The following information is a record of communications between one of our chatroom regulars indicating efforts to seek justice.
It breaks my heart that our Elderly are subjected to such abuse and are denied due process of civil and criminal law.
Our Mom was an Emergency Room Addmittance 10 April 1999.
On 12 April 1999, Hospital DHHS 'discharge procedures' began, whereas a State Liscensed Social Worker began inducing forfiture of our Mothers OPM FEHBP Services by falsely claiming her Federal HMO Contractor will NOT provide Covered posthospital services and that we HAVE to Apply for HCFA Medicaid.
When Dad refused to defraud State Medicaid the Hospital DHHS social worker threatened to throw him in Jail by claiming a bed sore wound was caused by Domestic Violance, then she threatened Siblings that We had to take custody and Apply for Medicaid or she throw Dad in Jail. Then the Hospital Social Worker created a False Police Report on 13 April 1999 making the above false claims to intimidate us. After that, she contacted APS in Detroit in attempts to cover her fraudulent activity against our family.
We were being threatened by Hospital DHHS and the HMO, that we had 2 weeks to Apply for Medicaid or ALL Services would be Terminated.
This criminal fraud and abuse was reported daily to Law Enforcement Officials who promptly placed our Criminal Complaint in the DHHS HMO grievance Service procedures ( also called the DHHS OIG Outreach Program ) to aid and conceal Hospital Insurance Fraud and Abuse being conducted against us. The 'Actual Commission of a Felony' federal health Care Offence.
On 20 April 99 our Mother was transfered by the Hospital, by ambulance, to a Hospital Extended Care Facility, where she was placed into a "medicaid bed ward ".
Criminal Complaints were being filed daily re: Anti-dumping and Anti-kickback Violations with OPM FEHBP, HCFA Medicaid Region V, and State of Michigan HCF et al. All refused to protect the Federal Beneficiary from Criminal Termination of a Federal Health Insurance Contract that would result in death.
On 5 may 1999, when arrived at the Extended Care Facility for a scheduled " Care Confrence " ( Utilization Review - dumping ), We found our Mother was allready out in the hallway on a girney discharged to go home.
A 'wound care specialist nurse ' greeted and told us she had gone into our mother room, prior to our arrival, and removed 'skilled care equipement' (foley cathitor), She also stated that the Doctor did NOT Order it, because 'He trusts her judgement'.
The Hospital Extended Care Facility ( Hospital Affiliate ) terminated our Mothers Federal OPM FEHBP Contract for "Hospital Extended Care Benefits" causing her onset of death.
1st cause of death Urinary Sepsis - 2nd cause of death Gastrointestinal hemmoraging, 3rd cause of death C Defile Colitis. Mom suffered for 3 days in sever pain ( untill her insides literally exploded from sever bacteria infections ) untill death on 8 May 1999.
We were also advised by the Hospital Extended Care Skilled Nursing Facility, at the " Care Confrence " that the ' long term care ' Patient, was discharged to go home OR that we could Apply for Medicaid and Private Pay untill eligibility ( Poor ).
We moved our Mom to a " Private Pay Ward " from the girney in the hallway.
Dad was BILLED for the 3 days of suffering and abuse ( 5 May - 8 May 1999 ) of his wife, untill she died on 8 may 99.
An 'administrative procedure' is being used to conduct and conceal Hospital Insurance Fraud against " covered individuals " targeting the Elderly.
Subj: FWD Rosenthaul # 506208 Health Alliance OPM Hospital Insurance Fraud
Date: 2/14/2003 12:02:52 PM Eastern Standard Time
From: Kstbylite1 <mailto:Kstbylite1>
To: DETRIOT@FBI.gov <mailto:DETRIOT@FBI.gov>
CC: Kstbylite1 <mailto:Kstbylite1>
Dear Ms. Rosenthaul,
I need an e-mail address to begin to supply my documented evidence for the FBI Investigation of Hospital Insurance Fraud.
The following is a list of e-mail corraspondance dates with OPM Health Care fraud Hotline reporting the Hospital Insurance Fraud ( OPM assisted in and allowed ).
After the OPM list, I have included information by HAP to State of MI Insurance Bureau ( false claims to conseal fraudulent insurance acts - accepted by MI Ins Bureau ) ****************************
The Health Care Fraud Hotline
Office of Personnel management
Contacted April 1999
20 April 1999 FEHB Patient was ( dumped ) transfered from the Hospital directly into a skilled nursing care facility for hospital extended care services.
Hospital denied Patient Advocate access or viewing of Hospital Medical records untill 21 April 99 : to conseal the * Skilled care needs* of the FEHB beneficiary. Hospital DHHS was trying to force family into illegal Medicaid application using threats, intimidations, false police report and other illegal acts of intimidation.
The Hospital DHHS Department was also consealing the Hospital * transfer * for extended care by calling the transfer a * referal *, decieving family members by claiming this was a transfer by Family not the Hospital.
OPM Contacted 1st by phone. Sharron Knight directed Family to write a " Formal Request " for Hospital extended care Insurance.
21 April 99 Hospital Medical Records were released to Health Alliance Plan to fight for for "Hospital Insurance " benefits.
Sharron Knight spoke with Diane Lapeer BonSecours Hospital Medical Records Department and was informed the transfer was for skilled care. Health Alliance Plan and BonSecours Hospital and HAP both falsely claimed the FEHB Patient was NOT a skilled care transfer.
E-Mail corraspondance with OPM Sharron Knight as follows:
22 April 1999 Formal Request to HAP ( as instructed by OPM by phone ) .......the week you have granted for Alexandra's skilled nursing care is not in accordance with her contract. ( Hospital Insurance ) extended care.
( 730 days contracted for skilled & basic Hospital extended care benefits )
23 April 1999 Formal Request responce: Final Decision of the HMO Grievance Procedure by Health Alliance Plan. HAP committs FRAUD and illegally limits Hospital Extended Care Benefits threatening to stop services in 2 weeks and LIES about the Skilled Care Needs of the FEHB Patient.
Sharron Knight was forwarded the final responce by HAP to show denial of CONTRACTED services.
24 April 1999 5:06 pm .... OPM S. Knight was notified the formal request for Contracted ' Hospital Extended Care Benefits ', have been illegally limitted to TWO ( 2 ) weeks ( of 730 days ) FWD HAP e-mail with request to OPM:
***" notify federal employees: HAP won't pay contracted benefits " ****
27 April 1999 3:40 pm .... S Knight OPM, requests Patient Information to discuss the situtation ( Fraud ) with Health Alliance Plan.
I phoned S Knight to make sure she recieved her copy of HAP's responce ( 3:51 pm ) showing the illegal limitation of contracted benefits, befor she sent me an e-mail changing the dispute and allowing insurance fraud.
27 April 1999 6:00 pm .... S Knight changes my grievance from Denial of Hospital Insurance to:
" the plan's denial to cover services for skilled nursing home care "
S Knight then gives HAP ( FOUR WEEKS ) to respond to the threat
of cancellation in TWO Weeks.
Sharron Knight is allowing HAP to committ HOSPITAL insurance fraud: by suggesting to them and us, that the skilled care services, have no connection to HOSPITAL services, so HAP can begin Another grievance for Nursing Home Care.
29 April 1999 Health Alliance Plan takes the lead given to them by S Knight OPM, as they send us a letter starting a NEW & Different grievance ( to conseal the hospital transfer ) requesting a Medical Records release for the Hospital Extended care Facility.
Hospital Medical Records were already released regarding our Grievance ( HAP & S Knight BOTH know this ).
1 May 1999 I notify S Knight that I am aware that HAP has intentionally changed the dispute and we will not continue this fraud. Hospital Medical records were already released in regard to this dispute.
4 May 1999 Doctor Mike Applefield recertified inpatient skilled nursing care for which the hospital transfer occured.
5 May 1999 Health Alliance Plan terminated Hospital Extended Care Benefits and services as threatened on 23 April 1999 causing the FEHB Patients onset of Death. A wound care specialist Nurse removed ALL skilled care equipement and services for HAP withOUT Doctor's ( or families ) knowledge or consent early morning 5 may 1999 befor the scheduled * care confrence * ( no Doctor present ).The FEHB Patient was moved to *Private Pay* and discharged to go home. Arrangements were scheduled during the Care Confrence to have a Nurse be at the Patients Home when she arrived, transfer as soon as can be scheduled.
Information ( names ect ) of the Hospice Service Nurse contacted thru Henery Ford Home Care ).
The Hospital Extended Care Facility consealed the skilled care needs of the Patient, illegally removed skilled care equipement, consealed the NEW HAP assigned Doctor's Name & Phone Number from the Patient Advocate to conseal fraud, tried to get us to apply for Medicaid ( a second time ) and made the Patient suffer in sever pain ( for 3 days ) untill DEATH.
Alexandra Rupert was Killed ( murdered ) as Threatened ( 4-23-99 ) because family refused to committ Medicaid fraud FOR BonSecours Hospital, Health Alliance Plan and Nightengale Health Care Center and OPM S Knight who was assisting the illegal termination.
6 May 1999 I notify S Knight OPM that Doctor's name & phone number are being consealed from Patient Advocate and that Alexandra's skilled care services have been removed / cancelled by HAP.
6 May 1999 I notifiy HAP " being HAP feels the FEHB Patient is NOT entitled to Hospital Extended Care services, she must be removed from the skilled care facility. If she dieds in transit, I will hold HAP responsible. cc: S Knight OPM
8 May 1999 OPM S knight was notified FEHB Patient DIED, HAP refused to provide contracted services, Social Worker conspiracy with HAP to induce forfiture with conversion into Medicaid, request investigation, and noted AGAIN about the Medical Release game to continue fraudulent insurance acts using the grievance procedure.
10 May 1999 S Knight OPM makes a condition to investigate the FRAUD I've been reporting: Quote:
" IF HAP's final decision ( see 4-23-99 and fact Patient was killed as threantened and died on 8 may 99 )
is to maintain ( Patient is already dead ) denial of coverage for extended care benefits ( S Knight purposely
omits the word HOSPITAL from extended care benefits ) we will obtain a copy of the records
( Hospital Medical records were already released to HAP & OPM on 21 april 99 regarding this fraud ) and
complete an OPM Review.
21 May 1999 HAP for the 1st time acknowledges the grievance is about " Hospital Extended Care Benefits " ( not nursing home facility care ) and states the case was reviewed by thier AMD, that we should be pleased to know HAP decided to approve our request ( S Knights request on 10 May 99 ) for 3 additional days of SKILLED care from 6 May 99 thru 8 may 99 at Nightengale Health Care center. HAP also states to OPM S Knight Quote:
" Please know that this approval in on a ( 1 ) ONE time ONLY exception basis & should NOT be considered a precedent NOR does it IMPLY Future Coverage of this type ".
1. For 3 days the FEHB Patient was DENIED Skilled care and suffered in sever pain untill Death.
2. FEHB Patient was killed as threatened and we should be pleased ?
3. HAP notified OPM they will NOT Provide a contracted service and proved it by killing the FEHB Patient.
4. Health Alliance Plan has NO Intent on providing contracted services to FEHB Beneficiaries. ALL are in DANGER.
27 June 1999 2nd request that S Knight Notify Federal Employees that HAP will NOT provide Contracted benefits or that HAP should be removed from the provider list to FEHB beneficiaries.
S Knight turned her e-mail address OFF, never responded, never did an opm review, allowed fraud resulting in death, refuses to protect future federal employees from being killed in the same manner as FEHB Alexandra Rupert. Allowing Hospital Insurance Fraud resulting in death of FEHB Patients.
Kimberly Kimball continues request for a federal investigation to OPM & other government agencies.
6 September 2000 Imogene E Thomas OPM accepts false claims by HAP regarding Hospital Insurance Fraud resulting in Death.
5 January 2001 HAP submitts more false claims to OPM ( cc: S Knight ) stating...." There has been NO denial of Services "
( OPM S Knight knows services were illegally terminated as threatend causing onset of death on 5 may 99 )
9 January 2001 OPM Mary Armwood was given information from State of MI Insurance Bureau and a copy of 5 Jan 01 letter from HAP showing false claims by HAP.
19 January 2001 2:17 pm OPM Mary Armwood allows fraudulent insurance acts resulting in death by Health Alliance Plan stating QUOTE: " It has been determined that there are NO Fraud Issues. This case has been through the final dispute stage and this is our FINAL responce. "
Question.........if there are NO fraud issues......why was HAP offering to pay 3 additional days at the Hospital Extended Care Facility, for the services they DENIED, REFUSED to provide, and CANCELLED that caused the FEHB Patients onset of Death ?
Office of Personnel Management - Health Care Fraud Hotline - Health Contracts Division III - needs to be investigated for KNOWINGLY & WILLFULLY accepting false claims, assisting and allowing fraudulent insurance acts, denial of Patient and Civil Rights, hospital insurance fraud resulting in death by a Federal Contractor in the State of Michigan. Discrimination of terminally ill FEHB Patients, denial of contracted services against ALL FEHB beneficiaries of Health Alliance.
According to LAW, these government employees are " Criminals " in what they are doing: Hospital Insurance Fraud.
OPM FEHBP = Office of Personnel Management - Federal Employee Health Benefits Program.
I am the daughter of a murdered Retired OPM FEHBP 'beneficiary' (Alexandra) who was Denied Due Process and Equal Protection of Law regarding criminal fraud that resulted in her death.
My Mother was killed DURING the commission of a felony federal health care offence - for refusing to defraud HCFA Medicaid. Her murder is being allowed and concealed by the DHHS HMO Grievance Service: which is Denial of Covered Prepaid HMO Federally Contracted Services.
My Parents (and siblings ) were seriously abused by a Hospital Social Worker conducting the DHHS " Hospital Discharge Procedures ", who was denying Covered Hospital Insurance Services to force Medicaid Conversion (felony).
I filed the DHHS HMO Grievance against the Social Worker and Hospital who were conducting Anti-dumping and Anti-kickback violations against our family.
My Criminal Complaint is Within the DHHS HMO grievance Service, that Denies Due Process and Equal Protection of Law against Covered Individuals.
The Victims Husband (George) was terrorized so badly by Hospital DHHS ( threats to throw him in jail if he didn't Criminally Apply for HCFA State Medicaid for services already covered under the OPM FEHBP Contract ) that He refused hospitalization for esophageal cancer a year later and choose to slowly starve to death at home, to avoid being killed after surgery by Denial of Covered Post hospital Services exactly like his wife was.
Hospital Insurance Fraud is a 'DHHS HMO Service' Against OPM HMO FEHBP-COVERED Individuals.
I have yet to obtain Rule of Law because of Public Corruption.
Thank you again Paks...........I appreciate your help.
Date: 7/7/2006 11:52:42 AM Eastern Daylight Time
FBI Tips and Public Leads
Your tip has been successfully submitted
MICHIGAN is being LOOTED by our Governor and Attorney General
who are allowing HCFA/CMS conduct Medicaid Kickback Fraud
against our Elderly.
In 1998 Medicaid used 8% of Michigan's General Funds.
By 2001 it used 35%.
The Health Care Financing Administration ( now called CMS ) is allowing its contractors to force Federal HMO Beneficiaries into State Medicaid. ( Felony fraud against Covered Individuals ). And AARP is assisting in defrauding the Public by teaching Victims how to conduct the DHHS HMO Grievance Procedures that DENY COVERED Serives and DENY Due Process of LAW regarding Felony Fraud against Federal Beneficiaries.
1998 - The 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 ( COVERED INDIVIDUALS ) beneficiaries and those who work with the ELDERLY to recognize Fraud and Abuse and to Report it Appropriately. ( DHHS HMO GRIEVANCE PROCEDURES USED TO CONDUCT, ALLOW AND CONCEAL FELONY FEDERAL HEALTH CARE OFFENCES against THE ELDERLY )
This Outreach Campaign ( was ) will be fully "launched" in 1999.
The beneficiary OUTREACH PROGRAM, in part, Encourages ( covered ) INDIVIDUALS to contact the HHS/OIG Hotline, 1-800-HHS-TIPS, which receives complaints of improprieties in Medicare and other HHS programs ( Medicaid ). In 1998, the Hotline received over 76,000 calls (up from 58,000 in 1997), which resulted in more than 12,500 complaints. Approximately $1.04 million in collections are associated with COMPLAINTS REFERED to and resolved by HCFA and ITS CONTRACTORS.
The ANTI-DUMPING STATUTE is Enforced Jointly by the Health Care Financing Administration ( HCFA ) and the Office of Inspector General ( OIG DHHS ) of the U.S. Department of Health and Human Services (HHS). Regulations implementing these statutory obligations are found at 42 CFR part 489.
Here's what the DHHS OIG Outreach Program Looks like for " Covered Individuals ":
Federal HMO Service Contract Provider - Health Alliance Plan Detroit MI ( Region V HCFA ) HAP PROVIDERS offers 2,596 personal care physicians (PCP) and 4,901 specialists. HAPís delivery system includes 45 hospitals ( inducing forfiture of OPM FEHBP Insurance by criminal enactment of DHHS HMO Grievance Service - 'Dumping' ) in southeast Michigan and the Flint area, including 23 major hospital networks ( robbing the Elderly of 401k's and savings accounts to force Medicaid Conversions ), 65 urgent care centers and 765 ancillary providers: Nursing Homes ( Criminally Billing FEHB for COVERED Posthospital Care for criminal conversion into State HCFA Medicaid - 'kickbacks' ),mental health facilities, optical providers, laboratories, durable medical equipment providers,ambulance services and pharmacy chains.
Office of Inspector General MISSION STATEMENT:
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 ( employee criminal misconduct ) or operations ( defrauding Federal Contract Health Insurance Programs ).
Department of Justice Mission Statement
To enforce the law and defend the interests of the United States according to the law; to ensure public safety against threats foreign and domestic; to provide Federal leadership in preventing and controlling crime; to seek just punishment for those guilty of unlawful behavior; to administer and enforce the Nation's immigration laws fairly and effectively; and to ensure fair and impartial administration of justice for All Americans.
[CITE: 5CFR185.104] PROGRAM FRAUD Sec. 185.104 Investigation. (d) Nothing in this section modifies any Responsibility of an Investigating Official to Report Violations of Criminal Law to the Attorney General.
Subj: RE: HHS OIG Hotline Web Submission
Date: 2/13/2003 10:29:22 AM Eastern Standard Time
From: email@example.com (Tips, HHS) To: Kstbylite1@aol.com
This is in response to your email of February 5, 2003, regarding the health care coverage for your deceased mother.
Although WE ACKNOWLEDGE that you have SERIOUS CONCERNS ( Hospital DHHS Workers conducting HMO fraud - dumping for medicaid kickbacks - against Retired FEHBP ), it is our judgment that the issues do not fall under the jurisdiction of the Office of Inspector General.
Since your mother was a federal employee, her FEHB would have been administered by the the Office of Personnel Management (OPM). If you contend that her FEHB insurer failed to ( Supply ) pay for contracted services, OPM would be the proper agency to handle your complaint.
Inspector General's Hotline
Title 18 US Code section 286 ( CRIME ) Conspiracy to defraud the Government with Respect To ( Health Insurance ) Claims - WHOEVER enters into any agreement, combination, or conspiracy to defraud the United States ( HMO Grievance Service ), or any department or agency thereof (Federal Health Care Programs), by obtaining or aiding to obtain the payment or ALLOWANCE of any false, fictitious or fraudulent claim ( DHHS HMO service -grievance procedures CITE: 42CFR417 Denial of Covered Services & OPM FEHBP -Filing for Denied Covered Claims CITE: 5CFR890.105 for HCFA Medicaid kickback Conversions for services allready covered under an HMO Program ), shall be fined under this title or imprisoned not more than 10 years, or BOTH.
[CITE: 42CFR1003.105] [Page 1166-1167] TITLE 42--PUBLIC HEALTH CHAPTER V-- (OIG DHHS ) OFFICE OF INSPECTOR GENERAL-- HEALTH CARE, ( DHHS ) DEPARTMENT OF HEALTH AND HUMAN SERVICES PART 1003--CIVIL MONEY PENALTIES, ASSESSMENTS AND EXCLUSIONS--Table of Contents Sec. 1003.105 Exclusion from participation in Medicare, ( HCFA/CMS) Medicaid and All Federal health care programs. [[Page 1167]] section, A Gross And Flagrant Violation is one that presents an Imminent Danger [ DHHS HMO grievance service: inducing forfiture of Individual COVERED HMO services FOR criminal kickback conversions into other federal programs ] to the health, safety or well-being of the INDIVIDUAL [ Retired OPM FEHBP - ALL HMO Beneficiaries ] who seeks emergency examination and treatment [ EXISTING HMO Hospital Insurance Benefits ] or places that individual unnecessarily in a High-Risk Situation...( T18CFRCrime DHHS OIG News Release dated 21 Oct 1998 denial of civil and criminal rights for due process and equal protection of law ).
According to the Detroit News, Between 1999 & 2001 Michigan's Medicaid clientele ballooned ( Felony Kickback Fraud Against Elderly Individuals with Federal HMO Policies in Region V HCFA Michigan ) to 1.25 million from 1 million, at a cost of approximately $6,000 on each Medicaid Reciepent.
Subj: Re: Health Alliance Insurance Fraud <~ Federal HMO Service Provider MI
Date: 2/21/2003 5:07:41 PM Eastern Standard Time
From: firstname.lastname@example.org (Senator Debbie Stabenow)To: email@example.com
February 21, 2003
Avoca, Michigan 48006
Thank you . . .
. . for contacting me about ( OPM FEHBP ) insurance & Medicaid ( kickback ) fraud committed by ( HMO ) 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.
United States Senator
VIOLATION OF CRIME VICTIMS RIGHTS
Under federal law [42 U.S.C.10606(b)]
U.S. Department of Justice
Office for Victims of Crime
810 7th Street NW.
Washington, DC 20531
About Crime Victim Rights in Michigan
In 1985 the Crime Victims Rights Act created comprehensive rights of notification and participation in all stages of the criminal justice process for felony crime victims in Michigan.
The law creates a duty for police agencies, sheriffs, the Department of Corrections, prosecuting attorneys, courts and other agencies to include crime victims within the formal conduct of investigative, judicial, sentencing and post sentencing proceedings.
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) ]
OPM FEHBP insurance Supersedes HCFA/DHHS Medicaid insurance for the Poor.
(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.
Region V HCFA " This Outreach Campaign ( was ) will be fully "launched" in 1999."
HCFA SPECIAL SERVICES - State of Michigan
John Engler, Governor / Attorney General Jennifer Granholm
Department of Consumer & Industry Services
Lansing MI 48909
RE: 990759 BonSecours Hospital -
Federal OPM Hospital Service Provider forcing HCFA Medicaid kickback conversions through Hospital DHHS workers -discharge procedures- by criminal enactment of DHHS HMO Grievance Service -Special Rules targeting OPM FEHBP - dumping for kickbacks - automatic denial of covered posthospital services.
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 ( Region V ) for thier evaluation and direction to the State.
HCFA has advised us that they are NOT authorizing an Investigation of the alledged allegation ( Hospital Insurance Fraud dumping Retired FEHBP into Medicaid ) 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.
signature : Mary Duncan
James L Buchanan, Chief
Detroit Field Services/'Special Services' Section
From: ......... Jeanette Girty HMO Health Alliance Plan Detroit Inc.
.............. OPM FEHBP " Hospital Extended Care Benefits " 730 days covered.
Re: ...... Hospital DHHS HMO Grievance - automatic denial of Covered Services
Dated.......... June 20, 2000 .......... [CITE: 42CFR438.704]
To: .............. Taber,Kristie - Michigan Insurance Bureau - OFIS
" After a two week stay, the ( Covered OPM FEHBP ) Husband STILL refused to apply for ( HCFA kickback ) Medicaid ". FELONY T18CFRsect24.
United States Attorneys' offices (USAOs) criminally and civilly prosecute health care professionals, providers, and other specialized business entities who engage in health care fraud, and work with the Department's Civil and Criminal Divisions, and the FBI.
USAOs continue to cooperate closely with numerous federal, state and local law enforcement agencies who are involved in the prevention, evaluation, detection, and investigation of health care fraud.
Title 18 U.S.C. 4. Misprision of felony ( OPM & DHHS dumping/kickback fraud ). Whoever, having knowledge of the actual commission of a felony ( conducted during DHHS HMO grievance procedures & OPM FEHB disputed claims ) cognizable by a court of the United States ( Jurisdiction ), conceals ( OIG's and Insurance Policy and Information Division ) and does not as soon as possible make known the same to some Judge or other person in civil or military Authority ( Law Enforcement US Attorney General etal ) under the United States, shall be fined under this title or imprisoned not more than three years, or both.
Subject: FBI Response
Date: 5/26/2004 10:26:33 AM Eastern Daylight Time
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.
Attorney General - health care fraud division # 2002-04-0925 - Mike Cox / Jennifer Granholm - original complaint #'s filed with State Law Enforcement Offices & dates filed:
Health Care Fraud Division # 99-05-1034 January 2000 Linda Damer
Insurance Bureau #31302-001 March 2000 Cindy Mielock , Kristie Tabor
Liscensing Division #68-99-3073-00 april 1999 Cynthia Samuel - victim still living
Bureau of Health Systems #990759 april 1999 Mary Duncan - victim still living
ACE Eastern District Ellen Christensen AG refused to investigate 2001.
In addition to the HHS/OIG and HCFA, these agencies include the State Medicaid Fraud Control Units; Inspectors General Offices of other federal agencies; the Drug Enforcement Administration; Department of Defense, Defense Criminal Investigative Service; and the TRICARE Support Office in the Department of Defense.
To assist in coordination and communication at national, state, and local levels, each USAO has appointed both a criminal and civil health care fraud coordinator. Prior to the enactment of HIPAA, USAOs dedicated substantial resources to combating health care fraud, HIPAA allocations have supplemented these efforts.
US Justice Department
Eastern District Michigan
dtd: 6 Nov 2001
" Without a finding from the investigative arm of Medicaid, of any other Federal Investigative Agency that there was impropriety in this case,this office is without authority to regulate the manner in which government and private insurance companies assess suscribers needs or define service coverage. "
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. <~ FELONY Kickback Fraud against Federal Beneficiaries for criminal State Medicaid Conversions.
The Largest Retirement Savings Plan in the U.S.A. with 1.8 million FEDERAL EMPLOYEE contributiors. treated as a 'trust' fund, exempt from taxation ( Tax Reform Act of 1986 Section 1147 Title 26 U.S.Code 7701 ( j ). THRIFT SAVINGS PLAN ( TSP ) G Fund ( gov securities investment fund ). Health Insurance Coverage is taken out of the Retired FEHBP retirement checks Befor they recieve it ( pre-paid ).
Why is the U.S.Government ( Judicial & Administrative Fraud ) ALLOWING Federal ( Racketeering ) by HMO Contractors AGAINST Federal Beneficiaries by Denial of COVERED ( DHHS HMO Grievance Service T42CFR417 ) Benefits ?
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, 1347, or 1518 of this title; ( 2) section 287, 371, 664, 666, 1001, 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 ( dhhs hmo grievance 'service' ) FOR WHICH PAYMENT MADE BE MADE UNDER THE PLAN OF 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.
Commission of a felony: Hospital Medical Records Released for Law Enforcement on 21 April 1999.
Subj:Skilled Nursing Facility Coverage <- OPM FEHBP Hospital Extended Care
Date: 4/23/99 8:19:16 PM !!!First Boot!!!
From:MSWEB1@hapcorp.org (Member Services Web)
Thank you once again for contacting the <~DHHS-HMO Grievance: dumping
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 felony to induce forfiture
Weeks for family training for maintenance of
her feeding tube. This family training is
considered to be basic care according to <--T42PHC409.32&33 Hospital Requirements
HAP criteria. Although the skilled nursing
facility benefit is for up to 730 days, HAP <--deception-Hospital Coverage 730 days
criteria require that the care must be skilled. <----Mattie of HAP, approved Skilled nursing with Hospital DHHS SW prior to Hospital Transfer on 20 April 1999.
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. <~ HMO inducing forfiture in direct contact with Hospital DHHS Marla Ruhana intimidation and threats.
Ms.Ogburn has spoken with Mr.Rupert and
is handling your Mother's case.
Member Services Web
The OPM FEHBP Victim was killed as threatened ( 2 weeks ) by criminal termination of OPM FEHBP Covered posthospital Benefits for refusing to defraud HCFA Medicaid.
Below: Federal Racketeering Against Hospitalized Retired Federal Beneficiaries:
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: firstname.lastname@example.org ('email@example.com')
Hello Ms. Kimball
I received a response from Jeanette Girty at Health Alliance Plan regarding
your mother Alexandra Rupert's DENIED CLAIM. ( OPM Hospital Extended Care Benefits 730 days 'You Pay Nothing All Services are Covered' )
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 BILL TO THEM. HAP need the information (the itemized bill) for proof of payment. HAP considers this case resolved and closed. Any questions let me know.
Imogene E. Thomas - OPM FEHBP Contracting Division
FEHB Consumer Protections Home Page
Fraud increases the cost of health care for everyone and increases your Federal Employees Health Benefits (FEHB) Program premium.
OPM's Office of the Inspector General ( OIG ) Investigates All Allegations of fraud, waste, and abuse in the FEHB Program Regardless of the agency that employs you or from which you Retired.
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 CITE: 5CFR890.105 against Retired FEHBP ). "
NO LAW ENFORCEMENT TO DATE -
FEDERAL HEALTH INSURANCE CONTRACTORS ARE GETTING AWAY WITH MURDER BY CRIMINAL USE OF DHHS HMO GRIEVANCE SERVICES THAT DENY DUE PROCESS AND EQUAL PROTECTION OF LAW FOR COVERED INDIVIDUALS.