Exposing the Truth: A Fight for Medicaid Transparency

Welcome to a story that pulls back the curtain on systemic suppression, data breaches, and a dangerous disregard for integrity within a program designed to serve millions of Illinois Medicaid recipients.

In a formal complaint submitted to key state officials, Dana Wilson—a Public Service Administrator and advocate for transparency—details the deliberate obstruction of efforts to uncover Medicaid fraud and ensure compliance with federal and state healthcare standards. This document reveals a disturbing pattern of suppressed claims data, halted audits, and ignored security vulnerabilities, jeopardizing the integrity of the HealthChoice Illinois ADT program.

Through this webpage, we share the unfiltered details of Dana’s letter to the Illinois Department of Healthcare and Family Services (HFS). As you read, you’ll uncover how data manipulation, insider connections, and inadequate security measures have endangered millions of lives.

This is not just an exposé—this is a rallying cry for accountability, public trust, and the protection of vital healthcare resources. Stay with us as we explore the full scope of this critical issue, and join the call for transparency and justice.

Formal Complaint: Suppression of Efforts to Uncover Medicaid Fraud and Ensure Data Transparency in the HealthChoice Illinois ADT Program; Data Breach Concerns

from:

Dana Wilson <wilsondanar@gmail.com>

to:

"Hinshaw, Kati E." <Kati.E.Hinshaw@illinois.gov>

cc:

"Black, Melissa" <Melissa.Black@illinois.gov>,
"Belke, Mary" <Mary.Belke@illinois.gov>,
"Clay, Shannon" <Shannon.Clay@illinois.gov>,
"RuthAnn.Day@illinois.gov" <RuthAnn.Day@illinois.gov>,
"JJay@afscme31.org" <JJay@afscme31.org>,
oeig@illinoiscomptroller.gov,
oeig@illinoistreasurer.gov,
Robert.Fehrholz@illinois.gov,
dzung.hoang@cms.hhs.gov,
landon.page@illinois.gov,
Teresa.Flesch@illinois.gov

date:

Dec 2, 2024, 11:56 AM

subject:

Formal Complaint: Suppression of Efforts to Uncover Medicaid Fraud and Ensure Data Transparency in the HealthChoice Illinois ADT Program; Data Breach Concerns

 

Dear Executives,

I am writing to formally file a complaint regarding the suppression of critical efforts to uncover potential Medicaid fraud and ensure compliance with federal and state standards for healthcare data transparency. This complaint pertains specifically to the following issues within the HealthChoice Illinois ADT program and related systems:

1. Suppression of Claims Comparison Data

Efforts to analyze claims discrepancies between HL7 events and actual billed claims have been deliberately obstructed. Despite the contractual obligation to ensure data transparency and accuracy, attempts to compare these data points have been met with resistance.

  • Blocked Communication:

    • The placement of Deepak Dhankar onto the HealthChoice Illinois ADT program introduced confusion in data processes and unauthorized access to accounts, bypassing proper authority through DoIT to the Enterprise Data Warehouse.

    • Deepak’s involvement initially improved query efficiency, but he later obstructed claims comparisons. This was done in collaboration with Kati E. Hinshaw, who explicitly instructed that claims comparison reports revealing significant discrepancies not be shared.

    • The grievances I filed regarding Deepak Dhankar’s inappropriate hiring, favoritism in office assignments, and HR policy violations have been ignored.  The intimate relationship between Kati E. Hinshaw and Shawn Cole, Medicaid and Behavioral Health systems Adviser with OMI (known revolving door issues) has been ignored by OIG.

  • Implications:

    • These discrepancies likely involve upcoding, unbundling, or phantom billing, potentially amounting to Medicaid fraud. The suppression of this data analysis violates the department’s obligations and impedes transparency.  Also the vendor selection of Collective Medical Technologies/PointClickCare underbid by millions of dollars securing their partnership with HFS but have not been able to comply with contract obligations and I have not received adequate assistance from OGC or Procurement with making adequate headway for holding this vendor accountable.

2. Prevention of HL7 Procedure Code Expansion and Additional Data Segments

Efforts to include essential data segments outlined in the vendor contract, such as procedure codes, were halted without justification.

  • Blocked Expansion Efforts:

    • The additional data segments—CCDs, labs, imaging, Rx, scheduling, physician notes, and billing data—were crucial for care coordination and fraud detection.

    • Despite requests for written confirmation to notify legal and the vendor of this decision, Kati E. Hinshaw refused such communication.

  • Benefits of the Additional Data Segments:

    • Fraud Detection: Procedure codes and billing data enable the identification of fraudulent practices, such as upcoding or phantom billing.

    • Care Coordination: Improved access to complete patient records ensures timely and accurate care transitions across providers.

    • Quality Improvement: Clinical data provides actionable insights into provider performance and adherence to best practices.

    • Public Trust: Transparent data sharing supports Medicaid program integrity and strengthens public confidence.

3. Noncompliance of Promoting Interoperability Program Providers

Efforts to audit providers who received federal funds under the Promoting Interoperability (PI) program but failed to participate in the HealthChoice Illinois ADT system have been systematically suppressed.

  • Audit Obstruction:

    • Preliminary audits revealed several providers, especially long-term care (LTC) facilities and dentists, may have falsely attested to meeting CMS interoperability standards to receive federal funding.

    • Providers failing to contribute or subscribe to required data under the HealthChoice Illinois ADT program compromise care coordination and compliance.

4. Reports of a Data Breach and Security Concerns

Reports of a data breach and significant security concerns were met with inaction.

  • Specific Incidents:

    • Multiple tickets were submitted to DoIT regarding password security, firewall issues, and Teams functionality. A summary was sent to Kati E. Hinshaw on July 23, 2024, with no response or guidance.

    • These incidents were also reported to the Office of the Inspector General due to the potential security risks posed by DoIT’s policies.

    • A new current investigation is being taken due to my report of my devices being mirrored and the security breaches and No Contact order with ex-hubsand Charles Wilson are of high concern along with relationships involving Lilith Reuter-Yuill and Mary Doran.

  • Implications:

    • Weak security policies jeopardize sensitive Medicaid data and increase the risk of fraudulent activities.

    • The lack of action demonstrates a failure to address systemic vulnerabilities.

Key Concerns

The suppression of these initiatives has significant implications:

  • Undermining Accountability: Failing to investigate discrepancies in claims and provider compliance fosters an environment conducive to fraud and abuse.

  • Public Trust and Financial Harm: These activities jeopardize Medicaid program integrity, impacting millions of Illinois residents reliant on this safety net.

  • Professional Retaliation: My attempts to fulfill my duties have been met with obstruction, raising concerns about retaliation and the ethical conduct of those involved.  HFS HR policy was just shared with me earlier today but does not have specific directives to be in an “on-call” paid status without the ability to login or go into the office.  These are not written policies and violate human rights.

Requested Actions

To address these concerns and ensure compliance with state and federal standards, I respectfully request:

1.       Independent Audit: Conduct an independent audit of claims discrepancies, HL7 procedure code expansion, and compliance with PI program standards, focusing on LTC facilities.

2.       Review of Suppression Efforts: Investigate the actions of individuals responsible for obstructing data comparisons, audits, and transparency initiatives.

3.       Policy Reinforcement: Implement clear policies to prevent future obstruction of legitimate fraud investigations and data transparency initiatives.

4.       Whistleblower Protections: Ensure protections for employees reporting misconduct or raising concerns about fraud, abuse, or noncompliance.

This complaint is submitted in good faith to address systemic issues undermining the mission of the Illinois Department of Healthcare and Family Services and compromising public trust. I am committed to providing all necessary documentation and evidence to support these claims if access is provided so that I am able to share this information.

I request a formal response to this complaint within  10 business days and look forward to your action in addressing these critical concerns.

Sincerely,
Dana Wilson
Public Service Administrator
Illinois Department of Healthcare and Family Services