Friday night, Legislative Auditor Jim Nobles was interviewed by TPT’s David Gillette and Cathy Wurzer. During the interview, Nobles explained what his team had found. After that, he was asked if the department needed to be broken up. What Nobles said next should catch everyone’s attention. He said that “there’s this picture of me holding this organization chart of this one slice of DHS down to where the decisions seem to be made about this and yet there’s layer after layer after layer after layer of supervision and management that let this go on year after year after year until it’s been disclosed and we have a huge problem to unravel and resolve.”

It appears as though the problem was caused by DHS. Further, it’s clear that clearly-written rules weren’t followed. Nobles explained that “what we’re talking about is paying a very high rate of $455 for somebody to take a pill at home. It’s called an encounter rate and it’s called an encounter rate — and this is the DHS policy — because there’s supposed to be an interaction between a health professional and a patient. That doesn’t happen when you open your medicine cabinet, pull out the bottle of medicine and take the tablet and yet, they on paying $455 every time a client was doing that. That should have been obvious to many people in that chain of command that that was not a proper payment but it went on for years.”

Though you will get upset, it’s important for you to watch the entire interview:

It shouldn’t require a rocket scientist to figure out whether a patient is taking the medication at home or whether that patient saw a physician. More than anything else, this sounds like a racket. How can a team of supervisors and managers not spot something that noticeable? What’s most disturbing is the fact that this isn’t the first time that we’ve detected DHS mismanagement:

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.

The fact that people did the same thing a decade earlier indicates that the problem is more personnel-centric than anything. This sort of thing shouldn’t happen. Everyone in that chain of command should be terminated immediately. The definition of supervise is “to oversee (a process, work, workers, etc.) during execution or performance; superintend; have the oversight and direction of.” There’s no sense in sugarcoating what happened. This group of supervisors and managers didn’t do their jobs:

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.

This isn’t a matter of breaking up DHS. It’s a matter of insisting the people doing their jobs. If the employees, at whatever level, won’t do their jobs, they need to get terminated.

Splitting up DHS might be needed. It might not. To me, that’s a separate issue. If employees don’t do their jobs, then it won’t matter if DHS is split up. Firing employees who don’t do their jobs is essential. If government employees won’t do their jobs, then it’ll require privatizing the employees.

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