Dragon’s Den: Medicaid and Medicare Fraud Exposure in South West Michigan
This is my report on Why Riverwood-center is a criminally oriented organization.
I deem this in the National Interest, so please do investigate. Especially their financials, dating back at least 15 years. They charge the Federal government ~$10,000 per person/client, and make the State government pay room and board for $995 (as of 2023
I believe it is 1,050 or so), while they keep the majority of the funds, and provide only a trickle of monetary compensation for the providers (foster business entities). They provide immense funding to large corporations and businesses, while for the little guys they squeeze them out for every dime they are worth. This is injustice and against the Law of the Nation, and immoral. This institution, auxiliary of the State under Berrien Mental HealthAuthority must be either dissolved and a new organization for the entire Berrien County in South West Michigan created, or must go to receivership. This is injustice! I petition the Federal government to change the laws of the land to suit the needs of the people. Keeping in mind that existing laws and statutes of the Federal, State, and Local are clearly violated, and must be vindicated. This information is derived from a tertiary source, which I am not willing to disclose. If I am found wanting for undue distribution of false information, I am willing to apologize in writing to the Board of Riverwood, anonymously As I still continued to be employed part-time. This is a civil rights issue, and also a grave National tragedy They are depleting the Federal funds necessary to sustain and upkeep countless citizenry and their families. This misuse of funds must stop.This investigation report is done to the best of my abilities. I appeal to
the Executive, Judiciary, and the Legislature. Fat-man in the Fat-house, do something for the Lord.Amen!
Start Date: 12/30/2022
End Date: 2/9/2023
1. The annual report is inadequate and incomplete. It does not include financials, or contributions from the community, nor does it mention internal state. The internal state must include the number of employees, contractors, part or full time, interns, their pay grade, duration of their service, and why these positions are needed. It has no grievance section for clients and community to address to, nor have a full-time ombudsman employed, nor is it mentioned. Does not mention providers, partners (business, like pharmacy, and other service providers). The latest uploaded on the website is 2022, there is no way to download those reports for technically non-savvy individuals. Old reports for 2021, 2020, 2019, and 2018 are not visible to visitors. The company profile is not mentioned, not its jurisdiction, nor its organizational structure with legal proof. Definitely no financial reporting included, not even a summary, nor any financial supporting reports of how the company or corporate is functioning.
2. How does the company/corporation manage its staff?As they serve a vulnerable community There is no mention of how they go about hiring individuals. Nor what training is required, and what capacity of individuals do represent the working
force of Riverwood center, not their daily schedule or even their yearly schedule. No work-force data.
3. It is not an annual report, but a company pamphlet, addressed to the community identifying its presence. It does not have any forecasting or prediction or a clear center future plan or vision.
4. In the 2017 annual report, the survey conducted by SWMBH clearly shows the inadequacies provided by the state.Around 5000 individuals served, only 180 were surveyed. What institutional error? This is inadequate for a representative survey for disabled individuals.Also, due to disability, these surveys should not be considered valid for reference or for promotional or for legal purposes. There should be an alternative survey arranged for their legal guardians, family and friends.And this is the survey which should count.As they have mental disability and mental issues, emotional response when dealing with riverwood-center is always positive, while the real behavior manifests when they (clients/consumers) engage with others including providers (foster homes). The survey should be done by an independent third party paid by the Michigan state. Michigan
Mission-Based Performance Indicator System (MMBPIS) used by Michigan is not relevant to such scenarios. For health, it generally might work, but due to the inherent nature of psychological dysfunction and the time and constraint involved in assessing such incidents.This statistical methodology is invalid, and not suitable. Most medical assessments are done in less than 30 minutes. I recall doctors/psychiatrists doing the regular checkup completing in less than 10 minutes, in some instances less than 5 minutes. This is no way to address the
mental/psychiatric problems.Asingle session is not enough to gauge the efficacy of any service, nor is definitely enough for identifying an underlying problem. Symptoms should not be equated with dysfunctional problems. The satisfaction report shown on the company website is of 2017. Many things could have changed, the service offered degraded, personnel changed, or even company policy and governmental restriction applied.
5. Berrien MentalAuthority has multiple companies to address the health and sociological issues in South West Michigan (namely Berrien County). The question is: Why does BMHAuse different companies to deliver services in one region that they have a domain over? Why don’t BMHAuse the Riverwood-center? Why have multiple companies/corporations/trust? To confuse, for better local management, or to prevent financial assaults (lawsuits)?
6. Michigan Department of Health and Human services [SouthWest Michigan Behavioral Health]= Berrien MentalAuthority = Riverwood-center, North Star, etc.
7. Riverwood-center is certified under Certified Community Behavioral Health Clinics (CCBHCs). SAMHSA(substance abuse and mental health service administration). Which is part of the US Department of Health and Human Services. According to criteria set by CCBHCS, these are the violations: (6.b.1: no active participation of clients and their families.) (6.a.3: no financial audit is done, in regard to public knowledge.)(6.b.2: it does not disclose in an accurate fashion how it helps its target population.)(6.b.6: The board membership is inadequate, there are no retired health providers, no MDs etc. Even if they do
have such titles of educational excellence it is not provided in the annual report.)(2.a.4 & 2.a.5:the corporation does not provide transportation services to its clients free of charge, nor does it allow for flexible appointment scheduling, even for those who are bedridden and severely disabled.)(2.a.8: has not provided such alternatives to consumers, can’t get emergency pills or the like, not flexible enough. Nor do they have empty rooms for severance mentally ill persons who are experiencing a resurgence of mental flux to stay. Not the best organizational behavior on their part.)(2.d.1.: no such details are made visible on the building.)(3.a.4: many of the clients I worked with have no way to do their group or single activity These activities are contracted by third-party companies who seldom commit high worth persons, and lack the consistency required to provide a pleasant experience for clients/residents. These activities include taking clients toYMCA, grocery store, movie theater, park, etc. Provides an out-side experience that is most useful for those who are affected by mental illness.)
8. CCBHC definition of Case management: “Case management may be defined in many ways and can encompass services ranging from basic to intensive. The NationalAssociation of State Mental Health Program Directors (NASMHPD) defines case management as “a range of services provided to assist and support individuals in developing their skills to gain access to needed medical, behavioral health, housing, employment, social, educational and other services essential to meeting basic human services; linkages and training for patient served in the use of basic community resources; and monitoring of overall service delivery”
(NASMHPD [2014]). See also the definition of “targeted case management.”
9. The corporation does not have an emergency service in place. I know for a fact. When I worked and am still working part-time for a provider That provider was not allowed to move the client who is a high-level psychiatric patient. This was not told to the provider And because of this, a lot of trouble the poor provider had to go through and endure. They have no decency nor have regard for the providers, and definitely not their clients. Harsh and crude business values, and surely immoral organizational behavior.
10.The 2022 report clearly mentions 73% of clients residing with family or alone. While 26% are in residential settings. Even with the low population of residential clients.They have no way of deciding their life-style. They are told where to be, and where to go. Even if they choose to stay with one provider, and the provider reasonably increases the due/fee, then due to internal policy changes (bitchy greed!), they are removed. I am an eyewitness to these kinds of atrocities.
11.2022 report continuation. 36% of clients are females, and those females have no ombudsman to talk to. There were a few incidents where I believe that the female client was exploited sexually by the case manager This old lady was used, I have no proof, by this old manager guy, with a large-beer belly, white, and old. Such incidents can be reduced. If females are taken care of females, and males taken care of males.Any male child 11 and under should be taken care of by female staff, and 12 and above taken care of male staff.This is a very real problem.Awhole lot of abuse can be reduced, in this way. It is time to change how things are managed.
12.2022 report.They should provide a venue for elderly to be taken care of. 45% are in the range of 25-65 years of age. This classification itself shows the lack of care and emotional empathy for clients. Due to medication, disability and lack of physical activity. Mentally disabled and mentally ill clients age fast, and their bodies start to behave differently.Also, some of those clients have bad habits, like smoking etc.These negative habits can accelerate aging. No additional help is provided for the elderly. I have seen, and witnessed. Primary source!Age distribution should be divided up into 5 blocks. 18-25 age range, 26-32, 33- 50, 51-64, and 65+.
13.Scroll down and the exact number of those for FY21 is 343, which are 25-64 years old, while 65+ years old is just 47.
14.Mentions 180 staff, but there is no breakdown of work or how the structure functions.
15.Riverwood must be uncertified from CCBHC certification.As they don’t allow proper freedom of movement, as their desire to stay in one place is often violated.The cause is monetary gain for the organization/company
16.Does not provide 24/7 described as indicated in the report.
17.Company claims to receive $15 million under BMHA. In addition to $3.4 million for CCBHC certified authority.This does not include revenue generated from services.This is just functional money provided to “sustain” the company.
18.2022 report.The company provides supportive employment services. There is no valid case justified for the continuation of such service. I am not saying such supportive measures should not be employed, but that the company fails in
delivering meaningful services. For 180 days of employment for the annual year, continuous is 1. For 365 days of employment for the annual year, continuous is 0. For 90 days of employment, it is a measly 7 persons, average for the whole year This form of supportive employment is not functional. What is the company doing? Who are they serving?
19.2022 report. SWMBH survey is invalid, as mentioned above, for fiscal year 2021. Dud!
20.The 2022 report is only 26 pages, and again not meaningful, does not contain relevant details pertaining to the company, or its function. No discussion of future plans, employees, laws and regulations, etc. No laws and regulations were mentioned, no employee details given (education, criteria for employment and training etc., no solicitation of help (employee wanted), and other relevant details Financial and political consideration.
21.Riverwood center does not provide adequate person-centered planning. They don’t allow clients to decide which place to stay This has happened repeatedly, and continues in my opinion. They show neither dignity nor respect for their clients.This is very evident from working with them that Riverwood center does not regard their providers in equal terms. You can find a report on my name in their database. Fraudulent, incomplete, and with inconsistent logic. The most absurd lies fabricated and blamed, so I can be humbled, and will be subservient to them. I am still employed by my employer, small-business. It is high time they account for their crimes and injustice done to the Federal, State and Local law andAmerican people.
22.Riverwood has removed several clients from my employer's facility, just because the employer was asking for a higher pay This was because the Level of Care (LOC) has increased, and more time and resources have to be allocated to provide the same set of Care that was available previously. No regard for the well-being of the person was considered.As they progress, as higher effort is needed, and more resources need to be allocated, naturally the cost of care will increase and thus the employer issues a desire to increase the price point of care offered. Most of the time they just removed the clients from the facility (I was working on).They did not bother asking the consumers/clients, nor their family members.This is very unjust and very unprofessional, not to mention immoral, as their civil rights, recipient rights, and the rights of the disabled are all violated due to monetary gain. Unjust!
23.The services offered by their (CLS) Community Living Support providers are horrible and undefined.They arrive early or late, don’t quite show-up, and will be employing individuals who are evidently not to be employed. Their clothing and verbiage clearly denote a lack of standard in employment offered by CLS providers. One CLS provider is, in fact, an auxiliary of Riverwood, a horrible CLS. They falsely reported on me, stating that they believed or suspected or did recognize that I punched a lady. Which was untrue, and might be included in the final report. Questions that should be asked?? Whereas I, and my supervisor have identified markings in our clients (in the past, working in a new home of the same provider), and have noted. It is reported when the incident is falsely attributed to the providers, or their employees, while these professional
corrupters go about not noticing when these same clients/consumers are in their vicinity. Bloody corrupters!
24.They don’t provide 24/7 pharmacy service. They should, as they get a whole lot of money from the Feds. Furthermore, they are in partnership with Genova, which is a distasteful, and very unprofessional company. Ban Genova from any Medical Health Partnership in the whole USA.Amen!
25.Why areTransportation services not provided for the consumers? Why does the provider have to do this?Are the providers paid in (hourly compensation or daily) for this kind ofTransportation services??
26.They lack provocation services. Some of the clients could be employed in the community settings, and can increase their emotional and social wellbeing. But the institution does not encourage it, according to my knowledge. I have been working with providers and providing this valuable service for about 10 years or so.They have a bad reputation, for being crude, mean and insensitive to their clients and service providers.
27.Their case-managers don’t have the necessary knowledge and education, nor have the emotional competence to relay the consumer's desire on paper, and make a meaningful contribution in the upkeep of social cohesion among their clients.
28.When we have to send clients to the ER, usually they are taken there by the ER ambulance, but the hospital will require if the ambulance is unavailable to move the clients by us.There was this incident when I was unable to go get the client, and the staff at the bitchy Lakeland Hospital threatened me, saying it is my
responsibility to do so. When the main party responsible is the Guardian, and the main service provider, Riverwood Center This incident had an emotional scare on me. Given the incident above, I like to add that no transportation services are offered by Riverwood-center, no ambulatory services either
29.LakeLand Hospital in Saint-Joseph and Niles, especially St.Joe is horrible and retarded.There was this incident with a client that I was responsible for.After the first operation, they did not provide a sling for the elderly lady, and thus the rod that was meant to attach her bones to heal, came off. She had to do a second surgery, this time with a nut and bolt type. The sling could have prevented the second operation, when the Doctor confronted me, I stated clearly that the Hospital did not give me, the discharging nurse, a sling to hold her hand still. Irresponsible Medical institution. I believe this was done on purpose, for monetary gain.The Doctor gets a percent every time he does a surgery.This should be investigated. Why does the Medical establishment have to do double surgery on the same issue?? Dubious and villainy!
30.Riverwood-center does not provide Integrated Health Care, nor contract with medical institutions in Berrien County
31.PIHP(Prepaid Inpatient Health Plan) for Berrien County is SWMBH, and Riverwood center is under it. They don’t have the right to be included in it. I believe no prepaid program should be allocated by the State and Federal, I find it amusing that just work can be carried out, as no services are rendered. By Law, any and all services must be paid for in the Nation. I believe it is against Law to
prepay. Post-service pay is ideal, as a whole lot of abuse and neglect and waste can be prevented. Similar to just-in-line inventory, as needed, and not more.
32.No legal services are provided for the clients and the providers. Services include training, advising, and the like. This should be offered to the providers, as they are the frontline providers/workers and institutions of choice. Berrien County has instituted a Mental Health Court (MHC). To ensure those affected by mental illness receive the full protection and assistance of the Law.This lack of legal training is glaring and unjustified.As providers have to endure complaints, sudden inspections, investigations and legal reporting. This is a vital aspect that is overlooked, and very much underrated. Needs to reform the pedagogical structure of caregiver and provider training and certification.
33.For those involved in continuous care, like caregivers, no additional help is provided. No free counseling, no free medications (for those suffering), no mental and emotional annual check-up, and definitely no additional medical insurance. These should be provided for those engaging in caring for the vulnerable and the elderly This is to ensure that only the best qualified individuals are hired and retained. I, personally, believe that we, as caregivers, do feel vicarious trauma. Especially, when dealing with those persons who are affected by their traumatic past. It still haunts us as well, via clients.
34.The oversight committee by the State, Local, and the Feds need to get the community involved in order to clean up the health care. For abuse and neglect, their corporate giants, like Lakeland Health Care in Berrien County MI, and Health ServiceAuxiliary, like Riverwood Center, do continue to violate with
impunity. No criminal and or civil lawsuits are filed.And definitely no fees. God forbid, these necessary organizations have to correct their wrongs. Definitely not! And not for the public good.
35.Do the institutions in concern get regular independent auditors, and do they comply with GAAS and GovernmentAuditing Standard. Do the auditors provide their professional opinion on the management and financials of the institution?
36.How many of the persons that committed suicide in the Berrien County are, and or were, being treated by the BMHA? Medical Examiner’s report for the year 2018 confined the persons lost to suicide has 26. Drug overdose was about 30, gun violence 19, and death by poison 1. The report does not go into additional detail. But this can be easily deduced, that 26 persons killed themselves in suicidal manner. Were they suffering from mental agony, depression, or were driven to utter despair due to mental fragility? We as the public need to know exactly why these people were killed. I will not digress, but clearly the institution in question Riverwood-center might have a serious role in the death, if not deliberate, then accidental through negligence and unprofessionalism. Nearly half of suicides, around 48% is done through firearm.Aprogram should be
37.Berrien County 2019 Behavioral Risk Survey clearly indicates certain anomalies. Either the data collected is not sufficient to understand the problem, and/or the method employed is not useful and relevant for mental health screening and survey.
For the Mental Health section, I stated: “The data is puzzling? Why is there such a wide gap? Either the sample size is not big enough for a mental health survey,
or there was something more dramatic happening behind the scenes.Achronic mentally fatigue, can be viewed/perceived as natural, and could be easily side-lined. Maybe is the method being employed.” For the Depression section I stated: “For this we need to know the time of day, and season (month). We know that depression gets its peak during winter months. We need to distinguish seasonal versus chronic.”
38.All documents that I can obtain from the Michigan State through FOIAseems to be isolated to only BMHA(Berrien Mental HealthAuthority), and does not pertain to Riverwood-center All the information about this was speedy (~2 week delay) granted. I strongly doubt that even the State is knowledgeable about the true financial condition of this institution/organization. Where is the financial information pertaining to this institution? My curiosity has only increased. I strongly believe this to have a somewhat spiritual barrier to entry.There is this conspiracy theory afloat regarding the true wealth of the Nation. It states that all the wealth is secretly being gathered in State auxiliaries (trusts, corporations, etc), while depleting the States, and Federal. This is done to misguide, delude, deceive, and to persuade the world that this Nation (USA) is, in fact, broken. Creating artificial chaos, and then appearing as angels for this man-created problem, they (SWAMP) can provide an alternative. But, the price will be very high.Total subordination and servitude to the new masters of the order. Hegelian dialectic!
Medical Fraud (SWMBH Customer Handbook 2022)
Examples of Medicaid Fraud.
Billing for medical services not actually performed.
Providing unnecessary services.
Billing for more expensive services
Billing for services separately that should legitimately be one billing
Billing more than once for the same medical service
Dispensing generic drugs but billing for brand-name drugs
Giving or accepting something of value (cash, gifts, services) in return for medical services, (i.e., kickbacks)
Falsifying cost reports
Missed appointments
Unnecessary medical tests
Telephoned services
My Opinion
1. Remove tax exemptions for all state auxiliaries, like corporations, LLC and the like. No, Section 501(c)(3) of IRS code.
2. Make all like corporations and companies which are state owned and operated to disclose their financial statements annually, without any interruptions.
3. Make the necessary changes in their management, have a third party annual audit on top of state and federal audit. Remove or change the entire management in a cyclic period of 5 years, to ensure continuity of righteousness/good governance.
4. Limit amount of reimbursement received by the company for each client.And ensure that such medicaid and medicare fraud don’t continue.
5. Make them publish their annual report in media, print, and radio. This is to ensure transparency and accountability. Let Lawmakers and relevant authorities ensure such malpractices don’t continue in the future. Make way for peace!
6. Aspecific program should be instituted for gun-owners, to prevent suicide and homicide.This should be a yearly voluntary training that is made available in partnership with State and Local governments. Should include Law-enforcement authority, and mental health authority. Gun-ownership should be enabled, not discouraged because gun-ownership is a God given right. The right for self-preservation, as stipulated in the US Constitution.
7. Every report by the Federal, State and Local should have an identification number attached to it. That will make it easily accessible to the public. It should include the jurisdiction, data, name of author(s), title, agency, department, branch, address, DOI, and other relevant information.Asingle repository for these can be helpful in educating the public, and helping to retrieve information for journalists.This can be considered to be an enhancement for existing FOIA. An example would be: US:MI:BC:BCHD:BCMHA:Riverwood-center:#report. This should accelerate the dissemination of information that could be publicly relevant.
Here the US is the nation, MI is the state, BC is Berrien County, and the rest are Berrien County Health Department, Berrien County Mental HealthAuthority, and Riverwood Center, respectively. FOIAinformation should be archived in such a manner that anyone from the public should have direct access to, and browser through. It is one thing to make information available through FOIA, but totally different if the public were allowed to browse through the entire set of information.This will be a game changer.Truly, a game changer! Should also include Court documents and all its fillings.
8. Most of the free services afforded by the government for the disabled are age-centric. One has to be identified disabled (mentally or having a mental spectrum of illness) by the age of 22, to receive full conditional help, based on available budget for the fiscal year.This needs to be changed to suit the needs of the community. Intoxicated to chemicals, brain damage by accidental or intentional act, and or belated recognition of mental disability can disqualify a person from receiving free mental health services. This is especially true for mentally handicapped, those suffering full mental capacity due to a varied spectrum of factors. For example, autism. Traditionally, autism was used to strictly classify a particular group with significant characteristics, but now has been seen as a spectrum or range of illness in disability or lack of mental growth among persons.
9. BMHAand the relevant auxiliary Riverwood-center must be investigated and prosecuted. It is not the Michigan State that is at fault, nor the Federal government, but the blame strictly falls on the County. It is the responsibility of
the Board of Commissioners to guide and lead the entire County. I am not sure even the BMHAknows what goes on with their branches. To prevent such an occurrence, we need to have a total in-depth audit of the County and all its auxiliaries and subsidiaries.
Report sent to the following addressing medicare and medicaid fraud, and extravagant fee accrued from Federal and state depository.
1. US Health and Human Service: Inspector General.
2. MDHHS: Office of Inspector General.
3. Michigan Department ofAttorney General.
4. Department of Justice.
5. US Marshals
Inquiry Request to MDHHS (FOIA)
Hi! My name is Mike Jenson Raj. I am requesting information about the following institutions, auxiliaries of Michigan State. I am writing a research report on the institution, and I am working part-time as a caregiver. Why additional funding for the elderly and the disabled should be mandatory, and should be set aside for “rainy days.” I would like to receive the complete financial reports (the previous 5 years, and needs to include Income Statement, Cash-flow statement, balance-sheet statement, changes in equity statement, and if they have note-to-financial statements that also.), IRS tax status verification document, all certifications that are made accessible to the public, any
criminal and/or civil (lawsuits) complaints faced by the institution in question, and any violation cited by relevant authorities for negligence and/or vagrant injustice. This is necessary for me to complete my report.Also, I would like to receive an estimation on cost and time. If the cost and time is prohibitive, I like to know which other alternative method can be used to receive such information. Much appreciates the work of the Inspector General for public awareness, and upholding Truth.This is in the public interest.Amen!
Institution in question: Riverwood-Center
SuperiorAuthority: Berrien Mental HealthAuthority
StateAuthority: Michigan Health and Human Services.
The received information is placed in the Riverwood-Center Folder. I have exhausted all avenues in finding information about this corporation. There is no more information that is available in Public Source, as much as I know. I tried to glean out some information from lawsuits, but the Court ofAppeals website did not reveal any information. One Court, Michigan Website.
References
1. Certified Community Behavioral Health Clinics (CCBHCs) | SAMHSA
2. https://www.riverwoodcenter.org/
3. https://www.swmbh.org/
4. https://www.michigan.gov/
ReferencesAPA
Berrien County Health Department. (2019, May). Berrien County Suicide Data 2018 (G. Miller,Author). Berrien County Health Department.
Berrien County Mental HealthAuthority Berrien County Health Department. (2022).
Riverwood Center
Annual Report 2022. Riverwood Center.
MDHHS Riverwood-Center. (n.d.). Your Rights.
Berrien County Health Department. (n.d.). 2018-2019 Berrien County Behavioral Risk Factor
Surveillance Survey
Swidwa, J. (2022, June 8). Report: St. Joseph parents had eight CPS visits prior to son's death
[Fact sheet].The Herald-Palladium.
https://www.heraldpalladium.com/communities/st_joseph/ report-st-joseph-parents-had-eight-cps-visits-prior-to-sons-death/ article_c4b5b050-86e4-590a-9f8f-6f6e0e19923f.html