care benefit program'' means any public or private plan or contract, affecting commerce, under which any medical benefit, item, or service is provided to any individual, and includes any individual or entity who is providing a medical benefit, item, or service ( OPM & DHHS HMO Grievance/appeals Procedures / Judicial Review ) for which payment may be made under the plan or contract.
-SOURCE- (Added Pub. L. 104-191, title II, Sec. 241(a), Aug. 21, 1996, 110 Stat. 2016.)-SECREF- SECTION REFERRED TO IN OTHER SECTIONS This section is referred to in sections 669, 1035 of this title; title 42 section 1395i.
.
Public Official Criminal Misconduct. Felony OPM FEHBP & Medicaid Fraud.