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.

Leave a Reply