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    Sunday, October 5, 2008

    Criminal Schemeof Illinois Attorney General Denied Mental Health Care to Needy in Illinois

    DISLOSURE (regional news in southern Illinois) Vol. 5 Issue 1 March 2007


    GUEST COLUMNIST Dr. Linda Shelton

    (The guest columnist this month comes to us from a reader of Rumor Mill News in upstate Illinois, who has been looking into how our state squanders resources and creates abuse for its mentally ill.)

    The State of Illinois denies mental health care to the neediest of its citizens in an illegal scheme to save the budget and claim officials are tough on fraud. Mental health care is very expensive because psychotherapy is time consuming. Weekly sessions for months to years with or without medications are required to treat major mental health disorders such as drug and alcohol addiction, bipolar disorder, borderline personality disorder, depression and mania. This is costly. However, the State is penny wise and pound foolish. The cost is clearly much more expensive to incarcerate the mentally ill, in court costs for increased crime, for welfare for destroyed and dysfunctional families and for medical care when the mentally ill neglect themselves and their families.


    The Attorney General (AG) Lisa Madigan claims it is a class 1 felony criminal fraud for physicians to bill Medicaid for psychiatric services done by employees of a physician. She claims that only community mental health centers can bill for psychiatric services provided by non-physicians. This is fraud upon the court. AG Lisa Madigan is using these fraud prosecutions to claim she is "tough on fraud." She is mistaken to the point of corruption.

    Any courts that continue with such fraudulent prosecutions based on fraudulent charges are aiding and abetting this impeachable conduct of the Illinois AG. One person, Dr. Maisha Hamilton (Hamilton Wholistic Healthcare) has already been fraudulently convicted on this fraudulent charge and numerous others are in the middle of defending themselves against these corrupt and ignorant actions of AG Lisa Madigan, including Dr. Linda Shelton and Vernon Glass (Right Frame of Mind & Associates and then Right Frame of Mind, P.C) and Naomi Jennings (Youth Empire Services). Cook County Circuit Court judges such as Kathleen Pantle and Lon Schultz have ruled that "federal law does not apply," or other nonsense, violating their oaths of office, denying due process and committing impeachable acts. I'm sure it is news to the public that Cook County does not have to follow federal law.


    The end result is that legitimate providers of mental health services to the poor and primarily minority populations have been placed under siege, their businesses forced into closure for bankruptcy and some of the most outstanding and dedicated providers of mental health services to poor and minority populations have lost their ability to practice and provide services while they defend their licenses and their freedom from this felony conspiracy to violate their civil rights under color of law and the felony conspiracy by AG Lisa Madigan, her staff, and others at Illinois Medicaid to violate the rights of Medicaid mental health patients under color of law. They are doing this to fraudulently claim they are fighting fraud and saving tax dollars. They are actually doing the opposite -destroying families, increasing crime, increasing suicide and pulling the wool over the eyes of the citizens of Illinois.


    All of these defendants allege that AG Madigan and others involved in this horrendous scheme should be impeached or fired. We all call upon the United States Attorney and investigative reporters to expose this scheme and prosecute those corrupt officials who are behind it. This is AG Madigan's and Gov. Blagojevic's "watergate." They must be stopped.


    The scheme is hidden, complicated and clever. The State has three sets of law including.

    1) The Illinois Medicaid Act which permits physician providers to bill Medicaid fee-for-service for medical and mental health services provided by the physician and his employees. This may include drug and alcohol addiction counseling,psychological testing to aid in diagnosis, parenting classes and drug treatment with anti-depression and anti-psychotic or other drugs with monthly follow up by a physician.

    2) The Illinois Community Services Act and Mental Health and Developmental Disabilities Administrative Act permits community health centers to be certified by the State and contract with Illinois agencies like the Department of Corrections,the Department of Child and Family Services or the Illinois Department of Human Services to provide mental health services. The contracts give extra payment for training of staff and missed appointments. The bills are sent to Medicaid under the name of the Health Center and not the physician, such as Hamilton Wholistic Healthcare, Right Frame of Mind, P.C or Youth Empire Services. Statutorily qualified and licensed therapists and counselors like psychologists, drug-addiction counselors and psychiatric social workers can participate in providing care. Trainees under supervision can also provide care. A physician is required as a medical director to help set policy, supervise and train employees.

    3) The Illinois Alcoholism and Other Drug Abuse Dependency Act sets up centers for alcohol and drug abuse treatment much like the community mental health centers.


    The Federal Medicaid Code contained in the Social Security Code specifically authorizes physicians to bill Medicaid for services of their employees "as if the services were performed by the physician." Federal Code requires state Medicaid programs to comply with the Federal Medicaid Code. There is no code or statute or rule that REQUIRES physicians to provide mental health services only at a community mental health center and NOT fee-for-service.


    In silence and secrecy Illinois Medicaid wrote a Physician Handbook that purportedly gives physicians guidelines as to how to comply with the Illinois Medicaid Act and its accompanying Administrative Code. However in 1998 Illinois Medicaid wrote in its handbook a policy - A210.4 which states as follows:

    "Psychiatric therapies must be provided by the physician who submits charges. Services provided by a psychologist, social worker, etc., are not reimbursable."
    This is in DIRECT violation of the Federal Medicaid Code and its accompanying Code of Federal Regulations, as well as the Illinois Medicaid Act and its accompanying Administrative Code, which state:

    1) 42 U S C 1396(a)30(A) "A State plan for medical assistance must - Provide such methods and procedures...and the payment for, care and least to the extent that such care and services are available to the general population in the geographic area." Blue/Cross Blue/Shield and other private insurers pay non-physicians such as psychologists and drug-addiction counselors as well as physicians for the services of such employees.

    2) 42 CFR 414.34 "Payment for services and supplies incident to a physician's service...Services of non physicians that are incident to a physician's service....are paid as if the physician had personally furnished the service."

    Therefore, when a physician's employee provides a psychiatric service the physician may send a bill to Medicaid under the physician's name and Medicaid provider number and leave off his employee's name.

    3) 89 IAC 140.400 "A practitioner may bill only for services he or she personally provides or which are provided under his or her direct supervision in his or her office by his or her staff.”

    There are numerous other sections of these codes, statutes, and regulations which clearly permit a physician to bill for services of his or her employees.


    Illinois Medicaid refers any provider who bills for psychiatric therapies under a physician's name when the therapies are performed by non-physician employees to the Attorney General for prosecution under the Medicaid Fraud section of the Illinois Medicaid Act. They however, state that billing for non-psychiatric therapies performed by non-physician employees of physicians is OK.

    The Illinois Medicaid Inspector General claims that A210.4 authorizes this allegation. However, A210.4 IS NOT LAW. It was NEVER approved by Congress or the Illinois Legislature and was NEVER approved as an Illinois Administrative Code by the Illinois Legislative Joint Committee on Administrative Rules known as JCAR. JCAR is the legislative body consisting of a committee of Senators and Representatives that reviews and approves executive branch administrative rules. When approved they have the power of law. JCAR is supposed to make sure they comply with statutes. The Illinois Medicaid Physician Handbook policy A210.4 has NEVER been submitted to JCAR or approved by JCAR.

    Congress and the Illinois legislature as well as the public should examine this issue closely and confront it. Civil rights activists should consider that civil rights concerning health care and mental health care is presently discriminatory and rife with political corruption. This is the new battleground for civil rights in this new century.

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