A scandal waiting to happen: NC DHHS

folks who pay attention have been waiting for the mismanagement and un-management at DHHS to come to public attention for many years.

Now it has.

Link to the audit of DMA by State Auditor Beth Wood released at a press conference in Raleigh today:

http://www.ncauditor.net/EPSWeb/Reports/Performance/PER-2013-7291.pdf

I don't know how Gov. McCrory can flush out the many rats associated with DHHS and DMA. They've been bringing in their own for years.

Comments

State Auditor's Report

While the State Auditor's Report brings up some legitimate concerns, it seems that the auditors have a fundamental misunderstanding about the way that federal dollars from the Medicaid administrative match are used to leverage State appropriations to support the administration of much needed programs for the disadvantaged. The BlueNC readers ought to be supportive of the use of federal dollars to sustain important programs at the Division of Mental Health, the Division of Public Health and other State agencies. These agencies have seen the money funneled through the Division of Medical Assistance (DMA) as a way to stave off very damaging cuts to programs that help many North Carolinians. Rather than criticizing Governor McCrory for something that flourished under the reign of Democratic governors and Democratic controlled NCGAs, perhaps you ought to study the issues more carefully. I would not be misled by the State Auditor's Report; other states do the same thing--they have others way to hide these interagency transfers. These states are certainly not going to share privileged information with auditors from North Carolina regarding how they use different revenue streams to fund their sister state agencies.

The real important story lost among all of the hoopla about contracts and interagency transfers is that DMA itself operates on a much leaner budget than most other State Medicaid agencies. More oversight would be possible if DMA was adequately staffed as compared to its' peer programs in other states. Does the report state how many employees DMA has compared to the Medicaid agencies in the State of Arizona, the Commonwealth of Massachusetts or other states with a comparable population of beneficiaries or comparable Title XIX expenditures? I say give DMA the resources it needs to do its job better and stop complaining about lack of oversight from an agency that has been operating on bare bones labor costs for many years.

2 questions about this response

One: Why not sign your name?

Two: Who said anything about agency transfers? I only raised the issue of excessive salaries and excessive administrative overhead. Care to respond to what was actually brought up?

PS Those who know me know I have lobbied for greater funding of DHHS for years--but not for higher salaries and overhead. Greater funds for useful services. Those are in short supply as the folks at the top are not concerned about the people they are supposed to serve.

Martha Brock

Oversight

A general comment about a broader issue:

Our paternalistic and paranoid culture has a fetish for oversight, even when it proves to be worse than a waste of resources. In public education, for example, we are testing kids to death, while ignoring the fact that the testing regimens are, all by themselves, degrading educational and teacher performance.

It's the old Hawthorne effect, and in many cases the effect is to depress effectiveness, distract professionals from doing their jobs, and perpetuate the culture of "gotcha" politics.

We now return to your regularly scheduled program.

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“Don't tell me what you value, show me your budget, and I'll tell you what you value.”
― Joe Biden

Thanks for your responses.

Thanks for your responses. Here are mine:

Ms. Brock's questions:

1) If BlueNC does not want anonymous comments, the web site should require a name from the person who would like to post a comment.

2) Please read the State Auditor's Report and listen to her presentation to the NCGA on Thursday. Ms. Wood will tell you that her primary concerns are what I described in my first post. As to salaries and overhead--please see the second paragraph of my first post. If you believe that DMA itself has excessive salaries and unreasonable overhead (it does not), then you may be pointing the finger at an executive and legislative branch of government that for decades was controlled by Democrats. I know of only one appointment in the State Medicaid agency leadership which was made during a time when there was a Republican governor with a Republican majority in the NCGA.

Mr. Protzman's comments:

Please understand that Medicaid is a state and federal partnership. Much of the oversight of the program is required by the Feds. The Obama Administration has stepped up its' oversight of state Medicaid programs. I am not saying this is right or wrong; it is just a fact. What I believe you are saying is that we should do away with government oversight. If you would dig deeper, I think you would find that there is good reason for concern about potential fraud, waste and abuse. The concerns of the federal government are not as much aimed at state administrators as they are at some Medicaid providers and beneficiaries who abuse their privileges. The total amount of money that the feds and state administrators are attempting to recover is significant.

My apologies for confusing the issues

I had just read a lengthy report about the deleterious effects of monitoring, testing, and oversight in public schools ... and was having a Libertarian knee jerk reaction. I completely agree that effective oversight of the Medicaid program is essential ... mostly to keep business interests from ripping off the public.

In this free market fantasy land, it seems that the vast majority of fraud is committed by companies, not individual citizens.

James

PS As I've said on many occasions, we're happy to have anonymous comments ... and understand that some people may not be able to write publicly because of their jobs or other personal considerations.

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“Don't tell me what you value, show me your budget, and I'll tell you what you value.”
― Joe Biden