Are you sitting down? A State and Federal Government SNAFU...

There are so many extant prefaces that will do, but I choose this one:

"Truth is stranger than fiction."

Yesterday, while playing with the up-and-down controls on my hospital bed, and listening to the "Summer Night" setting on my Homedics Sound Spa with 6 Sounds, Fred brought in the day's bundle of mail.  I almost missed the real challenge to my mental well-being , as we are receiving an inordinate amount of what amounts to Hate Correspondence thanks to my inExecutive Decision to cancel this year's ManorFest due to Personal Insanity.

You know, we paid through our considerable noses to have an unplottable address, so how are all these Haters getting the address to Marlinspike Hall, anyway?  Harrumph.

Unplottability refers to the deliberate concealment of several areas around the world. Unplottable locations are either magically hidden from plain sight or simply removed on maps. Common reasons for unplottability are for individual safety and the protection of certain secrets, particularly within the schools of wizardry.

Anyway -- too tired for more original segues -- about one-third of my way through the interminable gripes, most of the "we-all-have-problems-and-yours-are-nothing-special" sort -- my swollen and painful hand landed on a thick envelope of poor quality, making me cry out:  "Oh shit!  Something from the government!"

And so it was.  Apparently that brief trip to the United States of America, within which is located the land of Atlanta, itself subsumed by the backwardness of the state of Georgia -- a trip via miniature [pink] submarine and Captain Haddock's own wormhole, which originates in Marlinspike Hall's moat -- apparently, that brief trip to see the Board Certified Neurologist Doctor Raymon J Wilensky [RJW] left Fred, myself, the submarine, and all the physical holdings of the Haddock family PLOTTABLE!  How else to explain a thick envelope of poor quality from a division of the State of Georgia, made out to my Americanized moniker?

Eight pages long it was.  

It's title?  An initially agonizing, sharp-intake-of-breath inducing: NOTICE OF DECISION.

I make thousands of important decisions a day.  Still, I rarely issue an eight-page notice detailing them. That'd just be embarrassing. Besides, I have a blog for that!

Okay, to sum it up, it was from something called the "RSM Project Office."  
I went "Oooohhh!"
Then I went "Oooohhh, what the hell is the 'RSM Project Office' and do I have to freaking climb up to the Computer Turret to find out?"  

In case you've forgotten, this is the path from our cushy apartment in one of the Directional Wings off the main digs of the historic Marlinspike Hall, ancestral Manor home of the Haddock family to the modern convenience of wifi, as detailed in an early blog post:

The only way in or out, up or down, the pesky turret is via a thick rope ladder, dyed caution yellow, that extends down (but mostly sideways) out to the Manor Stables -- a remarkable outbuilding that is an alarming replica, as we pointed out in our last post, of the Knoppenburg Manor Stables. The proper term today is "agricultural building." You won't catch me calling it a barn if there are any prying ears about. Of course, the last outsider who dropped by was The Technician Overlord of Our Telecommunications Bundle, which he so wisely decided was best centered in the Hobby Room at the top of the Turret Tower. We had concocted a cover story about the rope bridge ("It's more a bridge than a ladder," Fred just said), which consists of the baldfaced lie that we are a new off season venue for those Cirque du Soleil performers who are fresh out of rehab. So the hefty diameter of that hemp monster, see, is easily explained away as necessary gear for these poor, troubled acrobats.

I'm usually not subject to such heights of embarrassment (heights, and, lately, riches) but I just don't want anyone to think that I have to zig zag my way from one Manor Wing to another, make it to the Grand Ballroom, out the entrance, patterned after Brunelleschi's bronze baptistery doors, over the drawbridge (Provided it is down! Men!), across the moat, down the lane, over the hedge, into the damned agricultural outbuilding, up the custom wheelchair ramp into the hayloft, and then, lickety-split, go hand-over-fist on the rope bridge for a good half mile... all just to get my email.

Yes, Dearest Readers, I did ["have to freaking climb up to the Computer Turret..."].  Because the (800) number listed for said RSM Project Office is One Of Those Maniacal Menu-Operated Weapons Of Governmental War Attrition Tactics. Also, as Our Beloved Milanese Nightingale, the Bianca Castafiore, recently discovered, we only have functional cell phones whilst leaning at a 70 degree angle out one of the turret's bow-and-arrow openings, necessitating that Sven Feingold stop his important topiary shaping to come up and hang on to our telephoning ankles for the love of God, and also for His Sake.

See? Either way, these "RSM Project Office"  arseholes from Atlanta, Georgia, necessitated the arduous journey to the Computer Turret.  Yesterday being Monday, that meant that my huffing and puffing and slip-sliding through the intervening barn, now renovated as the Carny Rehab Facility, meaning that, yes, red-faced, sweaty moi would be interrupting a post-weekend Group Therapy Session of pissed-off carnies. And why are they pissed off?  It would have been a great weekend for them, full of gainful employment and illicit drug transactions, had ManorFest 2014 gone off as scheduled.  And who cancelled ManorFest 2014 due to "personal insanity"?  That's right, moi again!

Anyway -- I made it to the Computer Turret, though more than disheveled, Sven batting off the intrepid acrobats with a police-grade head crusher and the occasional zap of a Taser.  He held my ankles as I plunged out the window and dialed the useless Georgia government phone number... then returned, using the stairs, this time, to his appointed duties.  We need to petition the Captain for a raise, or supplemental gratuities, or something, on behalf of Sven.  Just the fact that he's keeping The Castafiore occupied ought to be worth considerable "executive bonus" points to Archibald Haddock, y' know?

Okay, so I was stuck with email to shoot through the moat algae and out the other end of the wormhole to Atlanta, Georgia Land.

I wrote the email produced below, though for purposes of transparency and The Fair Reporting Act As It Applies To Blogs About Fictive [shut UP!] Lives, the last paragraph was added after 5 emails were returned as "undeliverable," except 1 reply from "customer service."

Please read this email in its entirety, paying attention to the details,
wherein lie many of the pertinent details. 

My name is, for your purposes, L. Ryan and today I received the "RSM Project Office"'s
denial of my "request for benefits." 

It's a fascinating document, for primarily two reasons. 

*One: I did not request Medicaid benefits. That must have been a glitch inthe ACA Marketplace application I completed in October 2013, as I would
never deign to bother the Great State of Georgia and its forward-looking
policies toward health care. I don't have that kind of time to waste. 

*Two: At the end of the document, I was intrigued to discover that Ireceive SSI benefits in the amount of $331.57. Why "intrigued"? Because I
don't receive SSI benefits.

If you'd please squelch the errant SSI payments I supposedly receive, I'dbe forever grateful. 

If, however, I somehow deserve that money... oh
please, send me a check that covers the last 14 years of our lives,
non-taxable, and that doesn't deprive me of the rest of my [private disability] "benefits." 

If someone has, by chance, been collecting SSI in my name? Well, it'sprobably your job to deflect that bit of larceny back to the federal
government. I've done my part as an [expatriate] citizen and submitted a fraud report,
just moments ago.  Having no "company" name to supply, I used the
"RSM Project Office" name and address as the fraudulent party.

I sat up here knitting apple and banana cozies, answering the occasional frantic email from family members, most perturbed, though, by the missing emails, and the cold-as-ice family sentiment poseurs -- figuring that SIX emails to the Department of Human Services should jolt some bureaucrat into a reply.  Yes, I mentioned in one of the [...] deleted segments that I am the Queen of Gullibility.  I am, I swear.  The thing is, once you screw with me, I don't forget you, ever, and, unfortunately, the organization for which you work is also tainted with your evilness, even if you have cozies on your rusty toaster and your 1970's avocado Salad Shooter.

Apple and Banana Cozy by BeadlesandPins at Etsy.com

[Oh, damn.  Fred just dropped a bottle of chardonnay. What a technological breakthrough, live blogging! Now, had I knit a chardonnay cozy, might that bottle remain intact?  We'll never know.]

Oatmeal Cable Knit Wine Cozy, $12, etsy.com

[Kind of disturbing, huh, this "cozy" craze?]

Well, anyway... This is the text of my email to the federal government Social Security Fraud Tip Thingy:

I was notified by letter yesterday from the "RSM Project Office" of the State of Georgia DFCS department of their decision regarding two things, an application for Medicaid coverage and my monthly SSI income. 

The small problems I have with this notification are mostly covered by these facts:
1.  I never applied for Medicaid -- unless the ACA Marketplace submitted the request in my name, something I explicitly asked not be done.
2.  I DO NOT RECEIVE THE $331.57 PER MONTH IN SSI THAT THE "RSM PROJECT OFFICE" CLAIMS THAT I DO. 

Either someone out there is receiving that amount in my name or the "RSM Project Office" just sits around making up stuff to foil anything to do with President Obama's landmark legislation.   

I consider either possibility equally probable. 

This is not a joke, despite my attitude.  I have no idea how long "I" have been receiving this imaginary money, but should I, indeed, prove eligible for its receipt, please forward it to my sad bank account, with interest.  In lieu of that, please find and arrest the person/entity who is enjoying that government benefit in my name. 

[...]

Do I really believe that a division of Georgia's government has stolen SSI funds from the good and decent Federal government?  No.  But I do believe they are ignorant enough and blinded by political animus to overlook an obvious bit of fraud.  I've asked them to report it... I doubt that they will. 

Sincerely,  

Moi 

Ah, those of you out there who just love State and Federal SNAFUs are waiting, breath-bated, for the one response that DID come!  Well, here you go, and look, Fred just found another bottle of chardonnay, duct-taped under the kitchen table by Bianca "Wile E. Coyote" Castafiore.  Just in time.

On Wed, Jul 23, 2014 at 2:35 PM, <customer_services_dfcs@dhr.state.ga.us> wrote:

Good afternoon,

Your request has been forwarded to the DFCS Fair Hearing Unit for review and response.

Have a great day.

© 2013 L. Ryan

Scott Reuben "MD": His Unmitigated Gall

Twenty-six thousand patients die each year in the US from NSAID induced complications. Paul White, an A & A Editor, has estimated that billions of dollars of Cox-2’s were sold based on Dr. Reuben’s papers and he adds,  “For now, at least, neither the drug companies nor Reuben’s co-authors are officially sharing in the blame, but that’s expected to change."

“There’s a lot of responsibility to pass around,” White says. “It’s all being focused on Scott Reuben, but the reality is there are many other responsible parties." We will never know how many patients received NSAIDs during a very stressful and high risk time and how many may have been injured or died from Cox-2 related complications.

-- "Welcome to the Fraudosphere," PainPoints

The Affordable Care Act contains some interesting, little known provisions, among them a strengthening of the preexisting federal False Claims Act.  As one article put it, "experts warn that doctors need to be ready." Guffaw!


It was this expansion of liability that resulted in GlaxoSmithKline's $750 million in penalties for having sold "mixed-up products, diabetes drugs with too much or too little of the clinically effective ingredient," and for manufacturing drugs in "a nonsterile area of the facility that was used to make injectable drugs and [using] a water system contaminated with microorganisms."

In 2009, the Health Care Fraud Prevention and Enforcement Action Team (HEAT) in the first six months of operation recouped almost $3 billion in penalty payments.  The ACA provides $350 million over the course of a decade for the work of the HEAT Task Force.  That's a pretty decent return.

All of that reading and talk of fraud made me wonder what the inimitable Scott Reuben, MD might be up to these days, now that he's out of prison and all.

By the evidence, he is no closer to renouncing the self-serving tendencies that got him to the Big House of Correction to begin with.  He continues to offer the transparent excuse that he was out-of-control due to undiagnosed bipolar disease.  Undiagnosed (and unremarked upon) for well over a decade!  Even his wife, a psychiatrist, failed to pick up on it during all those years that he spent assiduously committing one of the worst known cases of medical and academic fraud.

I guess we should file the following document under "Unmitigated Gall," next to my previous ten posts about Scott Reuben, the Medical Madoff.


Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Civil Remedies Division


Scott S. Reuben, M.D.,
(O.I. File No.: 1-09-40105-9),
Petitioner,

v.

The Inspector General.
Docket No. C-11-664
Decision No. CR2481
Date:  January 6, 2012

DECISION


Petitioner, Scott S. Reuben, M.D., asks review of the Inspector General’s (I.G.’s)
determination to exclude him for five years from participation in the Medicare, Medicaid,
and all federal health care programs under section 1128(a)(3) of the Social Security Act
(Act).  For the reasons discussed below, I find that the I.G. is authorized to exclude
Petitioner and that the statute mandates a minimum five-year exclusion.

Discussion 
The sole issue before me is whether the I.G. has a basis for excluding Petitioner from
program participation.  Because an exclusion under section 1128(a)(3) of the Act must be
for a minimum period of five years, the reasonableness of the length of the exclusion is
not an issue.  Act § 1128(c)(3)(B); 42 C.F.R. § 1001.2007(a)(2).

The parties have submitted their written arguments (I.G. Br.; P. Br.), and the I.G. filed a
reply.  With his brief, the I.G. submitted four exhibits (I.G. Exs. 1-4).  In the absence of
any objections, I admit into evidence I.G. Exs. 1-4.


I directed the parties to indicate in their briefs whether an in-person hearing would be
necessary and, if so, to describe the testimony it wishes to present, the names of the
witnesses it would call, and a summary of each witnesses’ proposed testimony.  I
specifically directed the parties to explain why the testimony would be relevant.  Order
and Schedule for Filing Briefs and Documentary Evidence, Attachment 1 (Informal Brief
of Petitioner ¶ III) and Attachment 2 (Informal Brief of I.G. ¶ III) (Sept. 9, 2011).  The
I.G. indicates that an in-person hearing is not necessary.  Although Petitioner does not
directly respond to the question, he does not contend that an in-person hearing is
necessary and lists no potential witnesses.  I therefore conclude that an in-person hearing
is not required.

Petitioner must be excluded for five years because he was 
convicted of felony fraud in connection with the delivery of 
a healthcare item or service. 1

I make this one finding of fact/conclusion of law


Petitioner was a Massachusetts anesthesiologist who contracted with the drug
manufacturer, Pfizer, Inc., to conduct clinical studies on patients to determine the efficacy
of a certain drug in treating post-operative pain.  Pfizer paid for the studies.  Petitioner
subsequently claimed to have conducted the studies, administering the tested drug to 100
post-surgical patients and a placebo to another 100 post-surgical patients.  He published
papers in a scientific journal claiming to have achieved success with the tested drug.  In
fact, he had not enrolled any patients in any study, and he fabricated the “results.”  I.G.
Ex. 3 at 12-16.

On June 24, 2010, Petitioner pled guilty in federal district court for the District of
Massachusetts to one count of felony health care fraud, 18 U.S.C. § 1347.  Under that
provision, a person commits health care fraud if, “in connection with the delivery of or
payment for health care benefits, items, or services,” he “knowingly and willfully
executes, or attempts to execute” a scheme 1) to defraud a health benefit program or 2) to
obtain, “by means of false or fraudulent pretenses, representations, or promises,” money
or property owned by a health benefit program.

The court accepted Petitioner’s plea and entered judgment against him. I.G. Exs. 2, 4.
In a letter dated June 30, 2011, the I.G. advised Petitioner that, because he had been
convicted of a felony offense related to fraud, theft, embezzlement, breach of fiduciary
responsibility or other financial misconduct in connection with the delivery of a
healthcare item or service, the I.G. was excluding him from participation in Medicare,
Medicaid, and all federal health care programs for a period of five years.  I.G. Ex. 1.


Section 1128(a)(3) provides that an individual or entity convicted of felony fraud, theft,
embezzlement, breach of fiduciary responsibility, or other financial misconduct in
connection with the delivery of a health care item or service must be excluded from
participation in federal health care programs for a minimum of five years.  See 42 C.F.R.
1001.101(c).  Because Petitioner was convicted of felony health care fraud, he is subject
to exclusion.

Petitioner does not deny that he was convicted of felony fraud in connection with the
delivery of a health care item or service.  Instead, he attributes his misconduct to mental
illness, points out that his practice as a clinician is unblemished, argues that he has paid
his debt to society, and maintains that he is ready to resume his medical career.  These are
simply not bases for overturning a mandatory exclusion.

Conclusion
For these reasons, I conclude that the I.G. properly excluded Petitioner from participation
in Medicare, Medicaid and all federal health care programs, and I sustain the five-year
exclusion.


Carolyn Cozad Hughes
/s/
Administrative Law Judge



Photo credit:  Details