From: SpiritDancerMita
To: Criminal.Division@usdoj.gov, caseintake@publicjustice.net, CongRel@gao.gov, communitywatch@hotsoup.com, SpiritDancerMita, submissions@truthdig.com, submissions@commondreams.org, takebackamerica@ourfuture.org, the.revealer@nyu.edu, truth@freepress.org
Sent: 9/30/2009 10:50:32 A.M. Eastern Daylight Time
Subj: Anti Trust Department of Health and Human Services Racketeering
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Anti Trust Department of Health and Human Services Racketeering
From, Kimberly Kimball
10073 Bryce Road
Kenockee Twp,MI 48006
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The illegal activity of the Justice Department through the Bush Administration needs to be investigated for Public Official Criminal Misconduct | Domestic Terrorism.
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[CITE: 48CFR3][Page 38-62] TITLE 48--FEDERAL ACQUISITION REGULATIONS SYSTEM CHAPTER 1--FEDERAL ACQUISITION REGULATION PART 3--IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Subpart 3.1--Safeguards
The general rule is to avoid strictly any conflict of interest or even the appearance of a conflict of interest in Government-Contractor relationships. While many Federal laws and regulations place restrictions on the actions of Government personnel, their official conduct must, in addition, be such that they would have no reluctance to make a full public disclosure of their actions.
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1998 U.S. Attorney General and HHS OIG PROVIDER Self-Disclosure Protocol (SDP), see 63 Fed. Reg. 58,399 Program ~ 1996 HIPAA Violation | T18CFR286CRIME | T18CFR371CRIME ~ Color of Law T42CFR417.1 Willfully failed to keep individuals from harm T18CFR242CRIME
DATED: November 24, 1998 June Gibbs Brown [ HHS ] Inspector General
DATED: November 24, 1998 Nancy-Ann Min DeParle [ HCFA ] Administrator
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1998 ANTI-TRUST ~ The HHS/OIG continues to work with the ( AOA ) Administration on Aging, ( HCFA ) Health Care Finance Administration, and the American Association of Retired Persons ( AARP ) to develop an OUTREACH CAMPAIGN [ 42CFR438.704 Marketing Violation ] to Educate Beneficiaries [ Entitled Individuals with Existing Federal HMO Hospital Insurance Benefits ] and those who work with the ELDERLY to recognize FRAUD AND ABUSE and to report it appropriately [ HHS|HMO illegal agreement T42CFR417.1 grievance procedure - alternate dispute resolution - systematic denial of COVERED Claims | Anti-dumping and Anti-kickback violation - racketeering ]. This campaign ( PUBLIC FRAUD T42CFR417.1 - ) will be fully "LAUNCHED" in 1999.
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The practice [ 1998 HHS OIG Provider [ HAPCORP.ORG ] Self-Disclosure Protocol (SDP) in 1998, see 63 Fed. Reg. 58,399 - 1996 HIPAA Violation - HHS|HMO illegal agreement T42CFR417.1 ] of " POST-CLAIMS UNDERWRITTING," which occurs when insurance companies [ Federal HMO Hospital Service Contract Providers ] cancel INDIVIDUAL health insurance policies [ T42CFR417.1 systematic denial of existing Federal T42CFR409.33 Insurance to force illegal HCFA State OFIS Medicaid Kickback T42CFR409.33 conversion ] after providers submit claims for [ T42CFR409.33 Post-Hospital Extended Care Services ] medical services
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1997 ~ A report of the Advisory Commission on CONSUMER PROTECTION and QUALITY in the Health Care Industry published in November 1997. The OPM FEHB Program is in full compliance with the President's Patients Bill of Rights
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President Obama introduces Nancy-Ann DeParle,as director of the White House Office for Health Reform, March 2, 2009. This afternoon, DeParle will represent the Obama administration at the third Regional White House Forum on Health Reform
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Challenges Ahead for DeParle, Obama's Point Guard' on Health Care - washingtonpost.com
Nancy-Ann DeParle was dubious - She had not even settled into her job as White House health 'czar' when the nation's big insurance companies made her an offer. - By Ceci Connolly
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HHS OIG News Release 21 Oct 98 - RACKETEERING
For Immediate Release Contact: Judy Holtz (202) 619-0893
Wednesday, October 21,1998 Ben St.John (202) 619-1028
OIG Issues Guidance on Volentary
Disclosure of Health Care Fraud
The Department of Health and Human Services's Office of Inspector General ( OIG ) today unveiled an expanded and simplified program for health care providers to volentarily report fraudulent conduct affecting Medicare, Medicaid and other Federal health care programs.
Called the Provider Self-disclosure Protocol, it replaces a volentary disclosure program piolet tested by the OIG over a two-year period. The Protocol, which is effective immediately, provides detailed guidance to health care providers that decide volentary to disclose irregularities in their dealings with the Federal health care programs. It will be published in the Federal Register and posted on the OIG's Internet Site ( www.hhs.gov/progorg/oig ).
Unlike the piolet program,which was only available to 'certain' health care providers in a few States and had strict eligibility requirements, the new program is OPEN TO ALL providers Nationwide under signaficantly relaxed requirements for participation. While not protected from civil or criminal action under the False Claims Act, providers disclosing fraud are advised in the Protocol that the self reporting of wrongdoing could be a mitigating factor in OIG's recommendations to prosecuting agencies.
" Major modifications have been made to the Volentary Disclosure Program in response to the needs of the many honest providers trying to do the right thing, " Inspector General June Gibbs Brown said in Announcing the revisions. " we have sought to address the concerns of the Provider community by removing disincentives to participation while at the same time emphasizing that providers have legal and ethical duty to identify and correct incidents of Non compliance with program requirements."
The Piolet Volentary Disclosure Program was introduced in 1995 as part of Operation Restore Trust ( ORT ), a major anti-fraud initiative aimed at Dishonest durable medical equipement, home health care, nursing home, and hospice care providers in California, Florida, Illinois, New York, and Texas. To be eligible, an applicant had to be a Corporate Entity doing business in one of the ORT States in one of the provider industries being examined. Morever, a participant had to disclose a matter that was not allready under investigation by or known to a Federal or State Law Enforcement Authority. In addition, the participant was required to sign an agreement to fully cooperate with authorities.
These requirements have been dropped from the Protocol. NOW ALL health care providers doing business with Medicare, Medicaid, or Other Federal health care programs that Want to disclose VOILATIONS OF LAW are eligible for acceptance into the Program. There are NO Pre-disclosure requirements, applications for admission, or preliminary qualifying characterisitics that must be met. If, after an initial assessment, a provider uncovers suspected Fraud or other problems involving the Federal health care programs, the Provider is urged to report the discovery to the OIG. The Provider will have the option of doing SELF-audit in conformance with OIG Guidance. The Protocol offers a detailed step-by-step explaination of how a provider should proceed in reporting and assessing the extent of Wrongdoing and how the OIG will go about verifying irregularities.
Self-reporting offers Providers the opportunity to minumize the potential cost and disruption of a Full Scale audit and Investigation, to negotiate a fair monentary settlement, and to avoid an OIG permissive Exclusion [CITE: 42CFR1003.105] preventing the entity from doing business with the Federal health care programs. Because a provider's disclosure can involve anything from a simple error to outright Fraud, the OIG is not making any commitments as to how a particular disclosure will be resolved or the specific benefit that will ensure to the disclosing entity. Providers are simply told that full disclosure and cooperation generally benefits the individual or Company, and that the OIG will report on the provider's involvement and level of cooperation to the Department of Justice or other government agency affected by the disclosed matter.
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MISPRISON of FELONY --- T42CFR417.1 alternate dispute resolution T18CFR242CRIME
(3) FELONY CONVICTION RELATING TO HEALTH CARE FRAUD.--Any individual or entity that has been convicted for an offense [ T18CFR24CRIME ] which occurred after the date of the enactment of the Health Insurance Portability and Accountability Act of 1996 [36], under Federal or State law, in Connection With the Delivery of a Health Care Item or SERVICE [ HHS|HMO T42CFR417.1 illegal agreement to induce forfiture - Adverse Determination - Anti-Dumping|Anti-Kickback Violation, to force, fraud by fright, HCFA State Medicaid KICKBACK conversion ] or With Respect to any Act or Omission in a Health Care Program ... (1) operated by or financed in whole or in part by any Federal, State, or local government agency, of a criminal offense consisting of a felony relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct.
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Under current United States law, set forth in the USA PATRIOT Act, acts of domestic terrorism are those which: "(A) involve acts dangerous to human life [ HHS|HMO T42CFR417.1 adverse determination - systematic denial of Covered T42CFR409.33 Claims - 42CFR438.704 ] that are a violation of the criminal laws [ T18CFR24CRIMES ] of the United States or of any State; (B) appear to be intended-[ DOJ Alternate Dispute Resolution T18CFR1518CRIME ] (i) to intimidate or coerce a civilian population [ to force, fraud by fright, illegal HCFA State OFIS Medicaid Kickback Conversion ]; (ii) to influence the policy of a government by intimidation or coercion; or (iii) to affect the conduct of a government by mass destruction, assassination, or kidnapping; and (C) occur primarily within the territorial JURISDICTION of the United States."[3]
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2007 - H.R. 3199 SENSENBRENNER - COLOR OF LAW - Judiciary (Subject to a Rule) (Sec. 4) Requires the ATTORNEY GENERAL, on an ANNUAL BASIS [ misprison of a felony ~ T18CFR242CRIME ], to submit to the House and Senate Judiciary Committees a report containing: (1) the Number of Accounts [ Federal HMO HAPCORP.ORG et al racketeering ] from which the Department of Justice (DOJ) has received VOLENTARY DISCLOUSURES [ 1998 U.S. Attorney General and HHS OIG Provider Self-Disclosure Protocol (SDP) Program, see 63 Fed. Reg. 58,399 ~T18CFR286CRIME 1996 HIPAA Violation T18CFR371CRIME Color of Law ] of customer communications or records under provisions authorizing disclosure of the contents of electronic communications in Emergencies [ Federal Hospital Insurance Services ] INVOLVING IMMEDIATE DANGER OF DEATH OR SERIOUS PHYSICAL INJURY [ T42CFR417.1 HHS Employee grievance procedure | Alternate Dispute Resolution 42CFR438.704 adverse determination T42CFR409.33 Anti-dumping - Anti-Kickback Violation ]; and (2) a summary of the basis for voluntary disclosures to DOJ where the pertinent investigation was CLOSED WITHOUT the filing of CRIMINAL CHARGES ( 9-110.100 Racketeer Influenced and Corrupt Organizations (RICO) Willfully failed to keep an individual from harm .... 42CFR438.704 misprison of felony T18CFR286CRIME ALLOWING ~ OIG, HCFA, FBI & U.S. Attorneys to conduct Federal HMO Hospital Insurance & HCFA State Medicaid kickback fraud, against American Citizens - Entitled INDIVIDUALs - COLOR of LAW T18CFR242CRIME ~ illegal kickback conversions - Anti-Dumping Violations - Consumer Fraud ) Contact - THOMAS (Library of Congress) . 9-110.800 Violent Crimes in Aid of RACKETEERING Activity (18 U.S.C. § 1959)
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What is Patient Abuse and Neglect ? - National Health -- NHDOJ Patient abuse or neglect is any action or failure to act which causes unreasonable suffering, misery or harm to the patient
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[CITE: 42CFR1003.105] Sec. 1003.105 Exclusion from participation in [ HCFA ] Medicare, Medicaid and all Federal health care programs [ OPM FEHB, TRICARE, CHAMPVA ]. A gross and flagrant violation is one that presents an imminent danger [ 1998 HHS OIG Provider Self-Disclosure Protocol (SDP), see 63 Fed. Reg. 58,399 ~ HHS|HMO T42CFR417.1 ~ 1996 HIPAA Violation ~ Denial of COVERED T42CFR409.33 Claims ~ 42CFR438.704 Anti-Dumping Violation, used to Force illegal HCFA State Medicaid KICKBACK Conversions ] to the health, safety or well-being of the INDIVIDUAL [ Retired OPM FEHBP all HMO Beneficiaries ] who seeks emergency examination and treatment [ Hospital Insurance Benefits T42CFR409.33 ] or places that individual unnecessarily in a high-risk situation T18CFR242crime: 1998 HHS|OIG - HMO - OUTREACH CAMPAIGN for the ELDERLY - Racketeering
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The practice [ 1998 HHS OIG Provider [ HAPCORP.ORG ] Self-Disclosure Protocol (SDP) in 1998, see 63 Fed. Reg. 58,399 - 1996 HIPAA Violation - HHS|HMO illegal agreement T42CFR417.1 ] of " POST-CLAIMS UNDERWRITTING," which occurs when insurance companies [ Federal HMO Hospital Service Contract Providers ] cancel INDIVIDUAL health insurance policies [ T42CFR417.1 systematic denial of existing Federal T42CFR409.33 Insurance to force illegal HCFA State OFIS Medicaid Kickback T42CFR409.33 conversion ] after providers submit claims for [ T42CFR409.33 Post-Hospital Extended Care Services ] medical services
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Region 5 HCFA : Illinois, Indiana, MICHIGAN, Minnesota, Ohio and Wisconsin
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Insurance Code of 1956 act 218 of 1956
500.2005 Misrepresentations: T42CFR417.1 grievance procedure | alternate dispute resolution DENIAL of COVERED claims, used to induce forfiture, to force illegal kickback conversions
Fraudulent Insurance Acts : 445.903 Unfair, unconscionable, or deceptive methods, acts, or practices in conduct of trade or commerce; rules.
(q) Representing or implying that the SUBJECT of a consumer transaction ( Hospital Insurance T42CFR409.33 post-hospital extended care services ) will be provided promptly, or at a specified time, or within a reasonable time, if the merchant [ HMO ] knows or has reason to know [ T42CFR417.1 grievance procedure \ Alternate Dispute Resolution - adverse determination, Systematic Denial of Existing Federal HMO T42CFR409.33 post-hospital extended care Claims ] It Will NOT be so Provided
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HHS - 42CFR438.704 ~ 1998 HHS OIG OUTREACH CAMPAIGN ~ T18CFR242CRIME
HHS|HMO T42CFR417.1 ~ fraud by fright | white collar crime 1996 HIPAA Violation ~ TITLE 42-[ HHS employee ]-PUBLIC HEALTH HUMAN SERVICES PART 417 -[ Federal HMO employee ]-HEALTH MAINTENANCE ORGANIZATIONS, Subpart B-( HMO )- Qualified Health Maintenance Organizations: SERVICES (g) Grievance procedures: Alternate Dispute Resolution, DENIAL OF Existing T42CFR409.33 OPM FEHBP HMO Hospital Insurance Services - HHS Anti-dumping violation, to force, fraud by fright, illegal HCFA State Medicaid T42CFR409.33 kickback conversions ]. (h) SPECIAL rules : Enrollees ( Covered Individuals ) under the Federal Employee Health Benefits Program ( FEHBP ).An HMO that accepts enrollees under the ( OPM ) FEHBP (Chapter 89 of title 5 of the U.S.C. - OPM T5CFR890.105 Denial of COVERED T42CFR409.33 Claims, Alternate Dispute Resolution | Anti-dumping violation - illegal agreement to induce forfiture to force illegal HCFA State Medicaid T42CFR409.33 kickback conversion - eligibility POOR ) may obtain and retain Federal qualification if ................
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AGREEMENTS WITH [ Federal HMO Hospital Service Contract ] PROVIDERS OF SERVICES [427] SEC. 1866. [42 U.S.C. 1395cc] (a)(1)[428] (M) in the case of hospitals, to provide to each INDIVIDUAL who is 'entitled to benefits' under part A (or to a person acting on the individual's behalf), at or about the time of the INDIVIDUAL's admission as an inpatient to the hospital, a written statement (containing such language as the Secretary prescribes consistent with this paragraph) which explains-- (i) the INDIVIDUAL's rights to benefits for inpatient hospital services and for post-hospital services [ T42CFR409.33 ] under this title
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TITLE 42--PUBLIC HEALTH CHAPTER IV-[ HCFA ]-HEALTH CARE FINANCING ADMINISTRATION, [ HHS ] DEPARTMENT OF HEALTH AND HUMAN SERVICES PART 409-- HOSPITAL INSURANCE BENEFITS --Table of Contents Subpart D-[ Federal ]-Requirements for Coverage of Post-hospital SNF [ NURSING FACILITY ] Care Sec. 409.33 Examples of skilled nursing [ Medically Necessary ] and rehabilitation services. ~~ To DENY this SERVICE [ HHS T42CFR417.1 systematic denial, Hospital HHS Employee T18CFR286CRIME enactment grievance procedure, Alternate Dispute Resolution - denial of Covered Claims 42CFR438.704 adverse determination ], is called an Anti-Dumping Violation - and results in Physical Injury and death.
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Failure to keep from harm [ 42CFR438.704 ]: The public counts on its law enforcement officials to protect local communities. If it's shown that an official willfully failed to keep an INDIVIDUAL [ Retired OPM FEHB|HMO ] from harm [ HHS|HMO T42CFR417.1 Anti-Dumping and Anti-Kickback Violation ], that official could be in violation of the color of law statute
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The Anti-Dumping Statute is Enforced [ 1999 still pending 2009 T18CFR242CRIME alternate dispute resolution T18CFR1518CRIME ] Jointly by the Health Care Financing Administration ( HCFA ) and the Office of Inspector General ( OIG ) of the U.S. Department of Health and Human Services (HHS). Health Care Finance Administration (HCFA), has jurisdiction over the Health Insurance Portability and Accountability Act (HIPAA) of 1996
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T18CFR242CRIME Color of Law - BY High Ranking Department Officials - US PATRIOT ACT sec 1001
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Presidentially Appointed Inspectors General
Health and Human Services, Department of
The Honorable Daniel Levinson, Inspector General
Main Phone Number: (202) 619-3148
Mailing Address: 330 Independence Avenue, S.W.; Washington, D.C. 20201
Hotline Number: (800) HHS-TIPS; email: HHSTips@oig.hhs.gov.
[Federal Register: January 24, 2008 (Volume 73, Number 16)]
[Notices] [Page 4248-4249] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr24ja08-92]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of Inspector General - White Collar Crime
Solicitation [ SSA 1128b ~ 1996 HIPAA Violation ] of Information and Recommendations for Revising the Compliance PROGRAM guidance for Nursing Facilities [ T42CFR409.33 ]
AGENCY: Office of Inspector General (OIG), HHS.
ACTION: Notice.
---------------------------------[ 42CFR438.704 ]--------------------------------------
SUMMARY:
This Federal Register notice seeks the input and
recommendations of interested parties as OIG revises the compliance
PROGRAM guidance (CPG) for Nursing Facilities, ESPECIALLY [ Targeting T42CFR417.1 HHS denial of covered claims ] THOSE SERVING Medicare, Medicaid, and other [ OPM FEHBP, CHAMPVA,TRICARE ] FEDERAL HEALTH CARE PROGRAM [ Entitled INDIVIDUAL ] BENEFICIARIES.
The nursing home industry has experienced a number of changes since OIG FIRST PUBLISHED a CPG in this area (65 FR 14289; March 16, 2000 ).<~~ RICO
Additionally, the subsequent years of enforcement and compliance activity in the Nursing Home Industry [ Judiciary Committee HR 3199 | FBI et al ~ T18CFR286CRIME - T18CFR242CRIME ] has ALLOWED OIG to address more fully the various risk areas in Nursing Home [ T42CFR409.33 ] compliance.
SUPPLEMENTARY INFORMATION:
The development of CPGs is a *MAJOR ( Program \ 1998 Volentary Disclousure Program ) initiative of OIG in its effort to engage the private health care industry in addressing and combating fraud and abuse. OVER THE PAST SEVERAL YEARS, OIG has developed and issued CPGs directed at various segments of the health care industry. These guidances are DESIGNED [ T42CFR417.1 to coordinate Federal, State and Local Law Enforcement activities ~T18CFR1518CRIME Obstruction T18CFR371CRIME ~ 1998 Health Care Fraud and Abuse Control T18CFR242crime Program ~ fraud by fright ~ RICO ~ 1996 HIPAA Violation ] to provide CLEAR DIRECTION and assistance to SPECIFIC sections of the health care industry that are interested in addressing compliance with Federal Health Care Program [ T42CFR409.33 ] requirements. The CPGs set forth OIG's suggestions on how [ FEHB|HMO HAPCORP.ORG ] 'PROVIDERS CAN' most effectively establish 'Internal Controls' [ SELF-Audit T18CFR286CRIME ] and implement monitoring procedures [ T42CFR417.1 grievance procedures - misPrison of felony T18CFR242CRIME anti-dumping violation ] to identify, correct, and prevent potentially Fraudulent Conduct.
OIG would appreciate specific comments, recommendations, and suggestions on risk areas for the nursing home industry, such as the submission of [ T42CFR417.1 Adverse Determinations ] FALSE CLAIMS, as well as QUALITY of CARE concerns, KICKBACKS, and accurate reporting of data to [ HCFA - forced T42CFR417.1 Medicaid kickback conversions ] Medicare and Medicaid. Detailed justifications and empirical data supporting any suggestions would be appreciated.
Dated: January 16, 2008.
Daniel R. Levinson,
Inspector General.
[FR Doc. E8-1213 Filed 1-23-08; 8:45 am]
BILLING CODE ~~ 4150-04-P .... Color of Law .. T18CFR371CRIME ~ INTENT to defraud 'Entitled Individual's and Federal Health Care Programs' with respect to T42CFR409.33 Claims T18CFR286CRIME
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9-110.100 Racketeer Influenced and Corrupt Organizations (RICO)
On October 15, 1970, the Organized Crime Control Act of 1970 became law.
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1999 OPM FEHBP - Federal HMO Hospital Service Contract PROVIDER - HAPCORP.ORG T42CFR417.1 ~ T18CFR371CRIME - T18CFR286CRIME ~ Health Alliance Plan Detroit ( Region 5 HCFA ) MICHIGAN -- HAP PROVIDERS offers 2,596 personal care physicians (PCP) and 4,901 specialists. HAP’s delivery system includes 45 hospitals ( 42CFR438.704 inducing forfiture HHS employee T42CFR417.1 Systemic Deprivations of Existing OPM FEHB T42CFR409.33 extended care ~ adverse determinations ~ 1998 U.S. Attorney General and HHS OIG VOLENTARY DISCLOUSURE Program: misprison of a felony ~ administrative Fraud by Fright - Anti-Dumping Violation, to force illegal HCFA State OFIS Medicaid Kickback Conversions ) in southeast Michigan and the Flint area, including 23 major hospital networks ( robbing the Elderly of 401k's and savings accounts to Force Medicaid kickback Conversions - Eligibility Poor ), 65 urgent care centers and 765 ancillary providers: Hospital Affiliate Nursing Homes [ illegally Billing OPM FEHB for criminally Denied T42CFR409.33 COVERED Post-hospital Extended Care Claims CITE: 5CFR890.105 illegal agreement | denial of COVERED Claims, to force illegal HCFA State OFIS Medicaid kickback conversions ),mental health facilities, optical providers, laboratories, durable medical equipment providers,ambulance services and Pharmacy Chains.
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MICHIGAN - According to the Detroit News, Between 1999 & 2001 Michigan's Medicaid clientele ballooned [ HHS|HMO T42CFR417.1 systematic denial of Existing Federal T42CFR409.33 Insurance - induced forfiture | $25,000 Anti-Dumping Violation, to force - fraud by fright - illegal HCFA State OFIS Medicaid kickback T42CFR409.33 conversion ] to 1.25 million from 1 million, at a cost [ 42CFR438.704 ] of approximately $6,000 on - each INDIVIDUAL Medicaid Reciepent. The Detroit News stated according to Paul Rienhart a Medicaid Expert in The State Budget Office of Michigan, says
HCFA | OFIS Medicaid consumed 8% of Michigan's General Funds in 1998.
HCFA | OFIS Medicaid will [ T42CFR417.1 ] consume 32 % of the General Fund budget by 2004.
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National Governors Association
January 28, 2008 letter (from NGA executive director Ray Scheppach) to U.S. Department of Health and Human Services Secretary ~ Michael Leavitt ~ requesting that HHS rescind the proposed rule amending Departmental Regulations Governing ADMINISTRATIVE REVIEW ~ by the Departmental Appeals Board (DAB). RE: Proposed Rulemaking: Revisions to Procedures for the Departmental Appeals Board and Other Departmental Hearings ~ 'Dispute Resolution' ( T42CFR417.1 grievance procedure, denial of covered claims \ misprison of a felony \ anti-dumping violation ) ~ For example, litigation briefs, memos, Emails, and other types of " informational documents interpreting STATUTES and published REGULATIONS " [ SSA 1128b Consumer Protection \ due process of law T18CFR24CRIMES \ Civil and Criminal Rights ] WOULD be deemed to HAVE equivalent AUTHORITY to the statute and regulations themselves. Governors OPPOSE the proposed rule [ T18CFR242CRIME ] and request that the department retain existing ( T42CFR417.1 adverse determinations \ misprison of T18CFR24CRIMES white collar crime ) DAB policies that provide STATES with the assurance of an impartial and independent dispute resolution process ~ RICO willfully failed to keep INDIVIDUALs from harm.
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TITLE 18 > PART I > CHAPTER 13 > § 242 Prev |
Next § 242. Deprivation of rights under color of law - Alternate Dispute Resolution T42CFR417.1
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Antitrust Enforcement and the Consumer
Many CONSUMERS have Never heard of ANTI TRUST LAWS, but when these laws are effectively and responsibly enforced, they can save consumers [ 42CFR438.704 ] millions and even billions of dollars a year in illegal [ HHS|HMO T42CFR417.1 KICKBACK ] overcharges.
Most states have antitrust laws, and so does the federal government. Essentially, these laws PROHIBIT BUSINESS PRACTICES that unreasonably Deprive consumers|individuals, of the benefits [ HHS|HMO T42CFR417.1 systematic denial of Existing Federal FEHB|HMO T42CFR409.33 Post-Hospital Extended Care Services, to force illegal HCFA State OFIS Medicaid Kickback T42CFR409.33 conversion ] of competition, RESULTING in higher prices for inferior products and services
Joel I. Klein
Assistant Attorney General
Antitrust Division
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Open Letter to Health Care PROVIDERS (PDF) - RACKETEERING
(April 15, 2008)
http://oig.hhs.gov/fraud/docs/openletters/OpenLetter4-15-08.pdf
Self-Disclosure Information | Office of Inspector General
http://oig.hhs.gov/fraud/selfdisclosure.asp
Self-Disclosure Information
The OIG introduced the Provider Self-Disclosure Protocol (SDP) in 1998, see 63 Fed. Reg. 58,399, after a pilot project involving PROVIDERS [ illegal agreement with Federal HMOs to induce forfiture of existing Federal Hospital Insurance Service Benefit Claims, T42CFR417.1 to force illegal HCFA State Medicaid kickback conversions \ felony ~ 1996 HIPAA Violation T18CFR24CRIMES ] from selected sectors of the health care industry PROVED SUCCESSFUL. [ T18CFR1518CRIME obstruction - color of law T18CFR286CRIME ~ 2007 SENSENBRENNER H.R. 3199 ~ and 2008 National Governors Association T18CFR371CRIME misprison of a felony - T18CFR242CRIME: Alternate Dispute Resolution T42CFR417.1 Anti-DUMPING and Anti-KICKBACK Violation ~ 9-110.800 Violent Crimes in Aid of Racketeering Activity (18 U.S.C. § 1959) ~ T18CFR371CRIME ~ RICO ] The SDP is INTENDED to be A VEHICLE under which the provider community can voluntarily disclose self-discovered evidence of potential fraud in an attempt TO AVOID the costs and disruptions that may be associated with A GOVERNMENT-directed INVESTIGATION and with CIVIL or ADMINISTRATIVE [ T18CFR242CRIME ] litigation. OIG verifies the information contained in the provider's submission and evaluates the matter for potential fraud issues. We endeavor to work cooperatively with providers who are forthcoming, thorough, and transparent in their disclosures in resolving these matters. While OIG does not speak for the Department of Justice [ T18CFR286CRIME | DOJ and HHS T42CFR417.1 grievance procedure -Alternate Dispute Resolution, fraud by fright, white collar crime - illegal agreement to allow fraud and abuse against Federal Beneficiaries - color of law T18CFR242CRIME RICO ] or other agencies, we consult with those agencies, as appropriate, regarding the resolution of SDP matters. The documents posted below set forth the history of the SDP, the requirements for submissions under the SDP, and the benefits to providers of disclosing under the SDP.
Sincerely,
Office of Inspector General
Department of Justice
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OFFICE OF PERSONNEL MANAGEMENT - OPM Sec. 900.401, Title VI of the Civil Rights Act of 1964 Authority: Sec. 602, 78 Stat. 252 (42 U.S.C. 2000d-1). Source: 38 FR 17920, July 5, 1973 - A PERSON SHALL NOT BE DENIED THE BENEFITS OF or be otherwise subjected to discrimination under a program ( OPM FEHB Health Insurance Program ) or activity receiving Federal financial assistance from OPM
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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 [ Individual ] WERE NOTIFIED in April and August 2002, this department is unable to assist you [ T18CFR242CRIME OPM FEHB T5CFR900.401 ] with your concern. If you have not already done so, I encourage you to contact the Michigan [ OFIS ] Insurance Bureau.
Sincerely, Joan Blair, Reconsideration Team Manager 313/456-3827
T18CFR1518CRIME - T18CFR371CRIME - T18CFR286CRIME - T18CFR242CRIME
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Criminal and Civil investigations may reveal indications of QUALITY of CARE Issues, and Patient Harm or abuse [ HHS|HMO T42CFR417.1 Anti-Dumping and Anti-Kickback Violation ]. Information concerning these matters should expeditiously be disseminated to the appropriate authority so that no further harm can occur.
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DECEMBER 2003
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TITLE 5 > PART III > Subpart G > CHAPTER 89 > Sec. 8912. Prev | Next Sec. 8912. - Jurisdiction of courts The district courts of the United States have original JURISDICTION, concurrent with the United States Court of Federal Claims, of a civil action or claim against the United States founded on this chapter
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Title 28 U.S.C. § 1361. Action to Compel an officer of the United States to Perform his DUTY. The district courts shall have original JURISDICTION of any action in the nature of mandamus to compel an officer or employee of the United States or any agency thereof to perform a DUTY owed to the plaintiff.
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$150.00 Filing Fee ~ T5CFR890.105 Judicial Review
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FEHB Consumer Protections ~ NONE
fraud upon the court
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UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF MICHIGAN - RACKETEERING
Chambers of Honorable George Caram Steeh
United States District Judge
Theodore Levin United States Courthouse
231 West Lafayette Blvd. - room 235
Detroit, Michigan 48226
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The Honorable George C. Steeh was APPOINTED United States District Judge in 1998 [ 1998 U.S. Attorney General and HHS OIG PROVIDER [ HAPCORP.ORG ] Self-Disclosure Protocol ~ Volentary Disclousure PROGRAM, see 63 Fed. Reg. 58,399 ~ 1996 HIPAA Violation HHS|HMO T42CFR417.1 Systemic Deprivations T18CFR242CRIME ~ T18CFR371CRIME ~ T18CFR286CRIME ~ RICO
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Kimberly Kimball
Vs
Office of Personnel Management OIG
& The State of Michigan
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Case # 03-75161 -- filed December 30, 2003
Regarding: T5CFR890.105 Judicial Review of Systematic Denial T42CFR417.1 of Covered T42CFR409.33 Hospital Insurance Claims
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The lawsuite was dismissed by the District Court, Sua Sponte, and for among other things LACK of JURISDICTION on JANUARY 2004 - T18CFR371CRIME ~ T18CFR242CRIME ~ Color of Law.
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The Judge also claimed the lawsuite: T5CFR890.105 illegal denial of COVERED T42CFR409.33 post-hospital extended care services, resulting in death, as threatened 4\23\99 HHS T42CFR417.1 Alternate Dispute Resolution T18CFR1518CRIME ~ of a federal beneficiary, was Without Merit and Frivolous, to ALLOW T18CFR286CRIME and Conceal T18CFR371CRIME Federal Hospital Insurance Fraud and Abuse, TARGETING T42CFR417.1 Entitled INDIVIDUALS with Federal HMO Hospital Insurance T42CFR409.33 Service Contract PROVIDER: HAPCORP.ORG - Health Alliance Plan, Detroit CITE: 42CFR438.704 adverse determination / denial of T42CFR409.33 Post-Hospital Services. White Collar Crime.
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JANUARY 2004
State of Michigan ALLOWING T18CFR286CRIME Federal HMO HAPCORP.ORG to harm 42CFR438.704 their Covered Individuals | Citizens of Michigan for Medicaid kickbacks
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PUBLIC CORRUPTION. In its efforts to anticipate or prevent crime, the FBI must at times initiate investigations in advance of criminal conduct. United States v. United States District Court, 407 U.S. 297, 322 (1972). Conversely, a racketeering enterprise investigation may yield information warranting a general crimes inquiry or investigation or a domestic security/terrorism investigation
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Investigation and prosecution of fraud related to Federal Health Programs is the Responsibility of the Department of Health and Human Services (HHS), the FBI and the Department of Justice|U.S. Attorneys. The FBI is the lead federal agency for Investigating color of law abuses
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MAY 2004
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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 [ STATE of MICHIGAN ] or DISTRICT ATTORNEY's Office. If you wish pursue legal matters against the Hospital you should contact an attorney.
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1998 Region 5 HCFA [ Chicago ] office -- Partnership Arrangements with [ Federal HMO HAPCORP.ORG T42CFR417.1 alternate dispute resolution T18CFR1518CRIME ] Contractors and U.S. Attorneys in MICHIGAN and Ohio.
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CRIMINAL PENALTIES FOR ACTS INVOLVING FEDERAL HEALTH CARE PROGRAMS SEC. 1128B. [42 U.S.C. 1320a-7b] --- DETERMINING RIGHTS
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Subj: RE: What the RICO Settlements Mean to You ( Physicians )
Date: 4/3/2006 2:11:45 AM Eastern Daylight Time
HOLDING Blue Cross and Other ( FEDERAL Contractors ) HEALTH PLANS ACCOUNTABLE
What the RICO Settlements Mean to You and Your Practice.
RE:" Seminar participants will learn how to maximize their relief under the settlements ~~
To date, six major health plans ( BlueCross, Anthem, Wellpoint, Aetna, Cigna, Health Net, Prudential,and Humana - Federal Contractors ) have settled CMAs RICO lawsuit, which Alleges that the Health Plan Defendants Engaged in Fraud and Extortion by Wrongfully Denying [ T42CFR417.1 ] payment to Physicians, in Violation of Federal Racketeering Law
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Where is due process and equal protection of law, for the Covered ( Patient | hospitalized INDIVIDUAL | Target T42CFR417.1 USED by Federal Contractors to conduct fraud against Physicians ?
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investigation and prosecution of fraud related to Federal Health Programs is the Responsibility of the Department of Health and Human Services (HHS), the FBI and the Department of Justice|U.S. Attorneys
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US Department of Justice 313-226-9764 - ALternate Dispute Resolution T18CFR1518CRIME
Eastern District of Michigan ~ T18CFR242CRIME willfully failed to keep Individuals from harm.
211 W.Fort Street Suite 2001 Detroit, MI 48226
November 6, 2001
Kimberly Kimball
Kenokee Twp, MI 48006
Dear Ms. Kimball:
We have received your letter dated October 9,2001 indicating your strong dissatisfaction over the way your mother's medical care was [ T42CFR417.1 denied ] handled by her [ Federal OPM FEHB ] HMO [ Health Alliance Plan Detroit ].
Your dissatisfaction appears to arise from the fact that her final days of care were paid in full by Medicaid rather than by her HMO [ <~ this is called a KICKBACK / felony ], which you believe should have been the financial responsible entity. It also appears that you have allready contacted the approiate Offices for [ HCFA ] Medicare / Medicaid [ False Claims Act ] and your mother's [ Federal OPM FEHB ] HMO and you have received responses, albeit unsatisfactory to you.
Without a finding [ T42CFR417.1 illegal agreement - Systemic Deprivations - misprison of a felony ] by the investigative arm of Medicaid [ Region 5 HCFA illegal agreement with U.S. Attorneys in MI and Ohio ], or any other Federal investigative agency [ misprison of a felony T18CFR1518CRIME ] that there was impropriety in this case this [ Region 5 HCFA ] Office is without Authority [ Color of Law ] to regulate the manner in which [ Federal/State ] GOVERNMENT and Private ( HMO ) INSURANCE COMPANIES assess suscriber needs [ T42CFR417.1 Denial of COVERED Claims ~ RICO ] or Define Service Coverage. [ T42CFR409.33 Federal Requirements ]
If you continue to feel that your mother's care or her [ OPM FEHBP ] ENTITLEMENT to benefits was JEOPARDIZED [ T5CFR890.105 systematic denial of COVERED Claims ], you are, of course, free to consult with a private attorney [ T18CFR1518CRIME Alternate Dispute Resolution T18CFR242CRIME ] to explore any legal options that may be available to you.
Sincerely,
ALLEN M. GERSHEL
United States Attorney
signature by: ELLEN CHRISTENSEN Assistant United States Attorney T18CFR1518CRIME Obstruction T18CFR286CRIME allowing ~ T18CFR371CRIME illegal agreement with HCFA Region 5 CMS ~ T18CFR242CRIME color of law -- RACKETEERING
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Sincerely,
All ENTITLED Federal Employee Health Beneficiaries & the General Public in Region 5 HCFA, who are being criminally denied HHS T42CFR417.1 Existing ( Federal \ State \ Private ) HMO Health Insurance Coverage, illegally billed for HMO denied covered claims and forced into HCFA State Medicaid Programs for the POOR. Title18CFR1001Crime. 1998 still pending 2009, denial of civil and criminal rights - reporting waste fraud and abuse - Color of Law, alternate dispute resolution T18CFR242CRIME. Kimberly Kimball - Kenockee Twp, MICHIGAN 48006