In an AP story this morning, the director of Mississippi Medicaid and Jim Hood each accused the other of failing to pursue Medicaid fraud claims involving a North Mississippi health care provider, with allegations of fraud to the tune of $24M. But Medicaid Director Bob Robinson won’t say who the fraud might involve.
Well, with the help of a reader, here’s an interesting affidavit from Janet Mann, the Deputy Director of Audit and Recovery in the Medicaid office, alleging that at the Tri-Lakes hospital in North Mississippi, while an individual named Ray Shoemaker was responsible, there was medicaid fraud claims to the tune of $24M. Does this perhaps answer the unanswered question in the AP story?
Here’s the story:
Mississippi’s Medicaid director told lawmakers Wednesday that Attorney General Jim Hood has refused to prosecute a possible case of $24 million in fraud by a man paid to provide behavioral services to patients.
“He wouldn’t get in there,” Medicaid’s Bob Robinson said of Hood.
In an interview later, Hood said he didn’t know the details of the case Robinson discussed. But, speaking of Medicaid officials, Hood said: “If they showed us a criminal case, we pursued it.”
Hood accused Robinson of trying to protect a rural hospital that filed for bankruptcy after allegedly misspending $24 million from Medicaid, the government health insurance program for the needy and disabled.
“He needs to resign and get out of that agency because it has been mismanaged,” Hood said.
Robinson was not immediately available to respond.
Robinson’s comments came as he appeared before the Joint Legislative Budget Committee to discuss Medicaid’s spending request for the year that begins next July 1. He told lawmakers he believes there is fraud and abuse in the program.
When Democratic Rep. Percy Watson of Hattiesburg pressed for details, Robinson replied: “Listen, it’s not the beneficiaries. It’s not even a blip on the screen. It’s the providers.”
Medicaid providers include hospitals, nursing homes, physicians, dentists, pharmacists, therapists and others who are paid to give services to patients. Officials say 605,289 people were enrolled in the program as of Aug. 31 – nearly one in every five Mississippi residents.
Robinson said he suspects a $24 million of fraud occurred two or three years ago when a behavioral services provider in northern Mississippi overcharged to drive patients to medical facilities where they were shown movies.
Robinson would not release the name of the person.
“Look, I’m not going to tell you that if he hasn’t even been indicted,” Robinson told The Associated Press as he left the legislative meeting.
“”Hood said: “If they showed us a criminal case, we pursued it.””
What Hood meant was: ” If they showed us a criminal case, we pursued it, unless it involved one of my many ‘family’ members. I wonder if Shoemaker has been a contributor to Hood’s past campaigns?
Robinson said he suspects a $24 million of fraud occurred two or three years ago when a behavioral services provider in northern Mississippi overcharged to drive patients to medical facilities where they were shown movies.
Now how many people does one have to take to the movies to run up a $24 million tab?
Somebody had to receive and review these claims, then pass them to someone for a certification that the claims are lawfully proper … that they comply with the appropriations statutes from whence cometh the money. And, after payment(s), all this would or should be subjected to both internal and external audits.
So let’s see the paperwork. Who all signed off on this? Names need to be named. It’s all a matter of public record. Paul Quinn up … mission for you.
According to the FEC website:
Mr. Shoemaker and his wife gave Steve Holland $4600 in the 2008 congressional race.
Mr. Shoemaker gave Travis Childers $2400 in June 2009.
Mr. Shoemaker gave the National Republican Congressional Cmte $3000 in 2006.
John Pittman Hey
The claim by Hood that DOM’s Robinson is “protecting the hospital” apparently relates to DOM and the Bankruptcy court and the parties coming to this agreement:
See the Panolian, 8/14/2009 at
http://www.panolian.com/content.aspx?Module=ContentItem&ID=141706&MemberID=1180
Apparently, they cannot get a decent bid on the hospital property if the $24 million debt goes with it.
Hood can prosecute whomever he wants. He should stop whining.
http://kingfish1935.blogspot.com/2007/07/more-medicaid-malarkey.html
ho hum.
Re: Kingfish’s link, keeping Medicaid under the Office of the Governor cannot be conducive to its responsible functioning. (Whoever the governor is.)
I hope they at least used a Limo to transport these patients to the movies, maybe diner at Mididi, some nice wine and then a movie. 24 MILLION? No one goes to jail? Jim Hood is a disgrace to this state!!! Can the Feds get involved in this? I think Hood should be investigated for his failure to do his damn job.
Ben and Hatfield, we all know how expensive those soft drinks, candy, and popcorn are at the movies these days.
NoMiss: Quoting our former president, I guess I misunderestimated the price of movies these days. I think the last movie I saw in a theater was probably Chinatown.. Clearly, movies are too expensive for my paygrade.
Medicaid is trying to cover their inefficiences. He states all providers are committing fraud. “ALL” Don’t believe it! Medicaid failed to adjust the rates of this hospital. Medicaid sets rates, not the hospitals.
Is Dr. Robert Robinson, the current Director of the Division of Medicaid qualified to occupy that position?
The statute that creates the Director’s position and establishes the criteria that must be met in order for him to be hired is SEC. 43-13-107 of the Mississippi Code of 1972. It states the following:
“Division of Medicaid created; director and other personnel; Medical Care Advisory Committee…..(2) The Governor shall appoint a full-time director, with the advice and consent of the Senate, who shall be either (a) a physician with administrative experience in a medical care or health program, or (b) a person holding a graduate degree in medical care administration, public health, hospital administration, or the equivalent, or (c) a person holding a bachelor’s degree in business administration or hospital administration, with at least ten (10) years’ experience in management-level administration of Medicaid programs, and who shall serve at the will and pleasure of the Governor.”
The law is quite clear that the intent of the legislature when drafting this law was that the Director should have extensive experience along with a high level of expertise in the field of administering Medicaid programs or health care administration.
Unfortunately, Dr. Robinson does not meet the criteria as established by law. His biography on the DOM’s website states:
“I chose Bob to serve in this position because of his leadership capabilities and many years of service in state government,” Governor Haley Barbour said. “He served as Commissioner of Public Welfare, which is the predecessor of the Medicaid program today and understands the inner workings of state government. After a nation-wide search, he is the best person to fill this important role.”
“Dr. Robinson is a graduate of the University of Southern Mississippi, and received his doctorate of business administration from Mississippi State University. He has served the state as Executive Director of the Mississippi Agricultural and Industrial Board, Executive Director of the Governor’s Office of Job Development and Training, State Personnel Director, and as Executive Director of the Mississippi Department of transportation.”
(http://www.dom.state.ms.us/Executive_Director/executive_director.html)
(Note: A check of the Bluebooks did not mention Dr. Robinson as Commissioner of Public Welfare although he could have served as an appointment. His term must have not been one that covered more than one governor’s term at the most.)
Dr. Robinson fails to meet the minimum qualifications as specified by the statute. He is not a medical doctor. While he has a Doctorate of Business Administration, that is not the equivalent of a graduate degree in a field related to public health, health care administration, etc. as the law says only people with medical, health care administration, or public health related degrees are considered to be eligible. The law does not make an exception for a nominee possessing a Doctorate of Business Administration with no health care-related background. It does allow for a person to have such a degree, even only an undergraduate degree but then it specifies that the candidate must have ten years of experience in administering Medicaid programs, which Dr. Robinson does not possess.
Dr. Robinson was once the Commissioner of the Department of Public Welfare which was the forerunner to DOM until over twenty years ago. It received federal welfare allocations and was in charge of administering them, not just Medicaid-related ones (There is also no question that Medicaid has changed drastically in over twenty years). However, Dr. Robinson did not serve ten years in that position and the law does not make an exception for previous commissioners who only served for a few years. The law created a new set of specific qualifications to be met before a nominee can be approved. The legislature was well aware of DPW’s history and scope when it created the Division of Medicaid but chose not to include a grandfather clause for prior Commissioners that exempted them from the new requirements.
There is no question that Dr. Robinson has a commendable history of public service and is obviously dedicated to improving state government. However, one must ask why Dr. Robinson was confirmed by the Senate, as it is that body’s duty to scrutinize the qualifications of candidates before confirming them. Did none of the Senators take their duty seriously enough to determine if Dr. Robinson was even eligible to be Director? It is tempting to give the Senate the benefit of the doubt as Dr. Robinson was appointed on October 1, 2005 which means that he was confirmed during the aftermath of Hurricane Katrina, when the Senate obviously had much more pressing matters.
One must also ask why the Barbour administration chose to deal with a Medicaid tar-baby that was experiencing deficits of hundreds of millions of dollars by nominating someone who was not qualified. Is the Governor serious when he states that out of all the Medicaid experts or experienced health care administrators/experts in the country none are as qualified as his nominee who has no experience in these fields whatsoever? Haven’t the Republicans for years railed against faceless bureaucrats regulating from the ivory tower fields in which they had no expertise?
Mississippi has had enough trouble and controversy with Medicaid programs over the years without allowing an unqualified Director to administer them. Under the Musgrove administration, Medicaid operated under a huge deficit. Since Dr. Robinson became Director, Medicaid has continued to face turmoil (taxing the hospitals, battling deficits, etc).
The law and intent of the legislature is clear as to who should run Medicaid: someone who is a health care professional and has experience in Medicaid programs along with government health care regulations, not a bureaucrat who has served in a variety of agencies from welfare to transportation to personnel to farming. The position demands a Medicaid expert, not a floating jack-of-all trades bureaucrat. Dealing with infant mortality and health care for children is very different from pouring asphalt, filling potholes, and selling soybeans.
The question that remains is: Will the Director of Medicaid’s resume finally receive some much-needed scrutiny and will there be some accountability?
To Robert Williams,
Nobody said in the article that ALL Medicaid providers committed fraud. This article is about a particular instance.
If you read the affidavit that NMC attached, you will see that DOM has documented, with an independent audit, etc., that improper billings were made by the hospitals that Mr. Shoemaker ran. It isn’t the amount of each claim, or the rate, as you put it, that is in question. You can bill medicaid a million dollars for an office visit, and they won’t overpay you a dime. They pay at the rates set in their computer system.
No, the claim is that the hospitals billed for improper services – not that they charged too much for each one.
John Pittman Hey
you need to check into the Rural Hospitals records and Medicaid Records, that Mr,Ray Shoemaker is apasrt of in Humphey`s County- Patient Choice Hospital-Belzoni,Ms, Claiborne County-Patient Choice Hospital-Port Gibson, Kings Daughter Hospital -Yazoo,Ms.Mr.Ray Shoemaker has a lot of Hospitalizaion Programs across the state of Ms.and Lake Charles,La. Jim Hood needs to investigate all of the Programs and Hospitals that are apart of Ray Shoemaker, because if he Frauded Medicaid one time he will do it again.
We pay too much money into medicaid and it is not right for some guy and his company to get over on tax payers. This guy has been evidently doing this to medcaid for a while and there has not been anything done about it. It seems that his followers should be held accountable as well. I have heard that the same practice in going on with the other hospitals associated with Shoemaker as well. Humphreys county, yazoo, etc. I have a relative that has worked in one of the hospitals that is managed by the Fraudster, and he has informed me on many occasions that the same practice is taking place where the patients are not meeting the criteria to receive funds from medicaid. If Jim Hood wont take care of this situation, then the FEDS should take over and get the job done . Where are the CEO, CFO, Administrators in this situation.
Mr. Shoemaker has proven to be so untouchable as evidence by what he has done from a business and personal standpoint. The system has been compromised and he knowingly did it. I am an Africna American male and this is the only african american that has been able to get away with such a crime with no backlash. Honestly, i hate his guts and would love to see him serve some time in jail and be exclude indefinetly from receiving federal funds. I find myself asking, who’s campaign did he give money to. I really can’t believe that we are letting our tax payers pay in to support movie outings or to get people rich. He has gotten rich from medicaid funds while his employees are going to be left searching for jobs. I have confidence in Jim Hood when it relates to medicaid and know that it is a matter of time before the curtian closes on Mr Shoemaker. If Jim Hood and his office can procecuted members of my family for $750 dollars for (Medicad fraud), then be placed on the exclusion list, then i know that $24 million is a must. Mr. Shoemaker has no choice but to understand that mental health, medicaid, medicare is what made him a wealthy man and on the otherhand, it is also whats going to place him on the same list of excluded person from receiving those funds. Jail time should be waiting and the true man will be revealed.
I don’t think Mr. Shoemaker was able to fraud medicaid by himself. Who are the COO’s, VP’s and Regional Directors. Are they not in charge of the daily operations and billing process? They are obviously helping him to commit fraud. They should be held accountable for their actions as well. Funny that most of his staff come from the Trilakes area, huh? Race or status should not be a factor in this matter. If you break the law, you should be punished accordingly!!! That should apply to all of his enablers as well. I just hate it for the honest individuals working for him that will be out of job if he goes down. Maybe the county board of supervisors should look into his actions and replace him before he ruins their reputation!
It was just a matter of time. Shoemaker’s 10 count indictment released Wednesday. See September 24, 2009 post on the subject.