Humana, EHealthInsurance.com denial of health insurance coverage, denied appeal process. Internet, Several Stales Nationwide

Bottom line: They don't have to insure you.

9-110.330 Charging RICO Counts -- 1996 HIPAA -- U.S. Attorney and Office of Inspector General MISPRISON of FELONY --- 1998 VOLENTARY DISCLOUSURE Program
.
Health Insurance Portability and Accountability Act of 1996 ~ T18CFR24CRIMES
(3) FELONY ~ CONVICTION ~ RELATING TO HEALTH CARE FRAUD.--Any individual or entity that has been convicted for an offense 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 [ T42CFR417.1 Adverse Determination/Anti-dumping Violation ] 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.
.
1998 - Clinton Administration - Health Care Reform / Fraud and Abuse Control Program ~ RICO
.
1998 NATIONAL HEALTH CARE FRAUD AND ABUSE CONTROL PROGRAM', under the Joint Direction of the ATTORNEY GENERAL and the Secretary of ( DHHS ) the Department of Health and Human Services (HHS)(1), acting through the Department's Inspector General (HHS/OIG), DESIGNED ( DHHS and Federal HMO - illegal agreement to induce forfiture; Grievance Procedure / Volentary Disclousure T42CFR417.1 SELF-Audit Program ) to coordinate Federal, State and Local Law Enforcement activities [ T18CFR4CRIME misPrison of a felony ] With Respect to ( Federal Hospital Insurance Benefit T42CFR409.33 Claims ) Health Care Fraud and Abuse. [ T18CFR286CRIME ]
.
DHHS OIG News Release 21 Oct 1998 ....... T18CFR371crime
VOLENTARY DISCLOUSURE of Health Care Fraud
For Immediate Release Contact: Judy Holtz (202) 619-0893
Wednesday, October 21,1998 .Ben St.John (202) 619-1028
The ( DHHS OIG ) Department of Health and Human Services's Office of Inspector General ( OIG ) today unveiled an expanded and simplified PROGRAM For ( Federal ) Health Care Providers to 'Volentarily Report' ( internal control / self-audit T42CFR417.1 adverse determination, grievance procedure: misprison of a felony: anti-dumping violation ) Fraudulent Conduct ( T18CFR24Crimes ) Affecting [ Entitled Individuals ] HCFA Medicare/Medicaid, and other ( OPM FEHBP,TRICARE,CHAMPVA ) Federal health care programs. The [ Federal ( OPM FEHBP T5CFR890.105 ) HMO Contract ] Provider will have the option of doing 'SELF-audit' [ DHHS T42CFR417.1 misprison of a felony \ Anti-dumping violation ] in conformance 'with OIG'.
.
The Health Care Financing Administration ( HCFA ) administers the Medicaid program. Authorized under Title XIX of the Social Security Act
.
The Region 5 HCFA [ Chicago ] office had a record high 940 new MSP cases filed in 1998. Contributing to this were Partnership Arrangements with [ Federal ] Contractors and U.S. Attorneys in Michigan and Ohio.
.
[CITE: 42CFR409.33] [Page 187-188]TITLE 42--PUBLIC HEALTH CHAPTER IV-[ HCFA ]-HEALTH CARE FINANCING ADMINISTRATION, [ DHHS ] 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 and rehabilitation services.
.
Federal \ State ~ DENIAL of COVERED CLAIMS ~ felony ~ RICO
.SPECIALIZED SERVICE ~ 1998 VOLENTARY DISCLOUSURE Program For PROVIDERS to conduct felony fraud AGAINST Entitled Individuals with Federal HMO Policies: intent to harm:
T42CFR417.1 -- CRIMINAL MISCONDUCT -- Illegal agreement to induce forfiture of EXISTING Federal Insurance to Force - Fraud by Fright - illegal HCFA State OFIS Medicaid kickback conversions -- TITLE 42-[ DHHS ]-PUBLIC HEALTH HUMAN SERVICES PART 417-[ Federal HMO ]-HEALTH MAINTENANCE ORGANIZATIONS, Subpart B-- Qualified Health Maintenance Organizations: SERVICES (g) Grievance procedures -ADVERSE DETERMINATION - illegal denial of Existing Federal HMO Hospital Insurance Services T42CFR409.33, Anti-DUMPING violation, to force illegal HCFA State ( MI- OFIS ) Medicaid T42CFR409.33 KICKBACK conversions ). (h) SPECIAL rules: Enrollees under the Federal employee health benefits program (FEHBP).An HMO that accepts enrollees under the FEHBP (Chapter 89 of title 5 of the U.S.C.) may obtain and retain Federal qualification if, for its other enrollees ( General Public ), it complies with the requirements of section 1301(b) and 1301(c) of the PHS Act and implementing regulations in this subpart D and subparts B and C of this .........
.
1999 Federal HMO Employee and DHHS Employee - T42CFR417.1 illegal Denial of Existing OPM FEHBP Hospital Extended Care Benefits to force illegal State HCFA Medicaid ( kickback ) application $50,000 Felony - Medicaid False Claims Act.
.
1999 Federal HMO Hospital Service Contract Provider
Health Alliance Plan Detroit Michigan - Region 5 HCFA
OPM FEHB ( Federal Employee Health Benefits Program RI 73-015 .... page 15 )
.
OPM FEHBP " Hospital Extended Care Benefits " CITE: 42CFR409.33 Post-Hospital Services
.
The [ Federal HMO & DHHS Employee ] Plan [ Denies T42sec417.1 ] PROVIDES a comprehensive range of benefits when skilled nursing care is necessary & confinement in a skilled nursing facility is medically appropriate as determined by a plan doctor.
The [ Federal HMO & DHHS Employee ] Plan [ Denies T42sec417.1 ] PAYS FOR up to 730 days ( 2 years ) each continuous period of confinement or for sucessive periods seperated by less than 60 days.
This 730 days period will be reduced by 2 days for every Inpatient HOSPITAL day Prior to ADMISSION to a Skilled Nursing Facility. ( Hospital Transfers ) A new period of 730 days will begin after at least 60 days have elapsed from the last date of discharge. You [ Covered Individual are Denied T5CFR890.105 OPM illegal agreement to induce forfiture ] Pay Nothing. All Medically Necessary Services Are [ Denied T42CFR417.1 Adverse Determination \ Anti-Dumping Violation ] Covered, including: ::::::: bed, board & general nursing care ::::::: drugs, biologicals, supplies & equipement ordinarily provided or arranged by the skilled nursing facility when perscribed by a Plan Doctor.
.
Hospitalized ENTITLED Individual's, are not able - physically or mentally - to fight T42CFR417.1 grievance procedures - for their DENIED Covered T42CFR409.33 Hospital Extended Care Claims.
.
CITE: 42CFR438.704 -- Federal HMO T42CFR417.1 Adverse Determination
Sec. 438.704 Amounts of civil money penalties
(1) The limit is $25,000 for Each Determination under the following paragraphs of Sec. 438.700:
(i) Paragraph (b)(1) (Failure to provide services).
(ii) Paragraph (b)(5) (Misrepresentation or false statements to
enrollees, potential enrollees, or health care providers).
(iii) Paragraph (b)(6) (failure to comply with physician incentive
plan requirements).
(iv) Paragraph (c) (Marketing violations).
(2) The limit is $100,000 for each determination under paragraph
(b)(3) (discrimination) or (b)(4) (Misrepresentation or false statements to CMS or the State) of Sec. 438.700. (3) The limit is $15,000 for each recipient the State determines was not enrolled because of a discriminatory practice under paragraph (b)(3) of Sec. 438.700. (This is subject to the overall limit of $100,000 under paragraph (b)(2) of this section).
(c) Specific amount. For premiums or charges in excess [ illegal kickback conversions ] of the amounts permitted under the Medicaid program, the amount of the penalty is $25,000 or double the amount of the excess charges, whichever is greater. The State must deduct from the penalty the amount of overcharge and RETURN IT to the affected enrollees.
.
Read the October 2006 Health and Human Services (HHS) Office of Inspector General report on [ HCFA ] Medicaid payments for deceased beneficiaries
.2007 ~ Illegal Immunity ~ RICO ~ 1998 - Clinton Administration - Health Care Reform / Fraud and Abuse Control Program ~ 1996 HIPAA Violation - 1998 U.S. Attorney General and DHHS OIG ~ Volentary Disclousure Program
.
(1) the Number of Accounts
1. Federal Hospital Insurance (HI) Trust Fund Account
2. Health Care Fraud and Abuse Control Account
3. Federal Employee Retirement Trust Fund Account
4. MICHIGAN / OHIO General Trust Fund Account et al .....
.
2007 -- H.R. 3199 - USA PATRIOT Conference Report (Sensenbrenner - Judiciary) (Subject to a Rule) (Sec. 4) Requires the ATTORNEY GENERAL, on an ANNUAL BASIS, to submit to the House and Senate Judiciary Committees a report containing: (1) the Number of Accounts from which the Department of Justice (DOJ) has received VOLENTARY DISCLOUSURES [ 1998 DHHS OIG T42CFR417.1 misprison of felony T18CFR24Crimes ] 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 DHHS Employee adverse determination: Anti-dumping 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 ( 42CFR438.704 misprison of felony T18CFR286CRIMES: ALLOWING OIG & U.S. Attorneys to conduct Federal HMO Hospital Insurance & HCFA State Medicaid kickback fraud, against American Citizens - COLOR of LAW: illegal kickback conversions - Anti-Dumping Violations Public Fraud ) Contact - THOMAS (Library of Congress)
.
9-110.800 Violent Crimes in Aid of Racketeering Activity (18 U.S.C. 1959) Section 1959
.
2000 NURSING HOME CARE T42CFR409.33 \ Adverse Determination T42CFR417.1 grievance procedures ~ misprison of a felony 42CFR438.704 Anti-dumping Violation ~ T18CFR286CRIME
.
Subj: Fwd: ATTN: Marsha Albert/MS Griev -Reply T42CFR417.1
Date: 4/26/00 1:29:47 PM Eastern Daylight Time
From: MALBERT1 ~ hapcorp.org (Marsha Albert) - Federal HMO Region 5 HCFA
To: Kstbylite1 ~ aol.com
Denise, I'm sorry I did not respond to you earlier, however, if you can
please let Ms. Kimball know that this is not a grievance from any member of the family. Actually, the Insurance Bureau of MIchigan [ OFIS ] wanted to find out if there were any QUALITY ISSUES involved [ ENTITLED Individual \ Retired FEHB killed during the commission of a felony T42CFR417.1 grievance procedures \ denial of T42CFR409.33 Post-Hospital Care \ adverse determination T18CFR24crimes HIPAA ], while the mother, Alexandrea Rupert was at NIghtengale Nursing Home. WE ARE INVESTIGATING [ T18CFR24CRIMES ~ HIPAA: internal control \ Self-Audit ] the portion of the case with Our Quality Management Department. They will respond to ME once their investigation is complete. ~ RICO
.
Investigation and prosecution of fraud related to Federal Health Care Programs is the responsibility of the Department of Health and Human Services (DHHS), the FBI and the Department of Justice.~~
.
2008 JANUARY ~ RICO 42CFR438.704 - illegal kickback solisitation
.
[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
Solicitation of Information and Recommendations for Revising the
Compliance Program guidance for Nursing Facilities [ T42CFR409.33 ]
AGENCY: Office of Inspector General (OIG), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
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 those serving Medicare, Medicaid, and other [ OPM FEHBP, CHAMPVA,TRICARE ] Federal health care program [ ENTITLED Individual's ] 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). Additionally, the subsequent years of enforcement and compliance activity in the Nursing Home Industry [ HOSPITAL Affiliates ] has allowed OIG to address more fully the various risk areas in nursing home compliance.
SUPPLEMENTARY INFORMATION:
The development of CPGs is a major
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 [ 1998 Clinton Health Care Fraud and Abuse Control Program ~ RICO ~ VOLENTARY DISCLOUSURE ] 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 'PROVIDERS CAN' most
effectively establish 'Internal Controls' [ SELF-Audit T18CFR286CRIME ] and implement monitoring procedures [ T42CFR417.1 grievance procedures - misPrison of felony - anti-dumping violations ] 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 Determination ] FALSE CLAIMS, as well as QUALITY of CARE concerns, KICKBACKS, and accurate reporting of data to [ HCFA forced Medicaid conversions \ fraud by fright ] 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 ....RICO....T18CFR286CRIME ~ INTENT to defraud 'Entitled Individual's and Federal Health Care Programs' with respect to T42CFR409.33 Claims T18CFR371CRIME.
.
Fraud by Fright: White Collar Crime by Health Providers, 67 N.C.L.Rev. 855 (1989).
.
USA PATRIOT ...... SSA 1128b ....... 1998 still pending 2008 ....... T18CFR1518crime ~ RICO ~ Obstruction ~ Violation of Crime Victims Rights - Under federal law [42 U.S.C.10606(b)] and also 42 USC 1983. Civil action for deprivation of rights and The U.S. Constitution: Fourteenth Amendment.
.
Sincerely,
All ENTITLED Federal Employee Health Beneficiaries & the General Public who are being criminally denied DHHS T42CFR417.1 Existing Federal HMO Health Insurance Coverage, illegally billed for HMO denied covered claims and forced into HCFA State Medicaid Programs for the POOR. Title18CFR1001Crime.

9-110.330 Charging RICO Counts -- 1996 HIPAA -- U.S. Attorney and Office of Inspector General MISPRISON of FELONY --- 1998 VOLENTARY DISCLOUSURE Program
.
Health Insurance Portability and Accountability Act of 1996 ~ T18CFR24CRIMES
(3) FELONY ~ CONVICTION ~ RELATING TO HEALTH CARE FRAUD.--Any individual or entity that has been convicted for an offense 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 [ T42CFR417.1 Adverse Determination/Anti-dumping Violation ] 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.
.
1998 - Clinton Administration - Health Care Reform / Fraud and Abuse Control Program ~ RICO
.
1998 NATIONAL HEALTH CARE FRAUD AND ABUSE CONTROL PROGRAM', under the Joint Direction of the ATTORNEY GENERAL and the Secretary of ( DHHS ) the Department of Health and Human Services (HHS)(1), acting through the Department's Inspector General (HHS/OIG), DESIGNED ( DHHS and Federal HMO - illegal agreement to induce forfiture; Grievance Procedure / Volentary Disclousure T42CFR417.1 SELF-Audit Program ) to coordinate Federal, State and Local Law Enforcement activities [ T18CFR4CRIME misPrison of a felony ] With Respect to ( Federal Hospital Insurance Benefit T42CFR409.33 Claims ) Health Care Fraud and Abuse. [ T18CFR286CRIME ]
.
DHHS OIG News Release 21 Oct 1998 ....... T18CFR371crime
VOLENTARY DISCLOUSURE of Health Care Fraud
For Immediate Release Contact: Judy Holtz (202) 619-0893
Wednesday, October 21,1998 .Ben St.John (202) 619-1028
The ( DHHS OIG ) Department of Health and Human Services's Office of Inspector General ( OIG ) today unveiled an expanded and simplified PROGRAM For ( Federal ) Health Care Providers to 'Volentarily Report' ( internal control / self-audit T42CFR417.1 adverse determination, grievance procedure: misprison of a felony: anti-dumping violation ) Fraudulent Conduct ( T18CFR24Crimes ) Affecting [ Entitled Individuals ] HCFA Medicare/Medicaid, and other ( OPM FEHBP,TRICARE,CHAMPVA ) Federal health care programs. The [ Federal ( OPM FEHBP T5CFR890.105 ) HMO Contract ] Provider will have the option of doing 'SELF-audit' [ DHHS T42CFR417.1 misprison of a felony \ Anti-dumping violation ] in conformance 'with OIG'.
.
The Health Care Financing Administration ( HCFA ) administers the Medicaid program. Authorized under Title XIX of the Social Security Act
.
The Region 5 HCFA [ Chicago ] office had a record high 940 new MSP cases filed in 1998. Contributing to this were Partnership Arrangements with [ Federal ] Contractors and U.S. Attorneys in Michigan and Ohio.
.
[CITE: 42CFR409.33] [Page 187-188]TITLE 42--PUBLIC HEALTH CHAPTER IV-[ HCFA ]-HEALTH CARE FINANCING ADMINISTRATION, [ DHHS ] 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 and rehabilitation services.
.
Federal \ State ~ DENIAL of COVERED CLAIMS ~ felony ~ RICO
.SPECIALIZED SERVICE ~ 1998 VOLENTARY DISCLOUSURE Program For PROVIDERS to conduct felony fraud AGAINST Entitled Individuals with Federal HMO Policies: intent to harm:
T42CFR417.1 -- CRIMINAL MISCONDUCT -- Illegal agreement to induce forfiture of EXISTING Federal Insurance to Force - Fraud by Fright - illegal HCFA State OFIS Medicaid kickback conversions -- TITLE 42-[ DHHS ]-PUBLIC HEALTH HUMAN SERVICES PART 417-[ Federal HMO ]-HEALTH MAINTENANCE ORGANIZATIONS, Subpart B-- Qualified Health Maintenance Organizations: SERVICES (g) Grievance procedures -ADVERSE DETERMINATION - illegal denial of Existing Federal HMO Hospital Insurance Services T42CFR409.33, Anti-DUMPING violation, to force illegal HCFA State ( MI- OFIS ) Medicaid T42CFR409.33 KICKBACK conversions ). (h) SPECIAL rules: Enrollees under the Federal employee health benefits program (FEHBP).An HMO that accepts enrollees under the FEHBP (Chapter 89 of title 5 of the U.S.C.) may obtain and retain Federal qualification if, for its other enrollees ( General Public ), it complies with the requirements of section 1301(b) and 1301(c) of the PHS Act and implementing regulations in this subpart D and subparts B and C of this .........
.
1999 Federal HMO Employee and DHHS Employee - T42CFR417.1 illegal Denial of Existing OPM FEHBP Hospital Extended Care Benefits to force illegal State HCFA Medicaid ( kickback ) application $50,000 Felony - Medicaid False Claims Act.
.
1999 Federal HMO Hospital Service Contract Provider
Health Alliance Plan Detroit Michigan - Region 5 HCFA
OPM FEHB ( Federal Employee Health Benefits Program RI 73-015 .... page 15 )
.
OPM FEHBP " Hospital Extended Care Benefits " CITE: 42CFR409.33 Post-Hospital Services
.
The [ Federal HMO & DHHS Employee ] Plan [ Denies T42sec417.1 ] PROVIDES a comprehensive range of benefits when skilled nursing care is necessary & confinement in a skilled nursing facility is medically appropriate as determined by a plan doctor.
The [ Federal HMO & DHHS Employee ] Plan [ Denies T42sec417.1 ] PAYS FOR up to 730 days ( 2 years ) each continuous period of confinement or for sucessive periods seperated by less than 60 days.
This 730 days period will be reduced by 2 days for every Inpatient HOSPITAL day Prior to ADMISSION to a Skilled Nursing Facility. ( Hospital Transfers ) A new period of 730 days will begin after at least 60 days have elapsed from the last date of discharge. You [ Covered Individual are Denied T5CFR890.105 OPM illegal agreement to induce forfiture ] Pay Nothing. All Medically Necessary Services Are [ Denied T42CFR417.1 Adverse Determination \ Anti-Dumping Violation ] Covered, including: ::::::: bed, board & general nursing care ::::::: drugs, biologicals, supplies & equipement ordinarily provided or arranged by the skilled nursing facility when perscribed by a Plan Doctor.
.
Hospitalized ENTITLED Individual's, are not able - physically or mentally - to fight T42CFR417.1 grievance procedures - for their DENIED Covered T42CFR409.33 Hospital Extended Care Claims.
.
CITE: 42CFR438.704 -- Federal HMO T42CFR417.1 Adverse Determination
Sec. 438.704 Amounts of civil money penalties
(1) The limit is $25,000 for Each Determination under the following paragraphs of Sec. 438.700:
(i) Paragraph (b)(1) (Failure to provide services).
(ii) Paragraph (b)(5) (Misrepresentation or false statements to
enrollees, potential enrollees, or health care providers).
(iii) Paragraph (b)(6) (failure to comply with physician incentive
plan requirements).
(iv) Paragraph (c) (Marketing violations).
(2) The limit is $100,000 for each determination under paragraph
(b)(3) (discrimination) or (b)(4) (Misrepresentation or false statements to CMS or the State) of Sec. 438.700. (3) The limit is $15,000 for each recipient the State determines was not enrolled because of a discriminatory practice under paragraph (b)(3) of Sec. 438.700. (This is subject to the overall limit of $100,000 under paragraph (b)(2) of this section).
(c) Specific amount. For premiums or charges in excess [ illegal kickback conversions ] of the amounts permitted under the Medicaid program, the amount of the penalty is $25,000 or double the amount of the excess charges, whichever is greater. The State must deduct from the penalty the amount of overcharge and RETURN IT to the affected enrollees.
.
Read the October 2006 Health and Human Services (HHS) Office of Inspector General report on [ HCFA ] Medicaid payments for deceased beneficiaries
.2007 ~ Illegal Immunity ~ RICO ~ 1998 - Clinton Administration - Health Care Reform / Fraud and Abuse Control Program ~ 1996 HIPAA Violation - 1998 U.S. Attorney General and DHHS OIG ~ Volentary Disclousure Program
.
(1) the Number of Accounts
1. Federal Hospital Insurance (HI) Trust Fund Account
2. Health Care Fraud and Abuse Control Account
3. Federal Employee Retirement Trust Fund Account
4. MICHIGAN / OHIO General Trust Fund Account et al .....
.
2007 -- H.R. 3199 - USA PATRIOT Conference Report (Sensenbrenner - Judiciary) (Subject to a Rule) (Sec. 4) Requires the ATTORNEY GENERAL, on an ANNUAL BASIS, to submit to the House and Senate Judiciary Committees a report containing: (1) the Number of Accounts from which the Department of Justice (DOJ) has received VOLENTARY DISCLOUSURES [ 1998 DHHS OIG T42CFR417.1 misprison of felony T18CFR24Crimes ] 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 DHHS Employee adverse determination: Anti-dumping 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 ( 42CFR438.704 misprison of felony T18CFR286CRIMES: ALLOWING OIG & U.S. Attorneys to conduct Federal HMO Hospital Insurance & HCFA State Medicaid kickback fraud, against American Citizens - COLOR of LAW: illegal kickback conversions - Anti-Dumping Violations Public Fraud ) Contact - THOMAS (Library of Congress)
.
9-110.800 Violent Crimes in Aid of Racketeering Activity (18 U.S.C. 1959) Section 1959
.
2000 NURSING HOME CARE T42CFR409.33 \ Adverse Determination T42CFR417.1 grievance procedures ~ misprison of a felony 42CFR438.704 Anti-dumping Violation ~ T18CFR286CRIME
.
Subj: Fwd: ATTN: Marsha Albert/MS Griev -Reply T42CFR417.1
Date: 4/26/00 1:29:47 PM Eastern Daylight Time
From: MALBERT1 ~ hapcorp.org (Marsha Albert) - Federal HMO Region 5 HCFA
To: Kstbylite1 ~ aol.com
Denise, I'm sorry I did not respond to you earlier, however, if you can
please let Ms. Kimball know that this is not a grievance from any member of the family. Actually, the Insurance Bureau of MIchigan [ OFIS ] wanted to find out if there were any QUALITY ISSUES involved [ ENTITLED Individual \ Retired FEHB killed during the commission of a felony T42CFR417.1 grievance procedures \ denial of T42CFR409.33 Post-Hospital Care \ adverse determination T18CFR24crimes HIPAA ], while the mother, Alexandrea Rupert was at NIghtengale Nursing Home. WE ARE INVESTIGATING [ T18CFR24CRIMES ~ HIPAA: internal control \ Self-Audit ] the portion of the case with Our Quality Management Department. They will respond to ME once their investigation is complete. ~ RICO
.
Investigation and prosecution of fraud related to Federal Health Care Programs is the responsibility of the Department of Health and Human Services (DHHS), the FBI and the Department of Justice.~~
.
2008 JANUARY ~ RICO 42CFR438.704 - illegal kickback solisitation
.
[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
Solicitation of Information and Recommendations for Revising the
Compliance Program guidance for Nursing Facilities [ T42CFR409.33 ]
AGENCY: Office of Inspector General (OIG), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
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 those serving Medicare, Medicaid, and other [ OPM FEHBP, CHAMPVA,TRICARE ] Federal health care program [ ENTITLED Individual's ] 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). Additionally, the subsequent years of enforcement and compliance activity in the Nursing Home Industry [ HOSPITAL Affiliates ] has allowed OIG to address more fully the various risk areas in nursing home compliance.
SUPPLEMENTARY INFORMATION:
The development of CPGs is a major
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 [ 1998 Clinton Health Care Fraud and Abuse Control Program ~ RICO ~ VOLENTARY DISCLOUSURE ] 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 'PROVIDERS CAN' most
effectively establish 'Internal Controls' [ SELF-Audit T18CFR286CRIME ] and implement monitoring procedures [ T42CFR417.1 grievance procedures - misPrison of felony - anti-dumping violations ] 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 Determination ] FALSE CLAIMS, as well as QUALITY of CARE concerns, KICKBACKS, and accurate reporting of data to [ HCFA forced Medicaid conversions \ fraud by fright ] 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 ....RICO....T18CFR286CRIME ~ INTENT to defraud 'Entitled Individual's and Federal Health Care Programs' with respect to T42CFR409.33 Claims T18CFR371CRIME.
.
Fraud by Fright: White Collar Crime by Health Providers, 67 N.C.L.Rev. 855 (1989).
.
USA PATRIOT ...... SSA 1128b ....... 1998 still pending 2008 ....... T18CFR1518crime ~ RICO ~ Obstruction ~ Violation of Crime Victims Rights - Under federal law [42 U.S.C.10606(b)] and also 42 USC 1983. Civil action for deprivation of rights and The U.S. Constitution: Fourteenth Amendment.
.
Sincerely,
All ENTITLED Federal Employee Health Beneficiaries & the General Public who are being criminally denied DHHS T42CFR417.1 Existing Federal HMO Health Insurance Coverage, illegally billed for HMO denied covered claims and forced into HCFA State Medicaid Programs for the POOR. Title18CFR1001Crime.

9-110.330 Charging RICO Counts -- 1996 HIPAA -- U.S. Attorney and Office of Inspector General MISPRISON of FELONY --- 1998 VOLENTARY DISCLOUSURE Program
.
Health Insurance Portability and Accountability Act of 1996 ~ T18CFR24CRIMES
(3) FELONY ~ CONVICTION ~ RELATING TO HEALTH CARE FRAUD.--Any individual or entity that has been convicted for an offense 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 [ T42CFR417.1 Adverse Determination/Anti-dumping Violation ] 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.
.
1998 - Clinton Administration - Health Care Reform / Fraud and Abuse Control Program ~ RICO
.
1998 NATIONAL HEALTH CARE FRAUD AND ABUSE CONTROL PROGRAM', under the Joint Direction of the ATTORNEY GENERAL and the Secretary of ( DHHS ) the Department of Health and Human Services (HHS)(1), acting through the Department's Inspector General (HHS/OIG), DESIGNED ( DHHS and Federal HMO - illegal agreement to induce forfiture; Grievance Procedure / Volentary Disclousure T42CFR417.1 SELF-Audit Program ) to coordinate Federal, State and Local Law Enforcement activities [ T18CFR4CRIME misPrison of a felony ] With Respect to ( Federal Hospital Insurance Benefit T42CFR409.33 Claims ) Health Care Fraud and Abuse. [ T18CFR286CRIME ]
.
DHHS OIG News Release 21 Oct 1998 ....... T18CFR371crime
VOLENTARY DISCLOUSURE of Health Care Fraud
For Immediate Release Contact: Judy Holtz (202) 619-0893
Wednesday, October 21,1998 .Ben St.John (202) 619-1028
The ( DHHS OIG ) Department of Health and Human Services's Office of Inspector General ( OIG ) today unveiled an expanded and simplified PROGRAM For ( Federal ) Health Care Providers to 'Volentarily Report' ( internal control / self-audit T42CFR417.1 adverse determination, grievance procedure: misprison of a felony: anti-dumping violation ) Fraudulent Conduct ( T18CFR24Crimes ) Affecting [ Entitled Individuals ] HCFA Medicare/Medicaid, and other ( OPM FEHBP,TRICARE,CHAMPVA ) Federal health care programs. The [ Federal ( OPM FEHBP T5CFR890.105 ) HMO Contract ] Provider will have the option of doing 'SELF-audit' [ DHHS T42CFR417.1 misprison of a felony \ Anti-dumping violation ] in conformance 'with OIG'.
.
The Health Care Financing Administration ( HCFA ) administers the Medicaid program. Authorized under Title XIX of the Social Security Act
.
The Region 5 HCFA [ Chicago ] office had a record high 940 new MSP cases filed in 1998. Contributing to this were Partnership Arrangements with [ Federal ] Contractors and U.S. Attorneys in Michigan and Ohio.
.
[CITE: 42CFR409.33] [Page 187-188]TITLE 42--PUBLIC HEALTH CHAPTER IV-[ HCFA ]-HEALTH CARE FINANCING ADMINISTRATION, [ DHHS ] 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 and rehabilitation services.
.
Federal \ State ~ DENIAL of COVERED CLAIMS ~ felony ~ RICO
.SPECIALIZED SERVICE ~ 1998 VOLENTARY DISCLOUSURE Program For PROVIDERS to conduct felony fraud AGAINST Entitled Individuals with Federal HMO Policies: intent to harm:
T42CFR417.1 -- CRIMINAL MISCONDUCT -- Illegal agreement to induce forfiture of EXISTING Federal Insurance to Force - Fraud by Fright - illegal HCFA State OFIS Medicaid kickback conversions -- TITLE 42-[ DHHS ]-PUBLIC HEALTH HUMAN SERVICES PART 417-[ Federal HMO ]-HEALTH MAINTENANCE ORGANIZATIONS, Subpart B-- Qualified Health Maintenance Organizations: SERVICES (g) Grievance procedures -ADVERSE DETERMINATION - illegal denial of Existing Federal HMO Hospital Insurance Services T42CFR409.33, Anti-DUMPING violation, to force illegal HCFA State ( MI- OFIS ) Medicaid T42CFR409.33 KICKBACK conversions ). (h) SPECIAL rules: Enrollees under the Federal employee health benefits program (FEHBP).An HMO that accepts enrollees under the FEHBP (Chapter 89 of title 5 of the U.S.C.) may obtain and retain Federal qualification if, for its other enrollees ( General Public ), it complies with the requirements of section 1301(b) and 1301(c) of the PHS Act and implementing regulations in this subpart D and subparts B and C of this .........
.
1999 Federal HMO Employee and DHHS Employee - T42CFR417.1 illegal Denial of Existing OPM FEHBP Hospital Extended Care Benefits to force illegal State HCFA Medicaid ( kickback ) application $50,000 Felony - Medicaid False Claims Act.
.
1999 Federal HMO Hospital Service Contract Provider
Health Alliance Plan Detroit Michigan - Region 5 HCFA
OPM FEHB ( Federal Employee Health Benefits Program RI 73-015 .... page 15 )
.
OPM FEHBP " Hospital Extended Care Benefits " CITE: 42CFR409.33 Post-Hospital Services
.
The [ Federal HMO & DHHS Employee ] Plan [ Denies T42sec417.1 ] PROVIDES a comprehensive range of benefits when skilled nursing care is necessary & confinement in a skilled nursing facility is medically appropriate as determined by a plan doctor.
The [ Federal HMO & DHHS Employee ] Plan [ Denies T42sec417.1 ] PAYS FOR up to 730 days ( 2 years ) each continuous period of confinement or for sucessive periods seperated by less than 60 days.
This 730 days period will be reduced by 2 days for every Inpatient HOSPITAL day Prior to ADMISSION to a Skilled Nursing Facility. ( Hospital Transfers ) A new period of 730 days will begin after at least 60 days have elapsed from the last date of discharge. You [ Covered Individual are Denied T5CFR890.105 OPM illegal agreement to induce forfiture ] Pay Nothing. All Medically Necessary Services Are [ Denied T42CFR417.1 Adverse Determination \ Anti-Dumping Violation ] Covered, including: ::::::: bed, board & general nursing care ::::::: drugs, biologicals, supplies & equipement ordinarily provided or arranged by the skilled nursing facility when perscribed by a Plan Doctor.
.
Hospitalized ENTITLED Individual's, are not able - physically or mentally - to fight T42CFR417.1 grievance procedures - for their DENIED Covered T42CFR409.33 Hospital Extended Care Claims.
.
CITE: 42CFR438.704 -- Federal HMO T42CFR417.1 Adverse Determination
Sec. 438.704 Amounts of civil money penalties
(1) The limit is $25,000 for Each Determination under the following paragraphs of Sec. 438.700:
(i) Paragraph (b)(1) (Failure to provide services).
(ii) Paragraph (b)(5) (Misrepresentation or false statements to
enrollees, potential enrollees, or health care providers).
(iii) Paragraph (b)(6) (failure to comply with physician incentive
plan requirements).
(iv) Paragraph (c) (Marketing violations).
(2) The limit is $100,000 for each determination under paragraph
(b)(3) (discrimination) or (b)(4) (Misrepresentation or false statements to CMS or the State) of Sec. 438.700. (3) The limit is $15,000 for each recipient the State determines was not enrolled because of a discriminatory practice under paragraph (b)(3) of Sec. 438.700. (This is subject to the overall limit of $100,000 under paragraph (b)(2) of this section).
(c) Specific amount. For premiums or charges in excess [ illegal kickback conversions ] of the amounts permitted under the Medicaid program, the amount of the penalty is $25,000 or double the amount of the excess charges, whichever is greater. The State must deduct from the penalty the amount of overcharge and RETURN IT to the affected enrollees.
.
Read the October 2006 Health and Human Services (HHS) Office of Inspector General report on [ HCFA ] Medicaid payments for deceased beneficiaries
.2007 ~ Illegal Immunity ~ RICO ~ 1998 - Clinton Administration - Health Care Reform / Fraud and Abuse Control Program ~ 1996 HIPAA Violation - 1998 U.S. Attorney General and DHHS OIG ~ Volentary Disclousure Program
.
(1) the Number of Accounts
1. Federal Hospital Insurance (HI) Trust Fund Account
2. Health Care Fraud and Abuse Control Account
3. Federal Employee Retirement Trust Fund Account
4. MICHIGAN / OHIO General Trust Fund Account et al .....
.
2007 -- H.R. 3199 - USA PATRIOT Conference Report (Sensenbrenner - Judiciary) (Subject to a Rule) (Sec. 4) Requires the ATTORNEY GENERAL, on an ANNUAL BASIS, to submit to the House and Senate Judiciary Committees a report containing: (1) the Number of Accounts from which the Department of Justice (DOJ) has received VOLENTARY DISCLOUSURES [ 1998 DHHS OIG T42CFR417.1 misprison of felony T18CFR24Crimes ] 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 DHHS Employee adverse determination: Anti-dumping 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 ( 42CFR438.704 misprison of felony T18CFR286CRIMES: ALLOWING OIG & U.S. Attorneys to conduct Federal HMO Hospital Insurance & HCFA State Medicaid kickback fraud, against American Citizens - COLOR of LAW: illegal kickback conversions - Anti-Dumping Violations Public Fraud ) Contact - THOMAS (Library of Congress)
.
9-110.800 Violent Crimes in Aid of Racketeering Activity (18 U.S.C. 1959) Section 1959
.
2000 NURSING HOME CARE T42CFR409.33 \ Adverse Determination T42CFR417.1 grievance procedures ~ misprison of a felony 42CFR438.704 Anti-dumping Violation ~ T18CFR286CRIME
.
Subj: Fwd: ATTN: Marsha Albert/MS Griev -Reply T42CFR417.1
Date: 4/26/00 1:29:47 PM Eastern Daylight Time
From: MALBERT1 ~ hapcorp.org (Marsha Albert) - Federal HMO Region 5 HCFA
To: Kstbylite1 ~ aol.com
Denise, I'm sorry I did not respond to you earlier, however, if you can
please let Ms. Kimball know that this is not a grievance from any member of the family. Actually, the Insurance Bureau of MIchigan [ OFIS ] wanted to find out if there were any QUALITY ISSUES involved [ ENTITLED Individual \ Retired FEHB killed during the commission of a felony T42CFR417.1 grievance procedures \ denial of T42CFR409.33 Post-Hospital Care \ adverse determination T18CFR24crimes HIPAA ], while the mother, Alexandrea Rupert was at NIghtengale Nursing Home. WE ARE INVESTIGATING [ T18CFR24CRIMES ~ HIPAA: internal control \ Self-Audit ] the portion of the case with Our Quality Management Department. They will respond to ME once their investigation is complete. ~ RICO
.
Investigation and prosecution of fraud related to Federal Health Care Programs is the responsibility of the Department of Health and Human Services (DHHS), the FBI and the Department of Justice.~~
.
2008 JANUARY ~ RICO 42CFR438.704 - illegal kickback solisitation
.
[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
Solicitation of Information and Recommendations for Revising the
Compliance Program guidance for Nursing Facilities [ T42CFR409.33 ]
AGENCY: Office of Inspector General (OIG), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
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 those serving Medicare, Medicaid, and other [ OPM FEHBP, CHAMPVA,TRICARE ] Federal health care program [ ENTITLED Individual's ] 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). Additionally, the subsequent years of enforcement and compliance activity in the Nursing Home Industry [ HOSPITAL Affiliates ] has allowed OIG to address more fully the various risk areas in nursing home compliance.
SUPPLEMENTARY INFORMATION:
The development of CPGs is a major
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 [ 1998 Clinton Health Care Fraud and Abuse Control Program ~ RICO ~ VOLENTARY DISCLOUSURE ] 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 'PROVIDERS CAN' most
effectively establish 'Internal Controls' [ SELF-Audit T18CFR286CRIME ] and implement monitoring procedures [ T42CFR417.1 grievance procedures - misPrison of felony - anti-dumping violations ] 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 Determination ] FALSE CLAIMS, as well as QUALITY of CARE concerns, KICKBACKS, and accurate reporting of data to [ HCFA forced Medicaid conversions \ fraud by fright ] 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 ....RICO....T18CFR286CRIME ~ INTENT to defraud 'Entitled Individual's and Federal Health Care Programs' with respect to T42CFR409.33 Claims T18CFR371CRIME.
.
Fraud by Fright: White Collar Crime by Health Providers, 67 N.C.L.Rev. 855 (1989).
.
USA PATRIOT ...... SSA 1128b ....... 1998 still pending 2008 ....... T18CFR1518crime ~ RICO ~ Obstruction ~ Violation of Crime Victims Rights - Under federal law [42 U.S.C.10606(b)] and also 42 USC 1983. Civil action for deprivation of rights and The U.S. Constitution: Fourteenth Amendment.
.
Sincerely,
All ENTITLED Federal Employee Health Beneficiaries & the General Public who are being criminally denied DHHS T42CFR417.1 Existing Federal HMO Health Insurance Coverage, illegally billed for HMO denied covered claims and forced into HCFA State Medicaid Programs for the POOR. Title18CFR1001Crime.

9-110.330 Charging RICO Counts -- 1996 HIPAA -- U.S. Attorney and Office of Inspector General MISPRISON of FELONY --- 1998 VOLENTARY DISCLOUSURE Program
.
Health Insurance Portability and Accountability Act of 1996 ~ T18CFR24CRIMES
(3) FELONY ~ CONVICTION ~ RELATING TO HEALTH CARE FRAUD.--Any individual or entity that has been convicted for an offense 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 [ T42CFR417.1 Adverse Determination/Anti-dumping Violation ] 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.
.
1998 - Clinton Administration - Health Care Reform / Fraud and Abuse Control Program ~ RICO
.
1998 NATIONAL HEALTH CARE FRAUD AND ABUSE CONTROL PROGRAM', under the Joint Direction of the ATTORNEY GENERAL and the Secretary of ( DHHS ) the Department of Health and Human Services (HHS)(1), acting through the Department's Inspector General (HHS/OIG), DESIGNED ( DHHS and Federal HMO - illegal agreement to induce forfiture; Grievance Procedure / Volentary Disclousure T42CFR417.1 SELF-Audit Program ) to coordinate Federal, State and Local Law Enforcement activities [ T18CFR4CRIME misPrison of a felony ] With Respect to ( Federal Hospital Insurance Benefit T42CFR409.33 Claims ) Health Care Fraud and Abuse. [ T18CFR286CRIME ]
.
DHHS OIG News Release 21 Oct 1998 ....... T18CFR371crime
VOLENTARY DISCLOUSURE of Health Care Fraud
For Immediate Release Contact: Judy Holtz (202) 619-0893
Wednesday, October 21,1998 .Ben St.John (202) 619-1028
The ( DHHS OIG ) Department of Health and Human Services's Office of Inspector General ( OIG ) today unveiled an expanded and simplified PROGRAM For ( Federal ) Health Care Providers to 'Volentarily Report' ( internal control / self-audit T42CFR417.1 adverse determination, grievance procedure: misprison of a felony: anti-dumping violation ) Fraudulent Conduct ( T18CFR24Crimes ) Affecting [ Entitled Individuals ] HCFA Medicare/Medicaid, and other ( OPM FEHBP,TRICARE,CHAMPVA ) Federal health care programs. The [ Federal ( OPM FEHBP T5CFR890.105 ) HMO Contract ] Provider will have the option of doing 'SELF-audit' [ DHHS T42CFR417.1 misprison of a felony \ Anti-dumping violation ] in conformance 'with OIG'.
.
The Health Care Financing Administration ( HCFA ) administers the Medicaid program. Authorized under Title XIX of the Social Security Act
.
The Region 5 HCFA [ Chicago ] office had a record high 940 new MSP cases filed in 1998. Contributing to this were Partnership Arrangements with [ Federal ] Contractors and U.S. Attorneys in Michigan and Ohio.
.
[CITE: 42CFR409.33] [Page 187-188]TITLE 42--PUBLIC HEALTH CHAPTER IV-[ HCFA ]-HEALTH CARE FINANCING ADMINISTRATION, [ DHHS ] 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 and rehabilitation services.
.
Federal \ State ~ DENIAL of COVERED CLAIMS ~ felony ~ RICO
.SPECIALIZED SERVICE ~ 1998 VOLENTARY DISCLOUSURE Program For PROVIDERS to conduct felony fraud AGAINST Entitled Individuals with Federal HMO Policies: intent to harm:
T42CFR417.1 -- CRIMINAL MISCONDUCT -- Illegal agreement to induce forfiture of EXISTING Federal Insurance to Force - Fraud by Fright - illegal HCFA State OFIS Medicaid kickback conversions -- TITLE 42-[ DHHS ]-PUBLIC HEALTH HUMAN SERVICES PART 417-[ Federal HMO ]-HEALTH MAINTENANCE ORGANIZATIONS, Subpart B-- Qualified Health Maintenance Organizations: SERVICES (g) Grievance procedures -ADVERSE DETERMINATION - illegal denial of Existing Federal HMO Hospital Insurance Services T42CFR409.33, Anti-DUMPING violation, to force illegal HCFA State ( MI- OFIS ) Medicaid T42CFR409.33 KICKBACK conversions ). (h) SPECIAL rules: Enrollees under the Federal employee health benefits program (FEHBP).An HMO that accepts enrollees under the FEHBP (Chapter 89 of title 5 of the U.S.C.) may obtain and retain Federal qualification if, for its other enrollees ( General Public ), it complies with the requirements of section 1301(b) and 1301(c) of the PHS Act and implementing regulations in this subpart D and subparts B and C of this .........
.
1999 Federal HMO Employee and DHHS Employee - T42CFR417.1 illegal Denial of Existing OPM FEHBP Hospital Extended Care Benefits to force illegal State HCFA Medicaid ( kickback ) application $50,000 Felony - Medicaid False Claims Act.
.
1999 Federal HMO Hospital Service Contract Provider
Health Alliance Plan Detroit Michigan - Region 5 HCFA
OPM FEHB ( Federal Employee Health Benefits Program RI 73-015 .... page 15 )
.
OPM FEHBP " Hospital Extended Care Benefits " CITE: 42CFR409.33 Post-Hospital Services
.
The [ Federal HMO & DHHS Employee ] Plan [ Denies T42sec417.1 ] PROVIDES a comprehensive range of benefits when skilled nursing care is necessary & confinement in a skilled nursing facility is medically appropriate as determined by a plan doctor.
The [ Federal HMO & DHHS Employee ] Plan [ Denies T42sec417.1 ] PAYS FOR up to 730 days ( 2 years ) each continuous period of confinement or for sucessive periods seperated by less than 60 days.
This 730 days period will be reduced by 2 days for every Inpatient HOSPITAL day Prior to ADMISSION to a Skilled Nursing Facility. ( Hospital Transfers ) A new period of 730 days will begin after at least 60 days have elapsed from the last date of discharge. You [ Covered Individual are Denied T5CFR890.105 OPM illegal agreement to induce forfiture ] Pay Nothing. All Medically Necessary Services Are [ Denied T42CFR417.1 Adverse Determination \ Anti-Dumping Violation ] Covered, including: ::::::: bed, board & general nursing care ::::::: drugs, biologicals, supplies & equipement ordinarily provided or arranged by the skilled nursing facility when perscribed by a Plan Doctor.
.
Hospitalized ENTITLED Individual's, are not able - physically or mentally - to fight T42CFR417.1 grievance procedures - for their DENIED Covered T42CFR409.33 Hospital Extended Care Claims.
.
CITE: 42CFR438.704 -- Federal HMO T42CFR417.1 Adverse Determination
Sec. 438.704 Amounts of civil money penalties
(1) The limit is $25,000 for Each Determination under the following paragraphs of Sec. 438.700:
(i) Paragraph (b)(1) (Failure to provide services).
(ii) Paragraph (b)(5) (Misrepresentation or false statements to
enrollees, potential enrollees, or health care providers).
(iii) Paragraph (b)(6) (failure to comply with physician incentive
plan requirements).
(iv) Paragraph (c) (Marketing violations).
(2) The limit is $100,000 for each determination under paragraph
(b)(3) (discrimination) or (b)(4) (Misrepresentation or false statements to CMS or the State) of Sec. 438.700. (3) The limit is $15,000 for each recipient the State determines was not enrolled because of a discriminatory practice under paragraph (b)(3) of Sec. 438.700. (This is subject to the overall limit of $100,000 under paragraph (b)(2) of this section).
(c) Specific amount. For premiums or charges in excess [ illegal kickback conversions ] of the amounts permitted under the Medicaid program, the amount of the penalty is $25,000 or double the amount of the excess charges, whichever is greater. The State must deduct from the penalty the amount of overcharge and RETURN IT to the affected enrollees.
.
Read the October 2006 Health and Human Services (HHS) Office of Inspector General report on [ HCFA ] Medicaid payments for deceased beneficiaries
.2007 ~ Illegal Immunity ~ RICO ~ 1998 - Clinton Administration - Health Care Reform / Fraud and Abuse Control Program ~ 1996 HIPAA Violation - 1998 U.S. Attorney General and DHHS OIG ~ Volentary Disclousure Program
.
(1) the Number of Accounts
1. Federal Hospital Insurance (HI) Trust Fund Account
2. Health Care Fraud and Abuse Control Account
3. Federal Employee Retirement Trust Fund Account
4. MICHIGAN / OHIO General Trust Fund Account et al .....
.
2007 -- H.R. 3199 - USA PATRIOT Conference Report (Sensenbrenner - Judiciary) (Subject to a Rule) (Sec. 4) Requires the ATTORNEY GENERAL, on an ANNUAL BASIS, to submit to the House and Senate Judiciary Committees a report containing: (1) the Number of Accounts from which the Department of Justice (DOJ) has received VOLENTARY DISCLOUSURES [ 1998 DHHS OIG T42CFR417.1 misprison of felony T18CFR24Crimes ] 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 DHHS Employee adverse determination: Anti-dumping 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 ( 42CFR438.704 misprison of felony T18CFR286CRIMES: ALLOWING OIG & U.S. Attorneys to conduct Federal HMO Hospital Insurance & HCFA State Medicaid kickback fraud, against American Citizens - COLOR of LAW: illegal kickback conversions - Anti-Dumping Violations Public Fraud ) Contact - THOMAS (Library of Congress)
.
9-110.800 Violent Crimes in Aid of Racketeering Activity (18 U.S.C. 1959) Section 1959
.
2000 NURSING HOME CARE T42CFR409.33 \ Adverse Determination T42CFR417.1 grievance procedures ~ misprison of a felony 42CFR438.704 Anti-dumping Violation ~ T18CFR286CRIME
.
Subj: Fwd: ATTN: Marsha Albert/MS Griev -Reply T42CFR417.1
Date: 4/26/00 1:29:47 PM Eastern Daylight Time
From: MALBERT1 ~ hapcorp.org (Marsha Albert) - Federal HMO Region 5 HCFA
To: Kstbylite1 ~ aol.com
Denise, I'm sorry I did not respond to you earlier, however, if you can
please let Ms. Kimball know that this is not a grievance from any member of the family. Actually, the Insurance Bureau of MIchigan [ OFIS ] wanted to find out if there were any QUALITY ISSUES involved [ ENTITLED Individual \ Retired FEHB killed during the commission of a felony T42CFR417.1 grievance procedures \ denial of T42CFR409.33 Post-Hospital Care \ adverse determination T18CFR24crimes HIPAA ], while the mother, Alexandrea Rupert was at NIghtengale Nursing Home. WE ARE INVESTIGATING [ T18CFR24CRIMES ~ HIPAA: internal control \ Self-Audit ] the portion of the case with Our Quality Management Department. They will respond to ME once their investigation is complete. ~ RICO
.
Investigation and prosecution of fraud related to Federal Health Care Programs is the responsibility of the Department of Health and Human Services (DHHS), the FBI and the Department of Justice.~~
.
2008 JANUARY ~ RICO 42CFR438.704 - illegal kickback solisitation
.
[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
Solicitation of Information and Recommendations for Revising the
Compliance Program guidance for Nursing Facilities [ T42CFR409.33 ]
AGENCY: Office of Inspector General (OIG), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
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 those serving Medicare, Medicaid, and other [ OPM FEHBP, CHAMPVA,TRICARE ] Federal health care program [ ENTITLED Individual's ] 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). Additionally, the subsequent years of enforcement and compliance activity in the Nursing Home Industry [ HOSPITAL Affiliates ] has allowed OIG to address more fully the various risk areas in nursing home compliance.
SUPPLEMENTARY INFORMATION:
The development of CPGs is a major
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 [ 1998 Clinton Health Care Fraud and Abuse Control Program ~ RICO ~ VOLENTARY DISCLOUSURE ] 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 'PROVIDERS CAN' most
effectively establish 'Internal Controls' [ SELF-Audit T18CFR286CRIME ] and implement monitoring procedures [ T42CFR417.1 grievance procedures - misPrison of felony - anti-dumping violations ] 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 Determination ] FALSE CLAIMS, as well as QUALITY of CARE concerns, KICKBACKS, and accurate reporting of data to [ HCFA forced Medicaid conversions \ fraud by fright ] 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 ....RICO....T18CFR286CRIME ~ INTENT to defraud 'Entitled Individual's and Federal Health Care Programs' with respect to T42CFR409.33 Claims T18CFR371CRIME.
.
Fraud by Fright: White Collar Crime by Health Providers, 67 N.C.L.Rev. 855 (1989).
.
USA PATRIOT ...... SSA 1128b ....... 1998 still pending 2008 ....... T18CFR1518crime ~ RICO ~ Obstruction ~ Violation of Crime Victims Rights - Under federal law [42 U.S.C.10606(b)] and also 42 USC 1983. Civil action for deprivation of rights and The U.S. Constitution: Fourteenth Amendment.
.
Sincerely,
All ENTITLED Federal Employee Health Beneficiaries & the General Public who are being criminally denied DHHS T42CFR417.1 Existing Federal HMO Health Insurance Coverage, illegally billed for HMO denied covered claims and forced into HCFA State Medicaid Programs for the POOR. Title18CFR1001Crime.

Bottom line: it's economics. If you have a pre-existing condition, you pay a couple hundred dollars, Humana definitely pays tens of thousands up front. That's not business. That's charity. My advice: apply for public assistance. Not trying to sound mean here, but that's how I see it.

health insurance companies are infested with Department of children and families employees and health and rehabilitative services and police agency anymore have been I am not hireable to sellhealth insurance coverage. I am not a DCF employee or a cop or a corrections officer we dont care never cared at all not going to care sold a bogus policy not just Humana insurance company it is any and all I used to process payments for a corporation however the paymentsfor the COBRA was about $400.00 per month people died the advertisements for Humana about providers was published by department of children and families andthe department of law enforcement in Florida and the United States corrections department and the federal penetentiary published the ads yearly refused to make changes that perveive this as a health plan for families you know formom and dad and the dependents. The only doctor your going to see will be hired by the united states department of corrections are sick weazles and dentists hired by them and medical doctors hired by them separate agency alltogether and prison hired psychiatric doctors this is all you can have. I know you dont want to believe me i worked for Wang Laboratories and attended harvard university took classes from professors in that state I can tell you wont believe me. The ads are fake Harvard HMO wasupfront with everyone there is a Harvard university in Massachusetts there are young people graduating from the university of medicine. This HMO was legitimate actually only one I found it was in one very large building in massachusetts you could do everything in this building your dental your medical your mental health and your psychiatry the harvard university HMOadvertised information about Kidney transplants and how much was covered I cannot recommend anyone else Im so sorry but I dont work for Humana seriously ill for selling this to you have been any plan at all even employers are not well had no right to sell it to you those advertisements are way off so far off as any reality at all other than this plan and wang had more you could opt for metropolitan life insurance company this allowed you to see any provider at all even on vacation in another country not the way it is inthe united States since 1950.

HMO'sclosed down were not making any money over mental health in Florida none in the united States had to close over corrections involvement with children homosexually im afraid plagued with failure to advertise names of their employees refuse to do so because criminals with histories of child molestation and firings by HRS agencies in other states. Like Brent Zellers who shot insured children in the mouth after forceful rape in the united States. but he did stuff the bodies into trash bags and drug the children into dumpsters and no doctors just HRS and social workers dominate the insurance industry and corections officers and cops wont put this in the advertisements Angela Ream another adult no one called this pervert either. plague in the industry. Under the Baker act felony act.

I want you to look at Humana on this web site Http://www.Doenetwork.org
look at suicide victims and unidentified remains and see humana these are people who paid humana premiums under cobra also. Their families they are unitedStates marines and their children AIR force and cops and their children also not just us few sheriffs them too. Everyone the outback steakhouse the bennigans and many more this is thier families on the network worked near cash registers were robbed also by circles of care a provider at 400 e sheridan Rd. melbourne flordia made it possible for anyone to be a doctor under the Baker act its anyone at all is adoctor in Florida inn the united States you can be arrested by anyone for anyone under this act no longer welcome in the united States and a whole lot more.
On the web site of Http://www.stateoffloridadepartmentofcorrections take a look at his Humana family a Shaun Allen on this web site the corrections department reads he was arrested at age 15 in Atlanta Georgia in the picture the photograph of Shaun Allen or Shaun evertt Allen a united States marinethis is his grandson in the photograph he is dead in the photograph is how sick florida is and has been with humana not just Humana its blue cross blue shield sold by HRS employees only not the law you can sell this andyour ex employees only why are you ex employees of the agency? This photograph he is dead in the picture he is white male dark brown hair and brown eyes Ive seen people shot inthehead with a handgun before eyes are open he is dead he was propped up in Taylor correctional institute by police gary boyer 721 titusville police officer by adult cops and corrections employees inside the prison if you look closely at shaun allen you can see bruises on the right side of his head these bruises are from the bullet a gunshot to the right side of the back of his head went in sideways he bledto death the correctioins department Taylor correctional institute cleaned the blood off dressed the humana insured dependent aetna insured and Blue Cross blue shield we have $4.5 million dollars in bills paid to florida we cant talk to the insurance company all DCF employees and cops believe it or FBI not. Even the veterans administration cant talk to them about the payments at the pentagon either police dont want you too your under arrest children are under arrest shaun allen in the photograph got off on shaun and his mommy thats me sure did for over 17 years. He is dead in the photograph dated 2001 accusedof using an alias of 6 different names burgularizing the cops home in titusville Florida also raped him have and needed our social security information which they the providers got from not us been doing this. Im being honest take a look on Myspace changed the information in a computer not alive no onewas released into the community he was burned in the woods in handcuffs in 2001 by these adult corrections hiding their homosexuality repressed whythey workthere. State and US wide in texas also the provider is circles of care 400 e sheridan Rd. Melbourne florida run by cops brent Zellers pedophiles a release pedophile child molester and his wife and eric vasquez get the names affter mass murderers not all gary boyer did entered a hospital healthsouth and cut other peoples hands off made copies of their hands not medicine never been care never going to be.YOur a child molester at Humana what the policy needs to read going to be a homosexual now your going to prison going to get raped by cops going to masturbation plan your children are going to have sex going to be a long excruciating life with any plan you sign up or pay in the united States police around.

Dear Thomas,

I am a licensed health agent in Pa. I do not sell Humana products nor am I connected in any way with ehealth. Unfortunately your situation is seen by agents across the country everyday with many different insurance companies. I am very sorry that you were declined by Human but I will try and explain the process that is involved with applying for and being accepted by health insurance companies today. When an applicant applies for coverage the first thing he/she does is fill out an application that will ask several questions regarding present and past health conditions, illnesses, injuries, etc. You will also be asked to provide names and addresses of doctors and dates that you were seen and what treatment you received. An agent will ask for detailed information about each health condition to help explain your situation. An example would be that you broke your leg 4 years ago but have made a full recovery and you are not receiving any treatment for your leg. An agent will explain this in notes that will be sent to the company's underwriters. Once an agent completes an application with a client the application is sent into the company to be reviewed for approval or decline by the underwriters. The agent should have told you
not to cancel any existing coverage until your policy has been reviewed and approved. The job of the underwriters is to verify all medical conditions both past and present and they decide if a policy will be approved based on medical history. Unfortunately due to the very high costs of health care today, underwriting guidelines for all health insurance companies are very strict and they do check every medical detail and look at every medical record and it is a lengthly process. Some insurance companies will offer a rider excluding a pre-existing conditon for a certain period of time or exclude it altogether depending on what the conditions are. However, if a person has serious pre-existing or present conditions most insurance companies will now simply decline the applicant. Guidelines can vary slightly from company to company. One company may accept a person with high blood pressure IF they had been diagnosed with the condition at least 1 year prior to applying for coverage and if there is at least a year history that the condition is being controlled by medicine but another company may simply just decline an applicant. You are absolutely correct that insurance companies only want to insure healthy people today as health care costs are very high. That is why it is so important for people to get a good quality health insurance plan when they are healthy so they have the coverage when they get ill or injured. High cost of health care, high premiums and strict underwriting guidelines have left millions uninsured in this country. We have a national health care crisis and the Reader's Digest did an excellent article on this same subject last month. If people think they can lie to an insurance company about a health condition they will be caught by underwriting and if it slips through underwriting and the person receives treatment and the insurance company determines the person lied about a pre-existing condition, the company has the right not to pay for treatment and it is also considered fraud and in most states there is a criminal penalty. Unfortunately you have now become a target for the discount health plan salespeople. You may receive calls telling you about great health insurance coverage and that everyone is accepted to the plan. They will tell you that you will get money paid to your for certain services if you are in a hospital or if you go to a doctor. These are in no way health insurance no matter what any salesperson tells you. This website has dozens of people that have been scammed by such plans as they are sold in a misleading manner misrepresenting the product as health insurance when it is not. These discount plans are sold by numerous companies on the internet and by phone so you must be very aware of them especially if they tell you they will cover you no matter your health is as no insurance company will do that as all plans are subject to approval by the company through the underwriting process. Do not be pressured into buying any kind of health plan and call your state to make sure the company and agent is licensed to sell health insurance in your state no matter what a salesperson or agent tells you. You've already been declined for a major medical policy, you do not need to be ripped off by a product that is not what you were looking to buy. I am not connected with any of the Blue Cross/Blue Shield companies in the U.S. but I know they will accept some pre-existing conditions but will put a time period on them for a waiting period of 1-2 years before they cover a pre-existing condition. I have sent people to them that I know my carriers will decline before I even submitted an application on them. All good agents know their companies guidelines and if they know the applicant will not be accepted by those companies the agent should be honest with a client and send them somewhere else where they may get coverage. Call your state dept. of insurance and ask them for the number for the blue cross that serves your area. There are simply no cheap health insurance premiums so I do not know how they will compare with your Humana quote. All premiums seem high to people but please remember medical debt for illness or injury is one of the top reasons people declare bankruptcy in this country and the new laws will exclude many from that option. If your income is lower, you may be able to qualify for a state insurance program and you can ask about that also at your state insurance dept. Check with your chamber of commerce for local agents that may be able to give you some other options also. I'm sorry I could not have been more helpful to you and I wish you the best in finding good coverage.
Sue