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Medical Care

FBI Investigating Autism Centers in Minneapolis & St. Cloud for Fraud

2024-12-12

This article delves into the concerning issue of Medicaid fraud within the realm of early intervention services. It exposes how some medical providers, both those not legitimately affiliated with certain companies and those located outside the United States, were billing Medicaid for EIDBI services. Like Smart Therapy, Star Autism Center also came under scrutiny for submitting large Medicaid claims for services that seemed improbable. Moreover, Star Autism Center billed Medicaid during periods when clients were attending school or otherwise unavailable for therapy.

Regulatory Challenges and Growth of the Autism Program

In Minnesota, nearly 300 agencies are involved in early intervention work. However, there is very little regulatory oversight as autism centers are not licensed. This lack of oversight makes it difficult for the state Department of Human Services to track caseload size and staffing ratios. Since the launch of the Minnesota autism program in mid-2015, it has witnessed rapid growth. Especially since 2018, when Minnesotans started using the benefit in earnest, the number of providers has increased from 41 to 328 last year. Simultaneously, the amount paid to providers has skyrocketed from about $6 million to nearly $192 million. This significant growth raises questions about the integrity of the system. 1: The lack of proper regulation allows for potential fraud to go undetected. With no clear guidelines and limited monitoring, it becomes easier for providers to engage in fraudulent activities. The increase in the number of providers and the substantial rise in payments highlight the need for stricter oversight and better monitoring mechanisms. 2: The growth of the autism program presents both opportunities and challenges. On one hand, it shows the increasing recognition and demand for early intervention services. On the other hand, it also exposes the vulnerabilities in the system that can be exploited by fraudsters. It is crucial to find a balance between providing necessary services and ensuring the integrity of the Medicaid program.

Investigations and Withheld Payments

As of September, the Department of Human Services was actively investigating 29 individuals or agencies providing early intervention services. Since 2018, the agency has withheld payments from seven providers due to credible fraud allegations. Five cases were also forwarded to the attorney general's Medicaid Fraud Control Unit. Additionally, the Office of Inspector General has withheld payments from seven providers. Over the past five years, another 10 investigations were closed. For example, an investigation into Sharmarke Issa was closed in June 2023, resulting in the provider being "terminated" from receiving Medicaid payments. Issa, the former board chair of the Minneapolis Public Housing Authority, pleaded guilty to a federal wire fraud charge in connection with the Feeding Our Future case. 1: These investigations and withheld payments indicate the seriousness of the issue. The fact that multiple providers have been targeted shows that fraud is not an isolated incident but a widespread problem within the system. It is essential to take decisive action to prevent further fraud and protect the interests of Medicaid beneficiaries. 2: The closure of investigations and the termination of providers serve as a warning to others who may be considering engaging in fraudulent activities. It shows that the authorities are committed to rooting out fraud and holding accountable those who violate the law. However, more needs to be done to strengthen the investigative and enforcement mechanisms to ensure the long-term integrity of the Medicaid program.This is a developing story, and readers are advised to stay tuned to startribune.com for updates.

Sofia Cano, a 22-year-old transgender woman, finds herself trapped in the custody of the South Carolina Department of Corrections. Over four years have passed since prison system employees documented her gender dysphoria diagnosis, yet SCDC officials are preventing her from accessing essential medical care. This situation paints a grim picture of the state prison system's mistreatment of transgender individuals.

"Transgender Prisoner's Fight for Healthcare Rights in South Carolina"

The State of Gender-Affirming Healthcare in S.C. Prisons

The South Carolina Department of Corrections (SCDC) policy claims to provide "medically necessary care" throughout incarceration. However, there's an exception for gender dysphoria. Under a "freeze-frame" policy, hormones for hormone replacement therapy are not purchased or prescribed unless the incarcerated person was already using them before incarceration. This creates a double standard where patients can receive certain medications for other conditions but not for gender dysphoria.About 30 transgender women are currently in SCDC custody. The legal team has uncovered how the prison system fails to meet their basic needs. SCDC employees witness the suffering of transgender inmates denied healthcare like hormone therapy and basic dignity. They have even seen patients consider and attempt self-surgery due to the lack of proper care.The prison employs a Transgender Service Coordinator who had limited knowledge about transgender issues. Internal training documents refer to international standards but are often ignored.

Sofia's Story

Since July 2020, when a mental health care provider documented Sofia's gender dysphoria, the prison system has known about her serious medical need. Yet, for over four years, SCDC has cruelly denied her care, violating her 8th Amendment rights.Prison officials recognize that Sofia legally changed her name to Sofia in 2021, but they still misgender her and force her to wear a badge with her former name. Staff have heard her describe "persistent thoughts of death" due to her gender dysphoria. She even attempted auto-castration. In January 2023, the U.S. District Court ordered SCDC to evaluate her need for hormone therapy, but the chosen psychiatrist had no experience in initiating hormone therapy and ignored WPATH Standards of Care. The psychiatrist claimed there was "no evidence of distress" despite Sofia's statements and medical records.

The Broader Struggle

In recent months, Sofia has had daily thoughts of suicide. She struggles to sleep and concentrate on simple activities. Her joy in teaching fellow inmates and playing games has been overshadowed by the distress she feels about her body.During her long fight for healthcare, SCDC has offered different rationales for denying her care. First, it was based on a budget proviso interpretation. After the court rejected that, SCDC then claimed she didn't have gender dysphoria despite documentation to the contrary.SCDC's refusal to treat Sofia's medical condition is alarming. It violates the 8th Amendment and 14th Amendment. To learn more, visit the case page for Cano v. South Carolina Department of Corrections, read the blog post on her personal journey, and see the ACLU-SC v. Stirling case for the right to publish her story.

Redesign Health, a prominent name in the healthcare industry, has made a significant announcement. With a new $175 million fund, they aim to launch innovative healthcare companies from their venture builder. This fund stands as their largest to date and is expected to support more than 20 startups.

Redesign Health's $175M Fund - A Catalyst for Healthcare Innovation

Founding and Background

Redesign Health was founded in 2018 by CEO Brett Shaheen. He started his career as an investor at Goldman Sachs and later moved on to be a private equity investor at Carlyle and a hedge fund manager at Lone Pine Capital. It was during his time at dental company Candid in 2017 that he became interested in healthcare venture funding. This diverse background has equipped him with the necessary expertise to lead Redesign Health.The healthcare venture builder has incubated over 60 companies, including Scriptology, UpLift, Vivid Health, and Baton. These companies have been nurtured and developed within the Redesign Health ecosystem, laying the foundation for future growth.

New Fund Details

The new fund contains $25 million more than its previous one, which was raised in 2021. With a substantial amount of capital at hand, Redesign Health is well-positioned to support a significant number of startups. Neil Patel, the head of ventures at Redesign, stated in an interview with Fierce Healthcare that the fund is expected to last for several years. This long-term commitment allows for a more stable and sustainable approach to healthcare venture building.The new fund has received backing from Declaration Partners, Euclidean Capital, and True North Advisors. This diverse group of investors shows the confidence they have in Redesign Health's vision and capabilities.

Value Proposition and Mentorship

Redesign Health prides itself on providing hands-on mentorship to the startups it supports. As CEO Patel mentioned, they position themselves as the premier platform for healthcare founders or those considering entering the healthcare space. By leveraging their research on specific pain points, relationships with healthcare stakeholders and incumbents developed over the years, they aim to accelerate the startups' ability and improve their odds of building a sustainable and potentially world-changing company.This mentorship goes beyond just financial support. It includes guidance on various aspects such as business strategy, market positioning, and technological innovation. The startups benefit from the collective wisdom and experience of Redesign Health's team.

Investing Themes and Technology Focus

Redesign Health has eight investing themes that guide their support across all ventures. These themes address crucial aspects of the healthcare industry, such as the healthcare labor shortage, accelerating value-based and longitudinal care, advancing healthcare interoperability, preparing for an aging population, eliminating barriers to health equity, expanding sites of care, growing the insured population, and driving healthcare personalization and consumerization.In addition to these themes, the company also looks for startups that effectively utilize technology and how it intersects with their investing themes. Technology plays a crucial role in driving innovation in healthcare, and Redesign Health recognizes its potential.

Investor Confidence and Market Outlook

Patel believes that the fundraise is an indication of investors' continued interest in the $4 trillion healthcare industry. Despite the challenges, there are still tremendous opportunities for innovation. As he stated, "There's a lot of wood to chop here; there's a lot of problems to solve... it's a large healthcare market." This confidence in the market drives Redesign Health's efforts to support startups and drive change.By addressing the various pain points and leveraging technology, Redesign Health is committed to making a significant impact on the healthcare industry. Their new fund and comprehensive approach offer hope for a more innovative and efficient healthcare future.