Linda Lorincz Shelton, Ph.D., M.D.
June 6, 2008
AUSA Kozlowski and
U.S. Attorney Patrick Fitzgerald
United States Attorney’s Office
Dirksen Federal Building
219 South Dearborn Street, Fifth Floor
Chicago IL 60604
Dear US Attorney Patrick Fitzgerald:
I am writing to inform you of extensive Medicaid/Medicare fraud, criminal violations of the ADA, fabrication of evidence by a member of the IL MFCU [Medicaid Fraud Control Unit], illegal conduct of the IL AG [Attorney General] in acts of retaliation against witnesses and possible money laundering, as well as kickbacks, even involving a chief judge of the Circuit Court of Cook County. I have, over more than five years, with the help of numerous other whistle blowers, uncovered much of this information and wish to share it with you at this time. I will help find the other whistle blowers and witnesses, if you request my assistance. Some are in hiding, as they have been viciously attacked or retaliated against by corrupt officials. They however, would need assurances concerning their safety.
1. I have recently been given Power of Attorney to have custody of and store records from a psychiatry/psychology group practice where I was one of a number of medical directors for a couple of years. The sole proprietor of this business is dying of liver failure and to ensure other's access to these records he gave me POA [power of attorney].
2. I have reviewed a lot of the records and I have found that two women who were previous employees, Itadel Shalabi and Nareman Taha, sent in fraudulent patient encounter forms to the outside billing agent for hundreds of bills. I knew nothing about this as that year I had only agreed with the business owner verbally to start this group practice and review charts, make medical policy, and see patients - after I recovered from extensive neurosurgical spinal surgery to correct a progressive paralysis, etc.
3. I also have discovered that the outside billing agent naively thought that since she had a contract with the owner to send in bills electronically to IL Medicaid through the 3rd party adjudicator, BC/BS that she thought she could sign my name as a physician on ANYTHING. She therefore forged my name on a POA form, a BC/BS electronic partner trading agreement, and on an alternate payee agreement so that invoices through BC/BS to IL Medicaid could be sent in under my name and the checks would come to the business instead of under my name. This occurred in summer 2000. I did not sign a POA form to allow the company to bill under my name until summer 2001!
4. At the time I thought that IL Medicaid allowed qualified psychiatric counselors and psychologist to bill under their own names. I was not involved in billing during this time when the contract biller handled the bills. I have found out that although most states allow this and IL licenses non-physicians (social workers, MS degreed psychologists, specially trained nurses, drug addiction counselors), that IL Medicaid did not allow non-physicians to be Medicaid providers of medical or psychiatric/psychological services. Instead invoices must be sent in for services under a physician’s name. Also, IL has a (hidden patronage) system where statutes allow groups to be licensed as community mental health centers and bill under the center name, for services of non-physicians. This is in a separate statute, not in the IL Medicaid Code and not described in the Medicaid Physician Handbook. I and the sole proprietor were only aware of fee-for-service billing (in my pediatric office, I billed under my name for all services such as blood draws and immunizations). Most physicians, most psychiatrists, and most psychologists do not have a clue about these billing issues. As >80% of psychiatric/psychological care is provided by non-physicians it is fraudulent for IL Medicaid to hide information about CMHCs [community mental health centers] from physicians, etc. Most physicians are only aware of fee-for-service billing and the fact that they can bill for services of their employees.
5. I have since discovered that most of these CMHCs were licensed through “connections” (patronage). I have also discovered that nearly ALL contracts in IL and Cook County require the groups to pay a 10% kickback to political funds such as “Friends of Madigan.” When are you going to obtain bank records for these “political funds” [funds to launder money from kickbacks], cross reference them with the owners and employees of firms contracting with the State, County and City of Chicago, compare the “donations” with the amount paid to these companies and persons under government contracts and then arrest IL AG Lisa Madigan and her partners in crime such as Chief Cook County Circuit Court Judge Evans, and other judges who have manipulated cases against whistle blowers such as me and Dr. Hamilton? Then you MIGHT start to breakdown corruption in IL. I believe this will never be done however, until there is a “truth commission” like in S. Africa, that ended apartheid and the strife between the blacks and the white Afrikaners. There are SOOO many people in bloated IL, C[r]ook County, and Chicago government that depend on patronage for their jobs that they keep their mouths shut about corruption. I know many of them, including a large family, many of whom are employed by the IL Secr of State, where corruption, same as under George Ryan, continues! You still can’t get promoted unless you “campaign” in certain ways. If you gave immunity to those that confess, bring transparency to the system, then corruption will stop. You can arrest all you want, but until the corrupt are enticed en masse to confess their crimes of patronage fraud and kickbacks, nothing will change, and others will simply replace the corrupt with more corruption and incompetence which endangers and harms the citizens of this State!
6. I have also discovered that IL statutes, federal Medicaid Code, and IL adm rules allow physicians to bill fee for service under their name for services by qualified counselors and psychologists. IL recently passed a law that social workers can bill for provision of psychological services. I have also discovered that IL Medicaid until 1998 did allow psychologists to register as providers and only one person did, Dr. Maisha Hamilton.
7. However, I have researched case law over the past four years and discovered that a fed court in IL, erroneously ruled that physicians cannot bill for psychological services provided by their employees. The 7th Circuit even sustained this false ruling through negligence in that its decision just mentioned it in passing and did not really look at the IL Adm Code.
8. The ruling was blatantly FALSE! I intend to challenge it as an intervenor because it is technically null and void, because it is based on misquoting of the code and ignoring Federal EPSTD guidelines. It is a tragedy that Dr. Mitrione was indicted and convicted in federal court. The AUSA and the Court ignored the illegal conduct of the IL Medicaid and IL AG in denying mental health services to people on Medicaid. From what I read, Dr. Mitrione was the ONLY doctor providing mental health services to persons on Medicaid in Springfield. He is apparently very talented. His conviction was a grotesque wrong! The USA and the IL AG are and have gone after the wrong people. Hamilton, Mitrione, XXXX, XXXXXX and I (in 4 separate cases 1 by USA and 3 by IL AG as prosecutor) are some of the most talented and dedicated provider of health and mental health services to the Medicaid population. We didn’t make big profits! Even Federal Judge Lefkow ruled that “Illinois Medicaid policies and procedures are in violation of the Federal Medicaid Code in denying access to care”. Please review Memisovski v. Maram. We were not storefront mills! It is a gross disservice to the community to have shut us down. Crime increases (look at Virg Tech, NIU, the number of murders in Chicago, the amount of drug crimes in Chicago) when mental health is ignored. To destroy mental health services in IL because of patronage, kickbacks, etc. with the cabal of corruption and to defame, destroy and put out of business some of the most dedicated and talented providers in IL, by the criminal and impeachable, as well as retaliatory actions of the IL AG, who has NO LEGAL AUTHORITY to prosecute criminal Medicaid Fraud without the invitation, consent, and participation, at least to a minimal degree of the county State’s Attorney, is beyond the twilight zone. The IL AG is violating the law, committing fraud upon the court, and acting unethically in these three prosecutions. Isn’t this felony obstruction of justice? Aren’t these void prosecutions?
9. If you read the IL Adm Code, it is flawed because there is no “definitions” section. A section defines physician services to include services of non-physicians under supervision. A few sections later it uses the term “physician services” without redefining that they include services of non-physicians. Later the code continues to use the general term “physician services” and clearly includes non-physician services. Yet, the court ruled that “statutory construction” rules must conclude that physician services do NOT include non-physician services for ONLY psychological/psychiatric services including psychological testing! You can’t say “physician services” excludes non-physician services in one section without saying so and before and after this section define physician services as INCLUDING non-physicians! How can IL be allowed under the ADA to discriminate against those ill persons ONLY with mental illness and deny a mandate of the Federal Medicaid Code to provide services equivalent to services provided to the community by other private insurers?
10. This is ludicrous as I don’t believe quality services can be provided without psychological testing, without a team approach, without psychologists, and ONLY by CMHCs! More than 80% of psychological and psychiatric services are provided by non-physicians. We need more than 30,000 child psychiatrists in this country and only have <5,000. If services of non-physicians are denied Medicaid patients then they would essentially be denied access to care – this would clearly violate Federal Medicaid code – especially under EPSTD guidelines and under the ruling in Memivoski v. Maram by Judge Lefkow, in around 2004. I am an EPSTD (early periodic screening, treatment, and diagnostic services) provider. As you know, federal code requires that states pay for these services (even psychological services) even if their rules forbid payment for it.
11. I have evidence, a trial transcript from another case in IL where this biller testified that the IL Medicaid Service provider unit told her to change the names on the bills to doctor's names even though the patient encounter forms stated that psychiatric/psychologic therapist provided the services. That trial was a wrongful conviction of Dr. Maisha Hamilton, the first female black psychologist in IL, who was running an INPATIENT alcohol and drug treatment program. I have discovered she was a registered provider, but IL Medicaid gave the IL AG altered registration forms. I personally saw her form where she was licensed and had a provider number and the adulterated form given to AG had the number whited out! Isn’t this felony obstruction of justice?
12. The IL AG state police inv., Reibel, fabricated false invoices for the case of Dr. Hamilton by cutting out handwriting exemplars made by Dr. Hamilton and putting them on invoices that he sent to the crime lab. The chain of custody documents prove that Reibel had a continuous custody of these documents, so this proves only he could have fabricated them! The crime lab would not analyze them because Reibel would not provide originals, just faxes – guess why! I personally saw these documents several years ago and a high school student would say my conclusion is obvious. Isn’t this felony obstruction of justice, perjury, official misconduct, and retaliation against a federal witness? Dr. Hamilton has proof of kickbacks, bribery, fraud, and corruption by judges of the Circuit Court of Cook County, and other Chicago and Cook County officials. Why have you not interviewed her and indicted these people?
13. Hamilton’s billing agent was the same as ours. XXXXX, the biller, forged signatures on necessary forms to bill for Hamilton, the same way she did with us. She charged fraudulently by percentage, just like she did with us. She failed to register the group as a CMHC or Alcohol and Drug Addiction treatment center, despite Hamilton’s group being licensed as such. Hamilton thought when the checks came in under the group name that the bills had been sent in as a center and not fee-for-service. The biller sent the bills in under a medical director’s name, fee-for-service. Why haven’t you gone after XXXXX and her company XXXXXXXXXX for fraud in billing providers by percentage? How many other contracts does she have like this? How many other providers has she committed fraud against in claiming she knows what she is doing? Why did the Cook Co SA along with the IL AG not indict her long ago for fraud, and prevent her from misleading so many people?
14. The biller, XXXXXXXX, held herself out to be an expert at setting up groups to bill electronically and in providing billing services. This was fraud, as she failed to tell us about the CMHC statutes and help us register as such. She failed to sign Dr. Hamilton’s group up an ADATC [alcohol, drug addiction, and treatment center] and instead signed her up as a fee-for-service provider, forged names for POA, etc., and changed the service provider, without her knowledge from the actual providers, to the medical director. I can blame her for fraudulently holding herself out to be an expert at setting up groups for billing purposes. She apparently didn’t know about CMHCs or ADATCs at that time too. I cannot really blame her for changing the names on the bills to doctors because the Medicaid Service Provider Unit told her to do so, according to her testimony in Hamilton’s trial. Isn’t this the affirmative defense of following the orders of a government agent? However, if she had sent in bills for Hamilton and for us under the counselor’s names, then they would have been rejected and we would have known that something was wrong. Then we could have learned about CMHCs and registered as such. Then Hamilton would have corrected the registration as a center provider instead of as a physician provider. Then there would be no phony excuse to indict anyone. This is grotesque government incompetence.
14. This is a wrongful conviction and was done because Dr. Hamilton is a whistle blower and target of the corrupt cabal in Illinois. She was appointed Asst Dir of the Chicago Board of Health under the Washington Adm 20 years ago. A Daley operative came in on her first day and told her she was a “figure head” and he was running things. She kicked him out of her office and this began 20 years of attacks against her. She asked Chief Cook County Court Judge Evans for a contract to provide mental health services at the jail and he said yes, but only if she paid a 10% kickback to the fund “friends of Madigan” so she refused the contract! She was wrongfully convicted in 2003 of billing fee-for-service under the medical director’s name for services not provided. This is false. The services were provided appropriately as a center. She is VERY talented and at the time was also chief mediator for the postal service. The community has lost one of its best providers of services because of this bogus conviction, and Reibel remains free!
15. The biller apparently forged my name on multiple documents and sent in fraudulent bills with my name on them generated from patient encounter forms listing the counselor (Shalabi and Taha) as provider. She received these forms by mail after they were faxed to XXXXX, the business owner and a master degreed psychologist, as well as one of the most talented at psychological testing and providing services to the poor, and mailed to her. She apparently did this during the time I was in surgery and recuperating.
16. The owner of the business, XXXXXX, had added these women onto his business as owners in a partnership agreement, because they were supposed to run the business and interview and counsel patients out of a branch office in SANAD, an Arab American Community Organization. I believe XXXXXX DID NOT know that the invoices were fraudulent. He supervised the main office in Harvey IL and only mailed the invoices to the biller after they were faxed to him from SANAD. I do believe he was negligent and ignorant in not checking what the biller was doing more clearly and in not supervising the services at SANAD. I also believe this was a case of the blind leading the blind with Shalabi and Taha taking advantage of this.
17. After about a year, the business moved billing in house. These two women were pushed out of the company because the sole proprietor found their records too meager and their verbal statements offensive. He had witnesses to their bad behavior, including the Dir of SANAD and the Sheik at the Bridgeview mosque.
18. I am unable to clearly determine, yet - although I'm trying to figure out whose handwriting is involved, but after billing came in house, despite legitimate psychiatric and psychological services, I have found numerous instances of ghost billing for children of patients.
19. I have discovered that the wife of the sole proprietor was throwing away about $40,000+ dollars per year on gambling at boats and the sole proprietor did not know this as she handled their income tax - I think, or they were somehow keeping this stuff separate. He became furious a year ago or so when he found out and was going to divorce her, but didn't because of his liver disease and need for health insurance. I have discovered that this wife was heavily involved in the in house billing.
20. There is much more to talk about - I am very upset. My attorneys have interviewed several witnesses and the results are disturbing. My Medicaid number was used for much of this fraudulent billing, although I never saw the money. More than $900,000 was billed, more than $300,000 was received by the business, and I was paid about $1800.
21. We are trying to obtain the business bank records to find out where the money went. I believe much of it went for salaries for employees (all quite small), but I had no idea so much was billed under my name. Each doctor was supposed to have a panel of no more than 200 patients (a policy stated by me to XXXXXX) to supervise counseling and see the patients periodically and screen for medical disorders, treat with medication as necessary, and approve and determine treatment plans from the team (psychologist, physician, therapist, psychiatric consultants).
22. I told the owner I had no trouble treating patients for psychiatric conditions as a board certified pediatrician IF they were properly diagnosed and a treatment plan made in conjunction with a psychologist and psychiatrist (for complex patients). I made it very clear that I believed a psychologist with proper psychological testing (if necessary) and myself were qualified to determine diagnosis and treatment plans (of non-complex patients) and a board certified psychiatrist must consult on ALL complex patients or any patient I was uncomfortable in making initial diagnosis. Pediatricians are certified to treat most basic psychiatric/psychological conditions and routinely treat such disorders as ADHD. When I started reviewing charts (a few in Oct 2000 and then many in Feb 2001) I told XXXXXX that the quality of the notes was poor and he needed to find better qualified counselors. He had begun to replace some with more qualified persons. I personally discussed cases with several of the Arabic counselors and found them to be quite talented, but poor in the written English abilities, so I trained them to write proper notes. A psychiatrist in the group also developed forms to use for notes that assisted them in writing proper notes.
23. I was under the impression everyone was legally qualified with at least a bachelors degree in social work, nursing, psychology, but find this was not the case. I was not involved in hiring of counselors and I had thought that XXXXXX, who had worked for Dr. Hamilton and the PhD psychologist XXXXX, were running this business owned by XXXXXX appropriately. I now, after studying the law and case law for over four years, understand that XXXXX and XXXXX were clueless. I am trying to obtain the employment records to clarify training received by counselors and reasons for hiring them and what they were supposed to be doing. I am trying to discuss this with XXXXX, but he is very ill, has gone from denial to anger psychologically due to his impending death, and it is very hard to investigate this myself. He has yet to produce the employee records, bank records, and patient sign in books/scheduling books.
24. You will see that I and XXXXX were indicted illegally by the IL AG without the consent, participation, or approval of the Cook County State's Attorney, for Medicaid fraud in 2004. The incompetent and corrupt IL AG has illegally withheld all of the electronic invoices for the first time period from my defense attorney. The billing agent stated she does not retain them after three years. We have still not been tried on the charges. I am very upset because I am innocent and the AG is prosecuting me (as I have discovered by reading law – statutes, codes, handbooks, case law, etc) without jurisdiction. The AG in IL has fraudulently received certification to have a Medicaid Fraud Control Unit because she informed DHHS that the IL AG can investigate and prosecute without the invitation, consent, participation, or agreement of the County State’s Atty. This is FALSE. Therefore, ALL Medicaid fraud prosecution in IL by the IL AG has been and is fraudulent without jurisdiction of the sham prosecutor or the courts.
25. I have asked for the IL AG application for a MFCU from both DHHS and the IL State Police and have not received it, so I can prove the IL AG committed fraud upon the DHHS. Both agencies, in violation of law have not provided this to me.
26. I should think the FBI and US Atty would want to prosecute Medicaid fraud. Instead, you are letting the IL AG muck up the prosecutions, which all will eventually have to be overturned as void. I would like you to carefully look at this situation and prosecute those that are truly committing Medicaid fraud, as well as prosecute corrupt state officials who have developed this scheme to deny mental health care to those on Medicaid by writing Codes and Statutes that are so confusing and then implementing them with wrongful interpretation of them ONLY through patronage.
27. I have found the handwritten invoices and computer generated invoices from in house billing and I am reviewing them slowly, and comparing them to the patient charts.
28. Bills were also sent in under other medical director's names until 2004, but none of them were indicted! It appears the IL AG is only prosecuting those who are whistle blowers against corruption in IL or who fight wrongful accusations of child abuse (in their pt population) or challenge the IL government in other ways. This includes Hamilton, myself, XXXXX, and XXXX who ran a group and she was also indicted. She had vigorously spoken out against corruption at the child protection agency – DCFS. Isn’t this felony retaliation against a Federal Witness (or potential witness)?
29. I told my attorney, I was going to get to the bottom of this, but it is too convoluted for me to do this without assistance and I don't have the resources to pay my attorneys to do it. They are doing the best they can.
30. I have discovered that the contract the business owner signed with the billing agent is for an 8.5% percentage of billings. I believe that billing the business by % is fraudulent under Medicaid and Medicare. XXXXXX apparently has been and still is billing many many providers this way for years. Isn’t this is a federal crime called Medicaid/Medicare fraud?
31. I have given the US Atty and your agents evidence of many federal crimes, including patronage hiring, etc., by Orlando Jones, who they indicted, but he shot himself in the head - I had opened the Cook County Provident Hospital pediatric dept with a contract group and witnessed corruption by Jones, the Godson of the President of the Cook County Board [John Stroger Sr.]. I have also witnessed corruption in the child protection department - false allegations of child abuse, etc. I have also witnessed abuse and fraud in the Illinois Department of Professional Regulation. Finally I have been retaliated against in CCDOC and IDOC for my vigorous and outspoken attacks on corruption in these agencies. Please note that I am physically challenged and this torture included gross violations of the ADA.
32. I have sent your federal agencies a lot of information. AUSA Laser has indicated to my attorney that what I sent about CCDOC civil rights violations and corruption is helpful. Former State legislator XXXXX also has reams of evidence of corruption in IL. Why don’t you interview him too? Why won’t you more vigorously use what I sent you, use Hamilton as a witness, and protect Hamilton, XXXX, myself, and XXXXX against this corruption? I am stunned, astonished, heartbroken, and despondent. The abuse and torture I have endured is as great as in any third world country. Gross systemic violations of the ADA, medical abuse, torture, and routine retaliation against witnesses to corruption occurs at CCDOC and IDOC. It is a disgrace – especially as I am innocent. My life’s work that means so much to me of helping the poor and providing quality medical services has been destroyed. I am destitute and dismayed.
33. I am requesting a long meeting with the AUSA in Chicago, in charge of Medicaid fraud, and with USA Patrick Fitzgerald to discuss all of the above and show him evidence. I have nothing to hide. AG Lisa Madigan, Reibel, and many corrupt officials in Illinois and Cook County have a lot to hide. I also strongly believe it would be appropriate for the USA to take over all Medicaid and Medicare fraud prosecutions in Illinois and move them into the Federal Court, as well as investigate the applications to DHHS of the IL MFCU for fraud upon DHHS.
Thank you for your attention to these matters. I await justice.
Sincerely,
Linda Lorincz Shelton, Ph.D.,M.D.
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