No Insurer Will Say FGM Physicians Should Be Removed From Their Network
FGM clinic remains part of medical system.
Taxpayer-funded insurance programs pay two physicians federally prosecuted for performing genital cutting on children. No insurer or government agency will say whether it has ever reviewed them.
Dr. Jumana Nagarwala and Dr. Fakhruddin Attar were charged in the first federal prosecution of female genital mutilation in United States history. Both hold active, unrestricted Michigan medical licenses after the state closed its investigations without discipline. As previously reported, they now practice together at Livernois Primary and Urgent Care in Detroit, a clinic Nagarwala founded. The clinic’s website lists 13 accepted insurers. Seven are taxpayer-funded programs.
On June 15, I sent comment requests to Blue Cross Blue Shield of Michigan, Aetna Better Health of Michigan, Priority Health, UnitedHealthcare, Molina Healthcare of Michigan, HAP, Meridian Health Plan and Ambetter (both operated by Centene), McLaren Health Plan, Humana, the Michigan Department of Health and Human Services, and the Centers for Medicare and Medicaid Services. Each received a set of questions about physicians federally prosecuted for genital cutting on children with a request to respond by June 18.
Three responded. None named either physician. None answered the questions.
Blue Cross Blue Shield of Michigan (BCBSM) issued a statement attributable to the company:
“Blue Cross Blue Shield of Michigan is committed to providing our members with access to high quality healthcare providers. Part of our role is to protect our members from the human and financial costs of waste, fraud, and abuse. Should we determine that a crime has been potentially committed by a provider in our network, we have a dedicated investigations team that works with law enforcement to bring that provider to justice.”
BCBSM did not confirm or deny whether Nagarwala or Attar are in its network. It did not say whether it had reviewed either physician.
Aetna Better Health of Michigan, a Medicaid managed care plan, responded through Phillip Blando:
“Aetna Better Health of Michigan complies with all federal and state rules and regulations. Health care providers serving Medicaid beneficiaries in Michigan are screened through the State’s provider enrollment system. In addition, providers that are suspended or removed from the system, or subject to state or federal payment suspensions are not reimbursed by the state’s Medicaid program.”
Aetna did not name either physician. It deferred responsibility to the state’s provider enrollment system.
The Michigan Department of Health and Human Services, which administers Medicaid in Michigan, responded through spokesperson Lynn Sutfin:
“MDHHS is committed to ensuring that Michigan families have access to affordable health care and that every Medicaid provider is properly licensed and meets all state and federal requirements.”
MDHHS did not name either physician. It did not answer any of the five specific questions it received, including whether it was aware that Nagarwala and Attar are Medicaid-eligible providers, whether it had reviewed the federal prosecution, or whether it had any concerns about these physicians treating Medicaid beneficiaries, including children.
The following eight did not respond:
Priority Health.
United Healthcare.
Molina Healthcare of Michigan.
HAP (Health Alliance Plan).
Meridian Health Plan and Ambetter, both operated by Centene
McLaren Health Plan.
Humana.
The Centers for Medicare and Medicaid Services.
All of the above insurers are listed on the website for Livernois clinic owned by Nagarwala here.
Aetna says Medicaid providers are screened through the state’s enrollment system. MDHHS says it ensures providers are properly licensed. The licensing agency, Michigan’s Department of Licensing and Regulatory Affairs, closed its investigations into both physicians without discipline. LARA’s Board of Medicine unanimously recommended summary suspension in April 2017. Neither license was ever suspended. Both investigations were closed before the federal case ended.
The insurer relies on the state enrollment system. The state enrollment system relies on the licensing system. The licensing system closed the case.
No institution in this chain said it had reviewed whether these physicians should be in its network.
Female genital cutting on children is a federal crime under the STOP FGM Act of 2020 and is illegal in most states, including Michigan.
This is an ongoing investigation. If you’d like to support this work, you can contribute here: Expose Medical Board for Licensing an FGM Doctor