State Medicaid Official Placed On Leave Following Negligence Accusation

Michigan’s chief medical director for Medicaid was placed on administrative leave May 9 after accusations of negligence and deficiencies in patient care.

Dr. David Neff, who had been recognized for helping combat the state’s opioid crisis, is accused of failing to meet minimal standards and violating his general duty as a health care provider, according to an administrative complaint filed by the Michigan Department of Licensing and Regulatory Affairs (LARA) that MIRS received via a Freedom of Information Act request May 31.

LARA spokesperson David Harns said the department is not commenting outside the administrative complaint.

Lynn Suftin, spokesperson with the Michigan Department of Health and Human Services, confirmed Neff’s leave from his $191,184 a year position began May 9. She also said the department is not offering further comments.

Efforts to reach Neff were not successful. A response to LARA’s complaint was filed May 31, but that report wasn’t immediately available for release.

The May 1 complaint filed with the Michigan Board of Osteopathic Medicine and Surgery alleges Neff overprescribed controlled substances to some patients in his part-time medical practice.

Specifically, the complaint alleges Neff didn’t request MAPS reports prior to prescribing controlled substances medication to patients between June 1 and September or October, and that there were three incidents when Neff requested a MAPS report on a patient after she died.

The report also alleges Neff failed to consistently use urine drug screens as a medication monitoring tool and that he allegedly prescribed opioid medication “in doses carrying high daily” MMEs that “posed significant risks.”

A 2018 press release from Michigan Academy of Family Physicians announced Neff was the recipient of the 2018 Friend of Family Medicine Award for his work “with large-scale planning programs to address opioid addiction and other population health-related issues, such as cardiovascular disease and diabetes, since 2000.”

According to his LinkedIn profile, Neff was appointed in March 2017 as the chief medical director of DHHS’ Office of Medical Affairs for state Medicaid programs. He served as a consultant to DHHS for nearly three years prior to his appointment.

Audit: Little Errors In Medicaid Records Could Result In $228M Overpayments

Small mistakes in medical record keeping for Medicaid patients through the Comprehensive Health Care Program could also lead to huge overpayments when the error rate is extrapolated through the entire $7.2 billion per-year program.

The Office of the Auditor General found recently that a 14 percent rate, in which medical records could not be provided or did not support the claim, could result in future overpayments of up to $228.1 million annually. Seven claims for which documents could not be found totaled $111.

“On an individual basis these costs can be small,” Lori Leaming, of the Auditor General’s office, told the House Oversight Committee at the end of May. “So when we extrapolate an error percentage comparing the dollar amount of our errors to the dollar of our sample . . . into a population of billions of dollars, we easily get to millions of dollars.”

Committee Chair Matt Hall (R-Emmett Twp.) was skeptical.

“I just don’t know, based on your response, that you are very confident that this is a substantial problem. My guess is the department, based on what I’m reading here, is going to say this really isn’t as significant of a problem as you think it is. They agree with the finding, they just say, ‘Look, this isn’t really going to cost us hundreds of millions of dollars.’”

Indeed, that was the response of the Michigan Department of Health and Human Services during the preparation of the audit. DHHS said it has contracted with one of the leading actuaries in the health care industry.

“They have a robust data integrity process, which requires extensive data quality and validation processes to ensure accuracy of data for rate setting purposes,” according to the department’s response.

But Leaming said DHHS did not provide the documentation to support that claim.

“I just find it odd that when the Auditor General, an independent officer of the State of Michigan, a constitutional officer, contacts a department and asks for this information and then the department doesn’t give it. That just seems bizarre to me,” Hall said. “Is that pretty typical when you interact with departments, they just say, ‘Oh, we cover this, but you don’t need the information and we’re not going to provide it’?”

Hall promised to get to the “get to the bottom of this” by inviting DHHS officials to the next Oversight meeting.

“Paying millions of dollars, perhaps hundreds of millions of dollars, more than we’re supposed to is a very serious matter,” Hall said. “. . . If the department is paying tens or hundreds of millions of dollars more of taxpayer dollars than it should be because they are not holding these Medicaid Health Plans (MHPs) accountable and actually verifying this information, it is a very serious matter.”

CHCP began as a program to control costs and improve care in the Medicaid program. DHHS contracts with MHPs. DHHS makes “capitated rate payments” — per person, per month fees for covered events, paid regardless of the number of services provided — to the MHP.

The MHP then pays health care providers for the actual services they render. Providers must send back “encounter claims” to the MHP to verify the service. And the encounter claims are used by DHHS’s actuaries to calculate the capitated rates for the future.

“Just to put this in a little bit of perspective for you,” said Mary Jo Koschay, also with the Auditor General’s office, “for fiscal year 2017, the $7.2 billion that they spent through this program was about 43% of what the state spent on the total Medicaid expenditures of $16.8 billion, which was about 30% of the state’s total general fund budget, or expenditures of about $56 billion.”

Rep. David LaGrand (D-Grand Rapids) suggested it might be a problem of people not paying close attention when dealing with small claims. If he buys something for a dollar, LaGrand said he is not careful with the receipt. If he buys a car, he makes sure to keep the receipt.

“You have given us a blow up, or explosion, on how many dollars of missing receipts we could be talking about, so we are talking about as many as $200 million worth of missing receipts, but if $190 million of that is services that were provided that people did bad paperwork on, then we are not talking about endemic fraud, we are talking about imperfect record keeping,” LaGrand said.

The audit, released earlier this month, had three findings, two considered “material,” or more serious.

– Medical records were not provided or did not support the encounter claims in 14 percent of cases.

– The Community Health Automated Medicaid Processing System (CHAMPS) did not identify or reject improper or duplicate encounter claims. Auditors estimated the future capitated rate overpayment could be up to $87.8 million.

DHHS responded that the actuary’s data integrity program would protect against overpayments from this problem as well.

– Finally, the audit found DHHS did not ensure that the MHPs were sufficiently using a Benefits Monitoring Program to prevent overuse or misuse of medical services. This finding is considered “reportable,” or less serious.

Leaming explained this program is intended to, for example, identify Medicaid recipients who go to the emergency room a frequent amount over a three-month period. The MHP could then work to get that person assigned to a regular health care provider and pharmacy.

In the audit, DHHS agreed with all three of those findings and agreed to work to improve its processes.

Fetal Heartbeat Bills Introduced In Senate

Legislation (SB 0357 and SB 0358) to outlaw performing an abortion when the heartbeat of the fetus can be detected was introduced in the Senate June 5 by Sen. Ed McBroom (R-Vulcan). Introduction of the legislation lines up with the strategy of the Michigan Heartbeat Coalition, an anti-abortion group planning a petition drive to collect enough signatures for an initiated law.

Legislation (HB 4664 and HB 4665) that is the same as McBroom’s had already been introduced in the House May 23 by Rep. Steven Johnson (R- Wayland Twp.) and Rep. Michele Hoitenga (R-Manton). Enactment of the bills would make performing an abortion after detecting a fetal heartbeat a four-year felony. All legal penalties outlined in the legislation would be against the person performing an abortion, not the patient.

“It’s necessary in the sense that ending all abortions is desirable,” McBroom told reporters. “It’s a human life and ending human life is not generally approved by society, except through the process of abortion and I believe that’s wrong. So, this is another attempt to validate the value of every human life.”

McBroom, who two weeks ago told MIRS that he would be introducing the legislation, said the bills include an exception for when a mother’s life is in danger.

June 5, MIRS asked if the legislation was likely to be passed by the Legislature and vetoed by Gov. Gretchen Whitmer in conjunction with the MHC petition drive.

“I never anticipate the veto of good policy,” the Vulcan Republican answered.

A reporter asked what argument McBroom would make if he had a chance to convince the governor not to veto the legislation.

“This is a human life,” McBroom said. “How can we, as a society, continue to condone ending human life? That’s wrong to me.”

MIRS asked if the Senate Republicans had caucused on the bills yet.

“I brought up that I was bringing forward the bill,” McBroom said. “We had some discussion and I got some co-sponsors.”

A reporter asked if McBroom had already been planning to introduce the legislation when he made impassioned anti-abortion statements on the Senate floor earlier this session.

“The speech came before I had really tied myself to this bill,” McBroom said. “Interestingly, the idea of tying abortion to heartbeat detection is something I’d thought of for a long time – dating back to when I was in high school and college. So, it wasn’t a new idea to me, but then seeing a lot of other states pursuing it, or doing it. . . It seemed like the time was right.”

MIRS asked approximately at what point in a pregnancy a fetal heartbeat generally becomes detectable.

“At six to eight weeks,” McBroom said.

Meanwhile, Sen. Mallory McMorrow (D-Royal Oak) called the legislation manipulative, disrespectful and a waste of time that would be better spent addressing more pressing issues.

“It’s really frustrating,” McMorrow told MIRS. “When you read the legislation you find that they intentionally use flagrant language to be emotionally manipulative. It’s so disrespectful of people—and so is wasting time on these bills just to score political points.”

“I understand where there are differing opinions,” McMorrow added. “But if they’re going to waste time on this, you’d think they could also find ways of addressing the need for more access to contraceptives or addressing infant mortality—something for which we rank 12th in the nation—and that is underfunded. And in addition, many people in Michigan still don’t have clean drinking water.”

SB 0357 and SB 0358 have been assigned to the Senate Health Policy and Human Services Committee.

Bills Banning Kids From Buying E-Cigs Signed With ‘Significant Reservations’

Teenagers 17 and under can no longer possess e-cigarettes and vendors face a $100 fine the first time they sell these “vaping” products to the under-aged after Gov. Gretchen Whitmer signed legislation “with significant reservations.”

Healthcare advocates urged Whitmer to veto a straight ban on under-aged e-cigarettes use and pressure lawmakers to define this nicotine delivery system as a tobacco product and regulate them like cigarettes. With vaping increasing 78 percent among high-school students from 2017 to 2018, the governor felt the ban would curtail use and signed it.

Whitmer wrote that SB 0106 and SB 0155 peel off “vapor products” and “alternative nicotine products” from the state’s tobacco laws regarding taxation, public smoking and advertising.

To address this, she is asking the Department of Health and Human Services to dig into federal recommendations on how states should handle e-cigarettes. She then wants the Department of Treasury to use those recommendations “for deeming e-cigarettes to be a tobacco product” and if they “should also apply to Michigan law on the licensing and taxation of tobacco products.”

“E-cigarettes were initially marketed as a tool to help smokers avoid the harmful effects of inhaling tobacco smoke,” Whitmer wrote. “Today, that pitch looks like a bait-and-switch: the marketing, packaging and taste of e-cigarettes are perfectly designed to create new nicotine addicts, who then convert to lifelong smokers at alarming rates.”

She pointed to flavors akin to Fruit Loops, Fanta and Nilla wafers for evidence. Research shows children who used e-cigarettes were more than four times more likely to try smoking tobacco cigarettes, and nearly three times more likely to become regular smokers within two years.

The chief bill sponsor, Sen. Rick Outman (R-Six Lakes), was stymied in 2014 when then-Gov. Rick Snyder vetoed a similar bill because he wanted one that treated e-cigarettes as a tobacco product. Outman pressed forward with the bill again because, frankly, e-cigarettes are not a tobacco product and should not be regulated as one, he said.

“I’m glad we finally got it done and we’re no longer the only state in the country to not have penalties for selling these products to kids,” Outman said. “I just wanted to get these e-cigarettes out of their hands. She can do anything she wants with it after that.”

The American Heart Association issued a release expressing disappointment at Whitmer’s decision to sign the bill, but pledged to work with her and the Legislature on how to ensure “these dangerous products stay out of the hands of our kids by providing financial disincentives to purchase them, keeping them out of public spaces and restricting marketing directed specifically toward children.”

Under SB 0106, kids who possess e-cigarettes or vendors who sell them to kids face a $500 fine on a second offense and a $2,500 fine for any offense after that. Federal law already prohibits the sale of vapor products to minors. However, there is no law in Michigan that prevents minors from possessing such products.

Under SB 0155, sponsored by Sen. Marshall Bullock (D-Detroit), those selling liquid nicotine to those 17 and under would face a $50 fine and vendors who don’t keep vaping products behind a counter or inside a locked case face a $500 fine.

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.