|An investigation by the Family Court Accountability Coalition has revealed alleged Medi-Cal billing fraud in the California court system. A similar scandal was recently uncovered by CNN and the Center for Investigative Reporting.|
Rehab Racket: the Sequel
California’s County-Level Judicial Branch Medicaid Oligarchy
A Family Court Accountability Coalition Special Investigative Report
Jointly administered by the California Department of Health Care Services (DHCS) and the federal Centers for Medicare and Medicaid Services (CMS), its many services are implemented at local level by California counties. Approximately 12.5 million Californians are enrolled in Medi-Cal as of May 2015, about 32.4% of the state’s population.
Recently, California’s drug rehabilitation program came under fire subsequent to a 2013 joint investigation between CNN and the Center for Investigative Reporting, which uncovered fraudulent Medi-Cal billing schemes by drug rehab centers who were billing for “ghost clients” and teens who did not have addictions.
Around the state, drug Medi-Cal clinics submit bills and regularly receive payment from California counties within weeks. State and county auditors discover taxpayer money has been squandered only if they later review the clinics’ client charts.
After weeks of silence, the DHCS jumped into action, dispatching audit “strike teams” to drug Medi-Cal rehabilitation facilities throughout California, eventually cutting off funding to more than 200 clinic sites. Auditors forwarded their findings to the state Department of Justice, leading to 11 people charged and nine convicted for Medi-Cal fraud.
The California Courts ConnectionHowever, what remains unaddressed in the days after Rehab Racket are the contractual relationships these county program drug clinics maintained with local county agencies in their provision of and billing for court-ordered drug rehabilitation; financial relationships with the county mental health agency networks that possibly explains the lack of oversight revealed.
Family Court and “Children’s Services”: the Connection.
California’s drug courts are specially designed “court calendars” that purportedly provide an alternative to traditional criminal justice prosecution for non-violent drug-related offenses. These Conciliation Courts purportedly combine close judicial oversight and monitoring with probation supervision and substance abuse treatment services.
Along with its connection to county drug rehabilitation agency networks, Family Court Services (FCS) (also known as Conciliation Court) provides a variety of other program services ostensibly designed to help divorcing and separating parents resolve disagreements about the care of their children. The Administrative Office of the Courts (which recently changed its name to “Judicial Council staff” just prior to a scathing state audit), provides linkage between these various county FCS networks.
Not surprisingly, enrollment in FCS program services is usually court-ordered at the genesis of all divorce cases in California, ensuring financial participation in county-based judicial programs on a massive scale. Family Court Services purportedly provides program facilitators or “court experts” toward resolving parental disagreements. These program facilitators enjoy a unique level of control over custody and visitation of divorcing parents in California.
Examples of such services, which are often contracted out to a network of local private, non-profit clinics in the area, are supervised visitation, behavior modification classes, and sham “domestic violence” investigations provided legitimacy without any discussion of the qualifications of the contractors involved; contractors who often share real estate with drug clinics like those exposed in Rehab Racket.
FCS personnel enjoy nearly unfettered discretion in “recommending” divorcing parents repeatedly purchase county mental health agency network services in exchange for court recognition of parental rights; creating, for all intents and purposes, an industry of legalized child trafficking at county level.
In the seminal case of Boddie v. Connecticut (1971) 401 U.S. 371, this forced patronage of court services has been recognized by the U.S. Supreme Court as involuntary on the part of divorcing litigants, and the forced nature of California’s family court system was further lamented by the Elkins Family Law Task Force as a socioeconomic bar for many parents to custody and visitation of their children.
[R]esort to the state courts is the only avenue [private citizens have] to dissolution of their marriages…Resort to the judicial process by these plaintiffs is no more voluntary in a realistic sense than that of the defendant called upon to defend his interests in court. For both groups, this process is not only the paramount dispute-settlement technique, but, in fact, the only available one. (Id. at 376–77)In a recent article by Capital Research Center, “Making Divorce Pay”, the author identifies an important control level over judicial branch “children’s services” by a veritable army of program facilitators, largely trained and licensed through the Association of Family and Conciliation Courts (AFCC); a collaborative network which took root in California in the spring of 1963, now a massive association of more than 5,000 members in dozens of disciplines throughout 25 countries.
Often styled the “divorce industry” by those acquainted with its reach, this network holds dominion over parent-child relationships in California and abroad, through an ever-increasing proliferation of individual county mental health agencies and their network of clinics. As the author, Michael Volpe notes,
AFCC didn’t create the term “high conflict” divorces, but the group has done a lot to turn it into a household word. “The challenges posed by high-conflict families were front-and-center issues for most courts, and AFCC members led the way in developing new processes and techniques for working with these challenging family members,” according to AFCC’s website.
“For the last 30 years, mediation and, to a lesser extent custody evaluations have dominated the family dispute resolution landscape,” an AFCC white paper from 2004 stated. “Only recently have a very few court service agencies begun to explore a triage process to select from a menu of services.”Currently, the reality of just how insidiously complex this corruption has become is reflected in the public’s resignation and common holding that divorcing parents can expect their parent-child relationships to be assessed, classified, and restructured around court-ordered therapies, visitation and ongoing control by county clinics who, like those exposed in Rehab Racket, enjoy less than no legitimate oversight.
Via authority granted pursuant to Government Code § 77212(d), in concert with orders from their own benches, family court judges regularly provide a steady flow of involuntary customers to county-contracted drug rehabilitation clinics, supervised visitation clinics, behavior modification clinics, as well as a host of other county businesses networked through local Health and Human Services Agency; directly converting the community property and wages of desperate parents into millions in profit for county and state judicial coffers.
While the bulk of these funds are largely netted from various grant awards from the U.S. Department of Justice in league with a plethora of congressional agencies such as the Office of Violence Against Women, as was demonstrated by Rehab Racket, a considerable amount of these monies are collected into county coffers by billing Medi-Cal for court-ordered services on divorcing parents. Quite often, these same parents are simultaneously required to pay for these same services out of pocket.
In striking similarity to the fraudulent drug rehabilitation services unearthed in Rehab Racket, many family law litigants and children complain these services are, in reality, never actually provided, and are usually for conditions they do not have. Often from unlicensed corporate staff.
Counties Financial Interest in Controlling Medi-Cal Administration
Each California county offers Medi-Cal mental health services termed Therapeutic Behavioral Services (TBS). Usually these services are administered by the same county mental health agencies proliferating California’s FCS network.
The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program is Medicaid’s comprehensive and preventive child health program for individuals under the age of 21. According to DHCS, the School-Based Medi-Cal Administrative Activities (SMAA) program “reimburses school districts for the federal share (50%) of certain costs for administering the Medi-Cal program.”
The Medicaid statute also requires that states provide any medically necessary health care services listed in Section 1905(a) of the Social Security Act to an recipient even if the services are not available under that state’s Medicaid plan to the rest of the Medicaid population.
Similarly, private, non-profit corporation networks in each county, in contractual agreement with those counties to provide court-mandated services for divorcing litigants and children, often share a similar financial arrangement where counties match federal funding that local contracted clinics rake in.
The Administrative Office of the Courts has provided for each superior court to act as a depositor for the AOC pursuant to Government Code § 68085.9, and much of the public funds that California courts collect, after being locally deposited and harvested for interest dividends, eventually find their way into each county’s Children’s Trust Fund.
In an atmosphere of such saturated cronyism, it is entirely probable that family law cases are being manipulated by county mental health agency networks and corrupt judges toward harvesting as much federal funds from these cases as the county can collectively draw.
In looking for evidence of such manipulation, it is noteworthy to again reference the CRC article, “Making Divorce Pay”, where it already exemplifies a family law case in California that is replete with factual indicators showing manipulation by county facilitators for Medi-Cal billing interests likely has occurred.
Take Charles Paclik’s divorce, which started in Illinois in 2006. After his ex-wife moved to California, the jurisdiction for the divorce moved with her. [...] After that testimony, the court ruled Paclik and his ex-wife should have shared parenting. He lost primary contact with his children again after his wife’s moved to an adjacent county in 2013 [which] triggered another custody fight. Paclik’s custody continues to be litigated nine years after it began.
Since the article’s publication, the Paclik case has taken a turn more closely resembling the Medi-Cal fraud unearthed in Rehab Racket; again suggesting that investigation did not go far enough in probing the larger issue of fraudulent enrichment off of Medi-Cal billing at county level.
In late 2013, impoverished by nine years of unending divorce litigation, Mr. Paclik relocated from Alameda County, California to Fresno County, California for economic reasons. Contemporaneously, he enrolled his children in the local school district he had moved to.
However, despite SMAA guidelines, which would have then shifted to Fresno County, Contra Costa County refused to relinquish control over his children’s Medi-Cal benefits regardless.
In November of 2013, coinciding with his relocation to Fresno County, Mr. Paclik requested inter-county transfer (ICT) of his Medi-Cal benefits from Alameda County to Fresno County, including transfer of his children’s Medi-Cal benefits from Contra Costa County to Fresno County as well. However, instead of transferring his children’s Medi-Cal benefits as requested, his “inter-county transfer” request was inexplicably put on hold – for over a year.
After numerous phone calls to Medi-Cal regarding the delay, Mr. Paclik subsequently learned that the clinicians, imposed into his parent-child relationship at the county level by Contra Costa Superior Court and its FCS, were billing his children’s Medi-Cal for provision of their court-ordered services – services that his children have reported to law enforcement that they do not receive.
In February of 2014, three months after his request for ICT, Mr. Paclik found himself inexplicably summoned back to family court where his custodial time was summarily decreased by one day; tipping the scales of primary custody to the Contra Costa County-based mother.
Finally, in January of 2015, a staggering fourteen (14) months after his request, Mr. Paclik received notice of action from Alameda County Medi-Cal agency stating his November 2013 request for ICT was denied – at his own request!
This Notice applies to: (names of his children). Your eligibility to receive Medi-Cal will be discontinued the last day of 01/2015. The reason for this discontinuance is: You requested that your Medi-Cal benefits be stopped.
Having requested transfer (not discontinuance) of his Medi-Cal benefits, and weary from over a year of skullduggery, Mr. Paclik exercised his right to call for a state hearing – and was shocked again when the State Hearings Division, shortly afterward, informed him he had withdrawn that request as well.
Where Mr. Paclik has been able to secure minimal discovery in that case, records of communication between Contra Costa and Alameda Counties Medi-Cal agencies during the delay are telling; revealing, at least in part, why Alameda County Medi-Cal agency falsely personated Mr. Paclik in its January, 2015 notice of action to him – the gravamen of that very hearing.
Against this unexplained year-long delay lies the specific modification of Mr. Paclik’s custody and visitation – as well as territorial relocation of his children’s school enrollment – during that time; these important Medi-Cal diacriticals inexplicably “tweaked” in his family court case – and his request for ICT subsequently denied along with his own Medi-Cal coverage, which, in actuality, were never transferred to Fresno County either.
In light of the fact that court FCS program facilitators often occupy the same county network as those tasked with administrating federal Medicaid services, a back-channel email from Contra Costa County Medi-Cal agency to Fresno and Alameda Counties, obtained via subpoena, revealed that Mr. Paclik’s family court case was a direct and causal issue for Medi-Cal officials refusing transfer.
Via the same “gas-lighting” as is frequently used throughout the divorce industry, Contra Costa County Medi-Cal agency’s Civil Rights Coordinator was gung ho in portraying Mr. Paclik as an abusive husband and absent father:
"He is not an applicant or recipient of aid in Contra Costa County. He is the absent parent in our case and we cannot share any confidential information about his ex-wife with him. It appears that the relationship was and is very volatile between the two parents.... he's the absent parent so he has no legal standing in our Medi-Cal case."Seemingly very familiar with Mr. Paclik’s family court case, Contra Costa County steadfastly balked at transferring his children’s Medi-Cal benefits, maintaining “school-based” or SMAA Medi-Cal guidelines forbade the transfer on the grounds they had unsupportedly asserted.
Whether it was a coincidence that his request for ICT was delayed just long enough for county facilitators to downward modify his custody and visitation – or no coincidence at all, the records obtained showed a clear and immediate relationship between his family law case and his Medicaid coverage under Obamacare. A relationship entirely under the discretion of county program facilitators who, pursuant to state and federal requirements, are tasked with policing themselves for fraud.
The Paclik case alone indicates that county forces in charge of administrating federal Medicaid can and will manipulate family law cases toward maintaining control over “school-based” Medi-Cal funding directly attended from custody and visitation orders.
Against Alameda County’s admission it has no explanation for the fourteen-month delay in processing his request for ICT beyond a vague reference to a “system breakdown”, the facts of Mr. Paclik’s inexplicably altered family law and Medi-Cal records together surface a far darker reality than that revealed in Rehab Racket; bringing into focus the increasing number of litigants in California decrying entrenched judicial corruption at county level, the edges and depth of which reach well beyond county limits.
While Rehab Racket lifted the rock over California’s Medi-Cal drug rehabilitation clinic network, shedding light on scurrilous Medi-Cal fraud and gross lack of county and state oversight, that investigation may have only lifted one manhole over a much larger network of subterranean Medicaid fraud.
County Mental Health Act Networks’ Administration of Federal Medicaid.
In most California counties, mental health or behavioral services are integrated with a strategic plan which is updated every three years – making county Medi-Cal TBS services part of the same network of county-contracted clinics assessing and reporting on family law litigants court-ordered to purchase their services.
In 2014, the number of Americans with health insurance grew by 9.25 million. However, a staggering 8.99 million of those folks had in fact enrolled in Medicaid, according to a report published by the Heritage Foundation. The majority of these new Medicaid enrollees are living well below the poverty line, according to a March study published by the strategic advisory firm Avalere Health.
Across America, the rising cost of Medicaid has been lamented as unsustainable without a concurrent rise in federal taxes. The Congressional Budget Office has repeatedly made clear that the main drivers of America’s debt is its unsustainable promises in Social Security benefit programs and unsustainable spending on federal health care programs – Medicare, Medicaid, health insurance subsidies under the Affordable Care Act, and others.
Medicaid expansion under the Affordable Care Act in 29 states, including California, has driven record enrollment and spending for the program in fiscal year 2015, according to a report by the Kaiser Family Foundation.
In expansion states, enrollment increased on average by 18% and total spending jumped by 17.7% – almost triple the rate in non-expansion states, where enrollment and total spending rose by 5.1% and 6.1% respectively.
In an all-new study by UC Davis researchers, it was discovered that cancer patients with Medi-Cal are generally less likely to be alive five years after diagnosis, compared with patients with other kinds of insurance. Where this is a direct byproduct of the forces between the implementation of Obamacare where it forces doctors to treat more of the poor and uninsured,
On June 28, 2012, the U.S. Supreme Court issued its landmark decision in the case of National Federation of Independent Business et al. v. Sebelius, Secretary of Health and Human Services, et al, 567 U.S. ___ (2012), 132 S.Ct 2566, challenging the constitutionality of the Affordable Care Act (ACA). Two main provisions of the 2010 health reform law were at issue.
However, a different majority of the Court held this issue was fully remedied by limiting the Health and Human Services (HHS) Secretary’s enforcement authority, thus leaving the Medicaid expansion (and all other ACA provisions) intact in the law.
States that choose to participate in Medicaid have substantial discretion in determining whether to cover optional groups and benefits, how care is delivered, and how and what providers are paid. However, participating states must follow certain federal rules as a condition of receiving federal matching funds.
Where states such as California simply pass along federal Medicaid compliance requirements to all counties, coinciding with the rise in Medi-Cal costs is the proliferation of county mental health act networks that, in the end, contract with local private, non-profit clinics in a network centered under county Mental Health Act strategy plans, provided linkage by county Health and Human Services Agencies, and geared toward Medi-Cal billing for such things as drug rehabilitation therapy and a host of other court-ordered services through divorce.
While Rehab Racket exposed an unpoliced fraudulent billing environment happening in Medi-Cal drug rehabilitation centers throughout California, that investigation arguably touched upon and even broader county network scheme siphoning Medicaid funding at an ever-increasing rate, through an ever-increasing “menu” of county-based “services”.
A problem now further expanded by passage of the Affordable Care Act, County-based federal Medicaid administration is increasingly revealed as the common link between two subjects heretofore having no shared bed; the proliferation of family court corruption, and sharply rising costs of sustaining federal Medicaid.
Where California’s family courts are increasingly outed for corruption (See, “Witch Hunt by Sean Penn; see also “Divorce Corp”; see also, Full Disclosure Network’s soon to be released “Corrupted Justice”), what begins to take shape is a possibility that, far worse than hundreds of California drug rehabilitation clinics bilking Medicaid, is the probability that counties in California and throughout America, ultimately tasked with administrating Medicaid expansion, are further using their administration for enrichment; indicating to forces interested in cutting Medicaid costs that a good place to begin would be an investigation into the “Pelletierian” divorce industry as the likely culprit.