Sunday, March 20, 2011

Fraud DoctoRx

Part I: Money Laundering
I have worked for many Medicaid providers in New York State over the years. I am seeing major Medicaid fraud, to the tune of hundreds of billions of dollars a year. Medicaid providers in New York State, such as Health First, HIP, Affinity, and Neighborhood Health Providers are actually money pipelines. The billions of state and federal funds that flow into these companies flows quietly back out to foreign shores.
I work directly for top level senior management. They can’t read so they hire me to do the reading for them. This gives me access to the books. I believe this money is going ultimately to Russia to fund some type of ‘White Supremacist’ agenda and in fact I believe it is being used to fund genocide.
I have been observing certain trends while working for these companies. The increase in membership is perfectly linear over time, as if the membership data was being generated from a spreadsheet formula. This is true of CHP, FHP, Medicaid, and a new group called Special Needs or SNP. If I do a cycle plot and look at the increase on a monthly basis over the course of eight years (2002-2010) the increase in member number is perfectly linear. This is also true of specialist visits (fee for service visits) for these members. This is true of number of visits and most importantly amount paid. The increase is perfectly linear on a per monthly basis over eight years for all these categories and so the average does not change over time. When creating financial reports averages are used and it all gets lost in the average. The tiny company I currently work for, Health Plus, Brooklyn NYC, which is a Medicaid provider takes in over nine hundred million dollars a year. At last look (July 2012)  it was US $950,000,000.00. Over 90% goes to fee for service specialist visits for members. This money is allocated by the State of New York!
I spoke to a Mr. Mahoney who is in charge of Medicaid Fraud division and I also spoke to a Mr. Yahuda (Yehuda?) who are in charge of the Medicaid Fraud division of New York State. (Medicaid Fraud Unit, 120 Broadway, New York, 10271). It is very clear to me how this kind of fraud could be occurring by so many Medicaid providers. I believe Mr. Yahuda, who is in charge of all medical and pharmaceutical transactions, as well as membership, is well aware of the issue. He was extremely nasty to me as I tried to point out inconsistencies in the state data. I believe he is in charge of managing the system that generates all membership, medical claims and pharmacy claims.
The problem is not with the companies that manage Medicaid services; the problem is with the state and those in charge of the Medicaid funding. There seems to be absolutely no functioning system of accountability in the Medicaid system – why is this? Why is there such a total lack of transparency? I have access to the actual books and so I see these things first hand.
Medicaid is a money pipeline to Russia to fund a Stalinist, fascist, White Supremacist genocidal agenda and Mr. Yahuda and Mr. Mahoney seem to be at the top of the New York State Medicaid Power Pyramid and Mr. Yahuda is in charge of the system that stores and processes all of the Medicaid, CHP, FHP and SNP transactions.

Part II : Drug Running
Furthermore, I have been looking for the sources of this funding and have discovered the following: I and others have seen multiple pharma sales on a single day to a single Medicaid ID.
I have enclosed a couple of examples of this. One is for fentanyl which seems to be a hottie and the other is for methamphetamine (Ritalin) which seems to be another favorite. Although I have only enclosed a couple of examples this seems to be a state wide phenomenon and there are millions of instances of these in their database.
Also, senior officials of NYSDOH are well aware of this.
I did some research and found that a claim status of ‘1’ is a purchase at the point of sale. A claim status of  ‘5’ is a manually inserted line called a manual edit. You can write whatever you want onto this line.
What we discovered was the following: For every claim status of 1 with a sale of $100.00 NYSDOH is manually inserting a line and adding -$100.00.  
This zeroes out all the Rx sales and so does not go on the books.
(They are also doing this for quantity sold and for days supply, although not consistently)
Because this is a state wide problem this adds up to a substantial amount of money.
I am also seeing this for private companies which contract out pharmaceutical services to Medicaid such as MedImpact, NMHC, Express scripts and Caremark.
I suppose NYSDOH officials are attempting to hide this drug money in some way, which would explain the laundering of money by the Medicaid MCO’s.
In effect, high ranking officials at NYSDOH are running drugs.(I believe this is a nationwide problem.)
I believe that these drugs are crossing international borders and going into South America. There is nothing illegal about Ritalin, which is a just a prescription medication, and it is already ‘paid for’ (at least on the books), so this drug running goes under the radar.

MARx: What does MARx stand for?
Medicare Advantage Prescription Drug System(CMS Washington,D.C.)
Do the MATH!

Please look below the comments: Methamphetamine Claims for Medicaid Children by Month 2006 - 2010. Each graph represents a month Jan - Dec. Each layer represents a year. For example the bottommost layer is claims for 2006, the next layer 2007 etc.
>> Please note that this blog is currently under construction and is not yet finished!!! More graphs and explanations to come. This data is from the State of New York Dept. of Health, NYSDOH Medicaid.

There is also trememdous fraud in Medicare. Washington D.C. contracts out to private companies to manage Medicare accounts. I know first hand that U.S. government pays $350.00 a month for a $32.00 a month Medicare Rx account.  I have access to the CMS database in Washington and I see what the government is paying private companies to manage its business. This is your money and it is being stolen. (this blog last updated 28Sept2014)


  1. For the record,
    I have gone to
    1. FBI
    2. DEA
    3. New York State Inspector General James Sheehan
    4. Director of Medicaid Fraud Paul Mahoney

    If they ignore my complaint then it will go away - or so they believe.
    If you ignore this problem then it will go away - or will it.
    In fact it will only get worse.
    I have the original transaction data for each member which went into making these graphs.
    This data is real.

  2. You need to consult an attorney who does "qui tam" litigation. I did a quick google on qui tam attorneys in New York, and there are dozens, here is just one name, not an endorsement, just the first one that came up.

    A winner in a qui tam case gets a share of the money recovered by the government. Doing well by doing good.

    God bless the few of us that still have consciences.

  3. Jon:
    Can't use a qui tam attorney because this is a criminal case involving 'High Ranking State Officials'. Please show me an attorney that will touch this - none