Archive for the ‘Healthcare’ Category

Despite all of the hearings into Minnesota’s Department of Human Services, this article hints that what’s been discovered thus far is just the tip of the proverbial iceberg. The article starts by saying “A top official at the Minnesota Department of Human Services has told Legislative Auditor James Nobles that recent overpayments to two Indian bands represented just ‘one example’ of wider dysfunction in the agency’s oversight of millions of dollars in state and federal money.” That isn’t difficult to believe.

Later in the article, it states “In an interview Friday, Human Services Commissioner Jodi Harpstead said she is on track to release a promised plan to address the agency’s problems in early December. She also is interviewing candidates with management experience to fill two assistant commissioner jobs, including one overseeing health care. We are working to be tough on the process and supportive and encouraging of our people, and trying to get that into the culture here.”

The people that are currently part of DHS are the problem. If they hadn’t screwed things up with program after program, Minnesota wouldn’t be in this fiasco. Minnesota isn’t alone in terms of Medicaid fraud but Minnesota is a leader in the worst way. This is frightening:

“No single person knows everything that is going on in DHS related to Medicaid” is what Marquardt, the assistant Medicaid director, told the Office of the Legislative Auditor, according to a summary of her comments obtained by the Star Tribune. Marquardt also described frosty relationships between Medicaid and other DHS divisions. “Our presence was not always welcomed,” Marquardt told the auditor’s office. “There is a culture of keeping HCA out of the business of the other divisions,” according to the summary.

Throw into this hot mess the fact that the DFL has a problem with Legislative Auditor Jim Nobles:

Thankfully, Mr. Nobles set the record straight on why he made the statements and characterizations that he did. It’s difficult to picture a department that’s been more mismanaged than DHS. Thank God Mr. Nobles editorialized a little so that it got people’s attention. It might make people uncomfortable but it got their attention. When a house is on fire, it’s ok to blast the sirens because you aren’t worried about waking up the neighbors.

According to this article from CBS Boston, the problems in the Minnesota Department of Human Services are widespread. To quote the article, “DHS lost track of hundreds of millions of dollars in taxpayer money in just the last five years. That’s according to numerous investigations, reviews and outside independent analysis of one of Minnesota’s largest and most important agencies.”

Check this out:

Here’s a partial list in one place:
DHS Fraud/Waste

  • 2016: $271 million to MNsure.
  • 2017: $7.7 million to Medicaid.
  • 2018: $30 million to MNCare.
  • 2019: $72 million in child care.
  • 2019: $3.7 million to dead people.
  • 2019: $30 million in opioid overpayments.

That list alone comes to $414,400,000. That’s almost half a billion dollars spent on people who allegedly didn’t qualify for their various programs. That’s quite stunning in light of this fact:

Minnesota’s sprawling DHS occupies a full city block in downtown St. Paul, with 16,000 employees and a budget of $17.5 billion.

That’s before learning this:

DHS manages thousands of programs for Minnesota’s most vulnerable poor, disabled, seniors and children. Those programs include food stamps and housing, health care, refugee resettlement, sex offender treatment, gambling, drug addiction and mental health, and much more.

Then there’s this:

That statement is from 2011. The statement said that oversight was weak even then. Think about that a minute. Things didn’t change in almost a decade. Then think about this frightening thought: Elizabeth Warren and Bernie Sanders want this to be the blueprint for health care ‘reform’. You can virtually hear people saying ‘Over my dead body’. The frightening thought about that battle cry in Minnesota is that those dead people might get a check from Human Services.

Trusting DHS isn’t a worthwhile effort.

After last week’s articles and statements about the difficulties identified within the Department of Human Services, Minnesotans didn’t expect to get blasted wit more graft, corruption and unauthorized payments. After reading this statement, though, it’s looking like reports like those will become relatively routine.

First, it’s totally legitimate to call some of what’s happening graft:

the acquisition of money, gain, or advantage by dishonest, unfair, or illegal means, especially through the abuse of one’s position or influence in politics, business, etc.

Let’s look at what’s been identified:

Senate Republican leaders announced a Senate Finance Committee hearing next week to examine the use of illegal contract and spending practices in state agencies. Based on recent reporting of brazen use by DHS employees of the 16A/16C forms that approve spending on services and purchases without a signed contract, a request has been made to the Department of Administration for their 16A and 16C forms across state government.

This agency is the fastest growing part of our budget,” said Senator Julie Rosen, Chair of the Senate Finance Committee. “We’ve heard about the fraud in childcare assistance, we’ve seen the waste in overpayments to the tribes, and now we have abuse by agency staff spending money without approval and filing a ‘get out of jail free’ form each time.

With the biennial budget signed, it’s time that Gov. Walz focused on fixing DHS. It’s the fastest-growing department in the budget. It’s filled with fraud, corruption or people who simply don’t give a damn:

Senator Michelle Benson, Chair of the Senate Health and Human Services Committee, said “Commissioner Harpstead has been given an impossible task. The CFO at DHS has been trying to fix this problem, but the entrenched bureaucracy is preventing meaningful change. The governor needs to stop the ribbon cuttings and dig into fixing DHS,” Benson concluded.

It’s time for heads to roll. It’s foolish to argue that the inmates aren’t running the prison within DHS. At this point, there’s too much proof that what few guidelines and safeguards exist aren’t taken seriously. Major departments can’t function without systems that are well thought out and taken seriously. Departments that ‘operate’ without well thought out guidelines are profiles in anarchy and chaos.

The 16A/16C form expressly states: A payment made in violation of this chapter is illegal. …the violation is just cause for the employee’s removal by the appointing authority or by the governor if an appointing authority other than the governor fails to do so. (Emphasis added.)

If Gov. Walz won’t take this crisis seriously, then he should get defeated in 2022 in a landslide. Wasting 100s of millions of dollars without legitimate oversight is certainly despicable, if not outright corrupt.

The frightening part of this is that it isn’t limited to a rogue agency. To use Jim Nobles’ characterization, this situation is “pervasive.” More on that in the next article.

It isn’t a well-kept secret that the Minnesota Department of Human Services is in utter chaos. This is one of the biggest crises we’ve seen in Minnesota. And remember that Minnesota is the state that brought us such wonderful experiences as MNLARS, MNsure and the lesser-known MnChoices. But I digress.

Last week, senators learned from the “Legislative Auditor’s report” that “DHS staff can make decisions to spend Medicaid funds without review and approval from DHS officials who are responsible for the state’s Medicaid program. The agency also lacks a policy that requires that its various divisions, offices and units to obtain approval from Medicaid officials before making spending decisions.”

That isn’t the worst of it. Then there’s this:

The legislative auditor found, for instance, that the agency’s behavioral-health division had its own staff for setting payment rates and that it did not coordinate with the health care division, which actually oversees payments. Because DHS failed to establish uniform payment controls, the unauthorized payments to White Earth and Leech Lake continued for several years, the auditor’s report said.

That led to this:

The overpayments were for an unauthorized billing practice that enabled the bands to bill the Medicaid program an unusually high rate, $455 a day, for an anti-addiction medication, Suboxone, even when patients took the drug at home without interacting with a clinician. The payments continued over several years even though they were never authorized. A month after that billing error became public, the agency disclosed that it was ordered to repay $48 million to the federal government.

That’s quite a lovely little slush fund that the Tribes might operate. After all, the Tribes were responsible for billing “the Medicaid program an unusually high rate” of $455 per day. That’s a fund of $166,075 per year per patient. The report didn’t state how many patients used this program so let’s go with 25 patients per year. Potentially, that’s a nest-egg of over $4,000,000 a year. The report said that this practice lasted more than a decade. A dozen years of doing this might lead to a balance of almost $50,000,000.

Sen. Michelle Benson, the chair of the Senate Health and Human Services Committee, said “Your internal auditors do not appear to have taken internal controls seriously.” That’s quite the understatement. Apparently, DHS auditors weren’t the only government employees who didn’t take things seriously:

In its report, the legislative auditor found that no one at the agency documented the decision that allowed the Indian bands to bill the Medicaid program for self-administering drugs at home. The state’s failure to do so, the auditor’s office found, violated the Minnesota Official Records Act, which requires that state agencies preserve all records “necessary to a full and accurate knowledge” of their official activities.

“We continually asked, ‘What is the documentation? Do you know who made the decision?'” Nobles told legislators at Wednesday’s hearing. “… No one raised their hand and said, ‘I made the decision and I’m responsible.’ It’s disturbing that this could occur.”

I can’t picture this working:

To address the problems, she said a team of experts is coming together to identify the root cause of the overpayments and map out how decisions are made and by whom. She also has proposed a tighter process for documenting decisions. The changes, Harpstead said, will result in multiple layers of approval before Medicaid funds are disbursed — and a clear paper trail.

Instead of hiring a “team of experts”, why not hire a competent person with executive experience, then task that person with the responsibility of implementing clearly defined procedures for each of the tasks that agency is responsible for? Hiring a team of experts might muddy things more than fix things. It’s better to hire one competent person, then give that person the authority to fix that agency. That’s because that person can’t pass the buck off when the problem isn’t fixed.

This must be fixed ASAP. Too many Minnesota and federal tax dollars have gotten spent improperly. That needs to end immediately. The OLA should audit DHS again within the next 3-4 months to see whether Commissioner Harpstead’s new plan is fixing the problem.

Further, there’s a legislative component to this, too. What’s required is the ability to terminate incompetent or corrupt officials. Letting incompetent or corrupt officials collect like deadwood is likely how DHS slid into this crisis.

Last Thursday’s hearing of the Senate’s Health and Human Services committees elicited important testimony, although it’s impossible to picture it having been pleasing. Michelle Benson is taking a trust-but-verify attitude towards Health and Human Services:

“For the most part, Commissioner Harpstead said all the right things in yesterday’s hearing,” said Sen. Michelle Benson (R-Ham Lake), chair of the Senate Health and Human Services Finance and Policy Committee. “Acknowledging they made errors and need to clean up their processes is an important step. One issue on which I will continue to demand a straightforward answer, however, is what will happen when the federal government asks Minnesota to return the $29 million in overpayments. Will DHS attempt to bury it in a forecast adjustment? Or will they be open and upfront? If it’s the former, I will have serious problems. I will be watching carefully to make sure they follow through on their promises and their accounting for these illegal payments is transparent.”

Sen. Benson didn’t pull punches:

Yesterday, Benson indicated major cultural changes need to happen at DHS. “If you want to know how much bureaucracy and unaccountability costs state government, look no further than DHS,” she said. “Several levels of management were either too incompetent or too indifferent to check for and identify obviously erroneous payments.” The OLA report yesterday indicated that no one in DHS has taken responsibility for the overpayments, and there is no documentation to determine who made the decision for the higher payment structure to the tribes. “There are six managers between the Opioid Treatment Authority Representative and the Commissioner,” Benson continued. “All of them failed—miserably. If none of them are going to take responsibility, none of them should keep their jobs.”

This is what happens when the people don’t care because it isn’t their money. It’s either corruption or incompetence or both. How do 6 managers not catch this simple mistake? This isn’t just about restructuring of DHS. It’s about getting rid of these potentially incompetent, corrupt employees. You’ll be shocked at Jim Nobles’ statement 4:20 into this video:

The standard payment for these opioid addiction programs is $455 when the patient visits the clinic and receives a dose of whatever medication they’re taking. According to Mr. Nobles’ testimony, there isn’t supposed to be a payment if the medication is self-administered at home. Mr. Nobles said that $455 was paid to the White Earth and Leech Lake tribes when patients self-administered their medication.

When the patient visits the clinic, then gets a dose of medication, that’s called the “encounter rate.” DHS kept paying the White Earth and Leech Lake tribes the encounter rate even when the patient self-administered. It isn’t surprising that these tribes refused to answer Mr. Nobles’ auditors’ questions when they did their audit. Further, DHS employees wouldn’t cooperate either.

The tribes have issued a statement saying that they won’t pay back any of the money because it wasn’t their fault. Knowingly accepting money that isn’t due to the tribes is certainly their fault. That being said, there’s no doubt that DHS is at fault, too. They’re the ones who made the allegedly unjustified payments. Nobles testified that “In fact, the tribes were told by officials at the Department of Human Services that they could receive those payments. That was direction and guidance that the Department gave.”

There’s no question that the tribes received a ton of money from this federal program. What isn’t known is who authorized the improper payments. If nobody at DHS admits who authorized the improper payments, that entire group of managers should get terminated. They didn’t have the statutory authority to approve those payments. If there wasn’t a clinic visit, there shouldn’t have been a payment. That isn’t difficult to figure out.

There’s no question whether Elizabeth Warren stirs passion with her followers. Sen. Warren’s followers aren’t her problem. She’s her own worst enemy at times. A perfect example of this happened when Sen. Warren explained her Medicare-for-All plan. There’s no doubt about whether she’d like to have this part back:


Saying that you’re putting people in the insurance industry through a major transition (that’s if you’re lucky) in Des Moines, IA, isn’t too bright. Sen. Warren’s plan includes eliminating private health insurance. Think of that statement to be the equivalent of Hillary making this statement:

Sen. Warren thinks about herself first, last and always. It isn’t surprising that she expects health insurance experts to just accept her edict. From a policy standpoint, Sen. Warren’s Medicare-for-All plan stinks. There’s no way to pay for it. From a political campaign standpoint, Sen. Warren’s campaign manager must’ve cringed when Sen. Warren told people living in the insurance capitol of the United States that they’re destined for pink slips if she’s elected president.

That’s like telling Iowa farmers that you hate corn and pigs. That’s like a Wisconsin politician telling tailgaters at Lambeau Field that he/she hates the Packers. It’s political suicide.

Recently, Joe Biden has struggled with Iowa. This incident won’t put Biden over the top in Iowa but it’s a great opportunity for him to sound like the sane candidate in Iowa. Frankly, it’s a gift to his campaign. The comparison isn’t flattering to Sen. Warren. I’m certain that this isn’t a coincidence:

Joe Biden raised $5.3 million through a surge of online contributions in October that rolled in after President Donald Trump launched unfounded attacks against the former vice president over his son’s Ukrainian dealings.

The swell of cash came from 182,000 donations, with $28 being the average amount given, according to figures provided to The Associated Press by the campaign, which did not include money that Biden raised through big-dollar fundraisers. It comes after his internet fundraising operation stumbled over the summer, leading critics to suggest he lacked grassroots support.

This helps, too:

Actress Alyssa Milano will co-host a fundraiser next month for former Vice President Joe Biden’s 2020 presidential campaign, Variety reported.

Sen. Warren just committed an unforced error. What’s still TBD is whether Biden can take advantage of Warren’s mistake.

Jim Nobles’ special investigation report highlights how lax the oversight of the Department of Human Services has been. It also highlights the corruption within the Department:

Over a decade ago, and without authority, DHS officials decided that it would pay opioid treatment providers when their clients took medication at home.

A few years later, and again without authority, DHS officials decided it would pay tribal opioid treatment providers the Indian Health Service (IHS) encounter rate when their clients took medication at home. That’s just the tip of the proverbial iceberg. Here’s more:

Who made the decisions, why, and when is not clear because DHS officials never documented their decisions. Even during the interviews we conducted, DHS officials could not recall who was responsible. In addition, none of the DHS officials we interviewed could offer a credible rationale for paying health care providers for their clients taking medications at home.

Frankly, all of the people involved with this corruption should be terminated immediately. They’ve proven that they aren’t people of integrity, which is a requisite for the position. If they can’t be trusted, they shouldn’t be employed. Period.

On February 12, 2019, a representative of the Red Lake Nation e-mailed a DHS opioid treatment expert to find out if Red Lake’s opioid addiction treatment program could receive the IHS encounter rate for days when clients took treatment medications at home. Red Lake already operated an opioid addiction treatment program, but it had not given its clients treatment medication to take at home.

The DHS expert told Red Lake “yes”; Red Lake would be able to receive the encounter rate when clients took treatment medication at home. But another DHS official copied on the e-mail told Red Lake to wait for an official response.

The department did not, however, issue an official response to Red Lake until May 1, 2019. In a letter to Red Lake, Leech Lake, and White Earth, the DHS commissioner reversed the department’s long-standing practice of paying tribes for their clients to self-administer treatment drugs at home. The commissioner told the tribal chairmen that DHS can only pay the IHS encounter rate when there is a face-to-face interaction between a client and a health care professional.

There’s no way it should take 11 weeks to respond to a question that simple.

Also on May 1, 2019, the department finally implemented a policy and a payment control that stopped the department from making payments to tribes when clients take medication at home. The department took another three months to inform the White Earth and Leech Lake tribes that they must return all of the payments their tribes received from DHS for clients self-administering medications at home.

Leaders of the White Earth Nation and the Leech Lake Band of Ojibwe have expressed frustration with how DHS has communicated with them about the overpayment issue. They have placed responsibility for the overpayments on DHS and questioned their obligation to repay the state. The state could face legal challenges in its efforts to require White Earth and Leech Lake to return the overpayments.

Republicans have ideas to reform Human Services. Unfortunately, the DFL is interested in reforms only if terrible employees are protected. That’s because the DFL is owned by the public employee unions. This corruption can’t continue.

President Trump’s marathon political rally ran the gamut of emotions tonight. The word from the MSM was that it was a vitriolic speech. The MSM rightly noted that President Trump reserved his harshest words for Ilhan Omar, Joe and Hunter Biden.

I can’t dispute that this 102-minute speech was filled with red meat for the partisans, of which I’m one. Of Omar, President Trump asked “How the hell did that happen?” I’m sure lots of people wonder what they did that they deserve that. Of Democrat leadership, President Trump called them “Chuck and Nancy”, sarcastically adding that they’re “2 beauties.” Isn’t that a fact.

At one point, President Trump brought Officer Robert Kroll up onto the stage, to the enthusiastic approval of the audience. Later, Lt. Kroll appeared on Shannon Bream’s Fox News @ Night program:

Let’s be clear about this. The Trump campaign is going all-in with Minnesota. They came close with a shoestring budget. This time, Campaign Manager Brad Parscale announced that Republicans will spend tons of money to flip Minnesota:

The Trump/RNC team already have 20 paid staff in Minnesota. Parscale anticipates a full-time paid staff of almost 100 by the time the parties’ national conventions happen. Based on what I saw at last night’s Trump rally, Minnesota Republicans have never been this excited and motivated. Minnesota Republicans want to flip Minnesota this time. I think that’s definitely possible. President Trump also hit the hot-button issue of the Somali Refugee Resettlement issue:

“For many years, leaders in Washington brought large numbers of refugees to your state from Somalia without considering the impact on schools and communities and taxpayers. I promised you that as president I would give local communities a greater say in refugee policy and put in place enhanced vetting and responsible immigration control. And I’ve done that,” Trump said, touting a reduction of refugee settlement by 85% since taking office and his “travel ban” on certain Muslim-majority countries.

This isn’t just about keeping a campaign promise, which is a significant accomplishment. It’s about imposing accountability on the State Department and organizations that use the program as a cash cow. It also refutes the things that St. Cloud Mayor Dave Kleis told Councilman Jeff Johnson. This proves that Councilman Johnson is right.

Predictably, the haters, aka anarchists, aka #BlackLivesMatter and Antifa, were out causing trouble:

Despite their antics, the rally was a huge success. All of the estimates I heard last night put the combined crowd at almost 50,000 people. The campaign announced that they got almost 100,000 requests for tickets to last night’s rally.

DFL Chairman Ken Martin put out this dishonest statement after the rally:

“Tonight Donald Trump’s rally was all about Donald Trump , just like his Presidency. No talk about policy, no talk about his vision for America, no talk about what he would do to improve the lives of Americans. Just a bunch of attacks, deflection, and stroking the egos of the blindly-loyal Republican elected officials and candidates who have clearly put their oath to Trump ahead of the oath they took to protect and defend the constitution of the United States of America. To paraphrase the late great Molly Ivins: Trump’s speech tonight was much better in the original German.

Despite Chairman Martin’s dishonesty, President Trump talked about the progress being made building the wall, the improvements already made in the refugee resettlement program, bringing troops home from the Middle East, cutting regulations that have produced the energy boom and providing veterans health care choice. Other than those substantive improvements, Chairman Martin is right.

According to this article, Democrat activists have pushed Angie Craig into supporting President Trump’s impeachment. Ms. Craig hasn’t been a portrait in courage since getting elected. Instead, she’s been part of the Do-Nothing Democrat Caucus since its inception. To her credit, Craig has admitted (in a roundabout way) that President Trump’s economy is working but that government is failing to provide Minnesota’s workers:

We have a major skills gap in the Minnesota job market. Minnesota employees cannot find the skilled workers they need with the right qualifications, and right now job seekers are having a difficult time getting the skills they need for the high-paying jobs that are available today. College isn’t the right path for every student and we shouldn’t be limiting the options of Minnesota students by underfunding or de-emphasizing technical education and career skills programs.

If employers are having a difficult time finding workers with the right qualifications, that’s an endorsement that President Trump’s economy is working. It’s also an indictment that government isn’t doing its job of training students to be productive members of the workforce. But I digress. That’s a topic for another day.

Far-left activists and politicians have been demanding the impeachment of President Trump since the first day he got elected. The problem is that according to a recent poll by Monmouth University only 35% agree that President Trump should be impeached.

University of Minnesota Professor Richard Painter who previously challenged Tina Smith for the US Senate in the Democratic Primary raised some eyebrows when he implied he was unhappy that he didn’t feel that Angie Craig was aggressive enough on impeaching President Trump.

No problem for Angie Craig:


All it took for Angie Craig to admit that she’s pro-impeachment was getting called out by a far left activist. If that isn’t a profile in courage, what is? Angie Craig is an empty pantsuit. How left is Richard Painter? This far left:


Angie Craig is now admittedly pro-impeachment and pro-single-payer health care. Whoever is the Republicans’ candidate against Craig should remind voters of those 2 things morning, noon and night every day through Election Day, 2020. I’ll buy that CD-2 is shifting demographically. I don’t buy that they’re shifting to a hard-left district that’s as far left as MN-04 or MN-05.

This election will come down to who the people think is best suited to make decisions. This isn’t just about whether President Trump is the best decider or whether it’s Bumbling Joe Biden, though that’s certainly part of it.

It’s also about governing philosophies. Nowhere is that more evident than in the fight between motorists and various transit authorities across the nation. In LA, they’re going through such a fight. This is a good depiction of what’s happening in LA:

Since 2013, public transportation in LA has seen a 24% decline, as commuters migrate to either their own cars to ride shares like Uber and Lyft. The reason is quite clear: mass transit is slower, less direct, and often entails sharing a bus with people who range from annoying to dangerous.

There’s more:

This is all very frustrating, of course, to the erudite bureaucrats who have been charged with getting the hoi polloi out of cars on to busses. This is especially true since the city is in the midst of a 40-year, $120 billion Maoist “master plan” to create a mass transit utopia.

Basically, there are two ways to influence consumer choice. You can either provide a superior product or service and entice change, or you can coerce people through the explicit or implicit threat of negative government sanction. In the eyes of the bureaucrat, there is only one way.

Providing a superior product is capitalism at its finest. It’s what’s produced the finest products in their categories. When the government tells a car company they must sell a certain type of car, sales of that type of car usually aren’t very good. If there was a demand for that type of vehicle, companies would’ve already started manufacturing it.

Compare that with the health insurance policies required by the ACA. They were such inferior policies that they couldn’t be sold except if they were forced down people’s throats with the individual mandate. Even with the penalty hanging over their heads, Democrats still couldn’t sell the ACA QHP (Qualified Health Plan) policies. Nothing says something’s a great product as the product that can’t be sold except at gunpoint.

This election is about electing a person that trusts people to make their own decisions vs. electing a person who thinks like this:

As Phil Washington, the bureaucrat in charge will lecture us, “Sometimes you have to tell people what’s good for them.”

Bernie Sanders certainly thinks that excessive government knows best. Joe Biden certainly thinks that forcing people to buy things is right. Does anyone think that Elizabeth Warren wouldn’t try shoving some form of Medicare-For-All down our throats?

It’s time for Republicans to come up with a single plan that lowers premiums and out-of-pocket expenses while increasing choices and returning decision-making to the people. The only way we come up with that plan, though, is if the politicians swallow their egos for the good of the team.

There’s no question the average family is best equipped to make decisions for their families. It’s time to tell Democrats that we want them out of the business of making our decisions.