Double-Dipping, Revisited

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Today the following memo, typed on school letterhead, was delivered to me as I taught a class; interrupting instruction, and causing me to wonder if the timing, and the topic, where chosen for effect…even for harassment:

“September 12, 2003
To all Special Education Staff:
I am requiring all Special Education Staff to track, document and report all Medicad (as spelled in memo) Caseload Coordination for reimbursement. The tracking documentations will be distributed to you by [name of special ed coordinator] routinely throughout this year.

~ [Principal]“

Year after year, attempts are made to force me to violate my conscience and file claims with Medicaid for ‘medical services’ that I do not provide for my students who are insured under the Medicaid program. I believe that the policy under which schools collect such Medicaid funds is a travesty at best, and demonstrates blatant disregard for the people of this nation.

Provisions for teacher salaries have already been arranged through local and state taxes. School districts have no right to trick taxpayers into paying, yet again, for the same duties that a teacher is expected to perform without those additional monies. In up to 34 states, school districts are also receiving ‘bounty money’ from the state and federal Departments of Education. All of these financial options serve as incentives to districts — incentives to classify even more children as ‘special needs’ and then assign them to special education programs which, on the whole, have very poor track records for ever accomplishing closure-oriented goals and thus getting children out of special education and into the general population.

When I was confronted with last year’s instructions on how to double-dip the taxpayers, I wrote “Double-Dipping: Special Education and Medicaid.” I had explained to my principal that I simply could not comply with a policy that I believe to be legally flawed, morally wrong; that I find personally and professionally offensive. The issue was dropped, and although they continued to fill my mailbox with the pink claim forms, I have not been reprimanded for leaving them there to gather dust.

Recently a Texas lawyer, defending a woman who blew the whistle on illegal filing of Medicaid claims in that state, contacted me and alerted me to the fact that the State of Michigan has agreed to repay the Feds over $325 million dollars in inaccurate claims. However, some districts seem almost driven to grab as much of the Medicaid booty as they can, before legality is decided and the doors to this profitable venture are closed.

A discussion of the “Michigan Medicaid School Based Services Program” provides this definition, “School Based Services (SBS) is a reimbursement program for services utilizing the rehabilitation option under the Medicaid State Plan in which Medicaid reimburses schools for health care services provided to students in Special Education. The SBS are provided during the school day by qualified personnel and billed to Medicaid by the Intermediate School Districts (ISDs).” The site lists the types of direct health services for which a school district can file Medicaid claims:

  • Speech, Language and Hearing Therapy and Evaluation
  • Occupational Therapy and Physical Therapy and Evaluation
  • Assistive Technology Device
  • Nursing, Physician, Vision
  • Psychological Counseling and Social Work
  • Developmental Testing
  • IDEA Assessment
  • Orientation and Mobility
  • Service Coordination
  • Medical Transportation

I am NOT a qualified health care worker and I do not provide “direct health services.” Neither do I coordinate any health care services. To claim that I do so would be fraudulent.

The examples provided to the special education teachers in my district, to aid us in completing the "Clinical Service Record" forms, list the following suggested entries:

  • “Discussed IEP goals & objectives with general ed teacher”
  • “Discussed IEP goals & objective with parent”
  • “Scheduled IEP with parent, gen ed teacher, social worker”
  • “IEP meeting”
  • a note states “Consulted with is even better!”

To equate any of these examples with any of the specific ‘direct medical services’ on the above list appears to be a stretch.

At the Michigan site, it is acknowledged that between 1998 and 2000, the state “received four reimbursement disallowances and one deferral, totaling $427.6M”; that the denials were appealed and resulted in a settlement in 2002. In a fully underlined statement: “The Administrative Outreach component is currently undergoing substantial changes to comply with terms of the May 2002 settlement, so the data included in each claim is also likely to change.” (pg. 2, 10/11/02)

Near the end of the document, concerning the collaboration between the Michigan Departments of Education and Community Health, we read, “Since then (1991-92 development of SBS program) there have been many hurdles, the most recent being the disallowance of over $400M that the school districts will never receive.”

As a local taxpayer supporting the school district, I am not concerned about monies that the district may never receive. I am concerned about monies that the district has received and will receive; has spent and will spend; monies that may need to be repaid. When taxpayers are called upon to reimburse those Medicaid funds, we will be paying — for a third time — the costs of the original services for which the district hired the teacher — 1) original taxes to support the schools; 2) original taxes for the Medicaid program; 3) taxes to repay the spent money collected from Medicaid. The initial funding of the schools, including teacher salaries, should have been the sum total expected from the People. But it won’t be.

Michigan is not the only state where this abuse of the taxpayer is not only condoned, but also encouraged. Because of the courage of two whistleblowers in Texas, investigations are being made into the filing of Medicaid claims there: “Medicaid School Billing Under Fire.” A Google search for an individual “state + Medicaid + schools” should provide readers with more information than anyone could wish to see. One will find sites like, “With More Guidance, Schools Could Tap Medicaid For Special Ed” and “Special Ed & Medicaid Knowledge Base,” where schools might learn more finesse for claiming more funds.

There appears to be plenty of advice for those eager to get their hands into the communal pot-of-gold. I find it all very disheartening, and my thoughts repeatedly return to two disturbing, but enlightening, quotes. The first, credited to historian, Alexander Tyler: “A democracy can only exist until the voters discover that they can vote themselves money from the public treasury. From that moment on, the majority always votes for the candidates promising the most money…” and the second from author, Alexis de Tocqueville, “The American Republic will endure, until politicians realize they can bribe the people with their own money.”

School districts are being bribed with double; maybe triple financial reimbursements for special needs students. I am being ordered to ignore my code of ethics in order to participate in the bribe. In addition, I will be expected, in my role as a taxpayer, to shoulder an additional tax burden when the local district is ordered to repay ill-gotten and misspent funds. The students are too often trapped in special education placements since financial incentives reward districts for each and every new special education student they can create, identify, label and serve — academically or ‘medically’ — in special education classrooms.

School districts have little-to-no incentive to remediate and release special ed students. Those unfortunate, marked individuals are ‘ladles,’ used by politicians and school districts, to dip for cash and empty the treasury. Double-dipping; possible triple-dipping; are far more financially advantageous than closure-orientated special ed programs designed to 1) make children academically whole within the shortest possible timeframe, and 2) return healed, remediated children to the ranks of the normal, one-time-funded general education population. The children, as well as the special ed teachers, are being set up to fail — for the general financial health of the school districts. The IDEA laws state that all special education students must be placed in the “Least Restrictive Environment” but fail to hold accountable districts that label and warehouse the children who most need structured, skilled and timely academic interventions.

“Most Restrictive Trap” more honestly defines most special education placements — placements with lowered or non-existent expectations for remediating and releasing labeled students.

Medicaid funding is unhealthy! It compromises the chances for academic rehabilitation, and the lifelong economic health, of these, our weakest citizens.

Linda Schrock Taylor [send her mail] lives in Michigan. She is a free-lance writer and the owner of “The Learning Clinic,” where real reading, and real math, are taught effectively and efficiently.

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