CIVIL RIGHTS COMPLAINT

June 10, 2015:

After I asked Susan McKinley of ODM about how my civil rights complaints were progressing, and if I will be receiving a copy of the reports, she wrote, “… it is not ODM’s policy to share information discovered during internal reviews, please be assured that ODM will address any problems that are discovered appropriately.” Should I be worried when a government official says “be assured”? These are, after all, civil rights complaints that I initiated; civil rights violations against me. Does the victim of Carestar receive a copy of the termination papers of Carestar employees that violated the law?

NOTE: These are not the subjective charges.  These are well-documented violations.

Here are the miscellaneous complaints that will most likely be ignored. Oh, well.

Carestar complaints sent to:
Mona Arrington, Columbus Region Carestar Contract Manager
Marilyn Henson, Clinical Manager

PCG complaints sent to:
Tara Stokes, Provider Oversight Contract Manager
Heather Hire, Provider Oversight Contract Manager

Susan McKinley
Medicaid Health Systems Administrator
Bureau of Long-term Care Services and Supports
Ohio Department of Medicaid

Charge No. 1
Abigail Mortine, Carestar

False statements written into official health records:

January 30, 2015:

At 10:10 a.m., my case manager, Abigail Mortine, called my primary physician. The phone log for my primary physician documented that the case manager and Carestar were actively taking steps to terminate hours for my mother/PCA and replace them with Skilled Nurses. (NOTE: My case manager stated this as an “FYI” and does not ask for the physician’s input.)

Five hours after calling my primary physician, my case manager visited my home just after 3 p.m. My case manager told my mother/PCA and me that if my request for additional PCA hours is rescinded by me, my current ASP will not be changed. Even though I have the right to “be treated with dignity and respect,” my case manager fails to mention Carestar’s steps to terminate my PCA hours without further discussion.

In the Event Based Update (EBU) 97567, my case manager documented this January 30, 2015 visit and wrote, “Case Manager explained to Kevin and his mother that I have consulted with my Clinical Supervisor regarding the request for an increase in aide services and that I would be in contact as soon as a determination is made.”

It’s clear that the determination was made before my case manager arrived at my home, and that this false statement was put in my official health records (EBU 97567) by my case manager.

Charge No. 2
Abigail Mortine, Carestar

Violation of HIPAA:

February 23, 2015:

I received an unexpected telephone call from Tim Spaulding from Access to Independence. He called to ask questions about the LCD arm to hold up my computer screen. I wasn’t expecting to be contacted by any vendors without signing a HIPAA Authorization form. When I contacted him via email, I asked, “Was it Abigail Mortine, from Carestar, who gave you my contact information?” Mr. Spaulding replied, “Yes. It was Abigail and Carestar that put out the request.”

Charge No. 3
Abigail Mortine & Robbin Zaborniak, Carestar

Failure to issue Hearing Rights:

February 27, 2015:

On page 2 of the ASPAR, it states that “This Case Manager consulted with Clinical Supervisor and submitted the following Hearing Rights:” Among them was, “Denial of 28 additional hours and 14 additional visits per week of Personal Care Aide services.” I emailed my case manager and told her that I did not receive these hearing rights. She replied with, “From what I understand, one hearing issue is addressed at a time.” When pressed, she replied, “As mentioned in my previous e-mail, from what I understand, one hearing issue is addressed at a time.”

March 17, 2015:

After asking my case manager about my missing hearing rights concerning adding additional PCA hours, she replied again with, “As explained previously one hearing issue is addressed at a time. The first being the termination of aide care. When you made the request for the increase in Personal Care Aide Services, it was determined that your needs are skilled in nature. This is the first issue that is being addressed through Due Process.”

March 30, 2015:

In a recorded conversation with my case manager, she placed all the blame on not issuing these hearing rights on her supervisor, Robbin Zaborniak.

Charge No. 4
Abigail Mortine, Carestar & James Rock, Public Consulting Group (
PCG)

Violation of HIPAA:

March 27, 2015:

I received a letter from a James Rock. He and his company, Public Consulting Group (PCG) had been harassing my nursing agencies about my skilled nursing care needs, and inquired if my mother/PCA was in violation of any Medicaid rules. This was the second time that I was contacted by a private company – who had access to my medical and contact information – without signing a HIPAA Authorization form.

Charge No. 5
James Rock, Public Consulting Group (
PCG)

Fraud with financial benefit:

The interventions written by my case manager in EBU 97567 on February 11, 2015 are a duplicate – word-for-word – of the prevention plan written by James Rock of PCG on March 24, 2015. This was more serious than simple plagiarism. James Rock misrepresented this official report as his own for reimbursement from the Ohio Department of Medicaid.

Charge No. 6
Sarah Beadling, Carestar

Perjury with intent to deceive:

April 6, 2015

Sarah Beadling represented Carestar in a State Hearing against me (Case Number: 1000175404 Appeal Number: 2089120). [ORC 5101:6-6-02(A) The agency representative presents and is the advocate for the agency’s case at the hearing…] As the representative of Carestar, she intentionally introduced fraudulent evidence.

My testimony included how my case manager agreed that my mother’s PCA care seemed appropriate during last year’s assessment (March 30, 2015 recording). My testimony also pointed out how my case manager gave detailed instructions – in my April 1, 2015 and April 16, 2015 ASP updates – on how I can appropriately keep my PCA services provided by my mother.

Instead of introducing these ASPs, which were available before the April 6, 2015 and April 27, 2015 hearing dates, Sarah Beadling, introduced an outdated ASP that did not contain the favorable information from my case manager. Sarah Beadling then testified that she spoke with my case manager. Sarah Beadling said that my case manager did not make these claims, and that my case manager agreed with the current determination by Carestar.

Sarah Beadling and Carestar continued to claim that my mother worked outside of her “scope” with personal disregard for the law. When I presented evidence showing that Interim Healthcare was responsible for the violation of “scope,” and that this situation was corrected per my Case Manager’s instructions located in my ASP, Sarah Beadling claimed that this was untrue. (See Interim Healthcare’s plan of care.) Interim Healthcare took responsibility for this event. (Hear supervisor’s recording.)

When I received Carestar’s hearing packet two days after the hearing, I discovered the version of the ASP that Carestar presented to the Hearing Officer. [5101:6-6-02(B)(2)(a) The individual and authorized representative shall have adequate opportunity to: Examine, at a reasonable time before the hearing as well as during the hearing, the contents of the case file, except for confidential information protected from release, as well as all records and documents to be used by the local agency at the hearing.]

Unlike a previous hearing when Sarah Beadling used a PEAT to determine the Level of Care of a consumer (See Exhibit page 5; Case Number: 5003978532, Appeal: 2085182), she testified in my case that my PEAT – which clearly ruled against “Skilled LOC Only” – was irrelevant in their decision to propose skilled care only.

Charge No. 7
Sarah Beadling, Carestar

Attempt to cause a Carestar consumer to violate the law:

On April 7, 2015, the hearing officer sent a PDF file containing my testimony and exhibits to date. He wrote via email that, “communication with me… outside of a state hearing is prohibited…” The PDF file the hearing officer sent me was either damaged or corrupt. It could not be downloaded correctly, so I contacted Carestar’s hearing representative and asked her to send me a copy of her copy. Only April 13, 2015, Sarah Beadling, falsely claimed that she did not receive a copy, and attempted to goad me into breaking the law mentioned in the email message from the hearing officer on April 7, 2015.

Charge No. 8
Abigail Mortine, Carestar

Per Carestar’s rules, EBUs are to be completed in 3 days:

At the bottom of EBU 97567, documenting a so-called “event” on January 30, 2015, it shows that this EBU was completed on February 11, 2015.

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One thought on “CIVIL RIGHTS COMPLAINT

  1. January 14, 2016

    Mr. John McCarthy, Director
    Ohio Department of Medicaid
    50 West Town Street, Suite 400
    Columbus, OH 43215

    Re: Private Duty Nursing for Individuals with Developmental Disabilities

    Dear Director McCarthy:

    We are writing to formally request a review of Private Duty Nursing (PDN) policies as they relate to individuals with intellectual and developmental disabilities (I/DD).

    Last summer, we began hearing from family members of individuals with I/DD that their private duty nursing services were being reduced and/or eliminated. The number of these complaints grew and a forum was held at the Delaware County Board of DD in early October 2015 to discuss the issue. It was very clear from the forum that some sort of policy change has occurred within the Department of Medicaid that has impacted PDN.

    In addition to concerns over PDN reductions, we have also learned that the appeals process is inadequate and that the state hearings seem to be more of a formality than an actual platform for a just review of PDN determinations by the state.

    There have been several attempts to informally resolve issues related to policy changes on PDN. Unfortunately, ODM maintains that no rule changes have occurred regarding PDN, and therefore there is nothing to address. While there may not have been any formal rule changes to PDN, the facts show that there have been changes to policies and implementation of the rules that have indeed led to a reduction to this service to individuals with developmental disabilities, some of whom may not be enrolled on Medicaid HCBS waivers.

    We are concerned that this may be the first step toward the elimination of PDN. We hope this is not the case given the population that is being impacted. The Ohio Department of Medicaid has a responsibility under the Americans with Disabilities Act and the U.S. Supreme Court’s decision in Olmstead v. L.C. to provide services and support to people with developmental disabilities in the most integrated, least restrictive setting in the community and to avoid unnecessary institutionalization or risk of institutionalization. Also, to be clear, we object to any policy changes related to PDN that would shift costs to Ohio’s county boards of developmental disabilities.

    Page 1 of 2

    (Continued from previous page)

    Furthermore, we find the Medicaid state hearing process is fundamentally unfair and extremely frustrating to people with I/DD and their families who are challenging these decisions to reduce or eliminate PDN services. For example, substantive decisions are often not made; instead, the hearing officer will frequently order a reassessment of the person’s need for services, thereby prolonging the entire ordeal. It is not uncommon for families to attend three or four hearings for the same issue. This is inconsistent with federal and state law.

    Also, the PDN program and its administrative rules are incredibly complex, and people and their families usually have an almost impossible task in trying to dispute the determinations made by the Ohio Department of Medicaid. Hearing officers appear to rule in favor of the Ohio Department of Medicaid almost reflexively.

    We understand that growing costs in the Medicaid system require ODM to pay special attention to cost containment. However, balancing the growing costs of the broader Medicaid population on the backs of the most vulnerable Medicaid population is fundamentally wrong. We assume that this is not the goal, and we hope we can work together to resolve this issue in the coming months through an inclusive stakeholder process. As PDN is a State Plan service that is based exclusively on medical need we believe it should not be altered whatsoever until an agreeable solution is found.

    We would appreciate the opportunity to meet with you to discuss possibilities to resolve issues pertaining to the reduction in PDN services and the appeals process. We request that any further reductions in PDN services be halted until we are able to find an agreeable resolution.

    We look forward to hearing from your office soon.

    BRIDGET GARGAN MICHAEL KIRKMAN GARY TONKS
    Executive Director Executive Director Executive Director
    Ohio Association of County Disability Rights Ohio The Arc of Ohio
    Boards Serving People with
    Developmental Disabilities

    CC: John Martin, Director, Ohio Department of Developmental Disabilities

    Like

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