Jock Stender

commented on New York 2012-03-19 20:02:28 -0500 · Flag
I see that New York State earned a “D” and is 36 in “state corruption ranking.”

I cannot be proud that my state, South Carolina, earned an “F” and is ranked 45, but feel compelled to quote, for New Yorkers, part of today’s front-page New York Times article about your fair governor and the Medicaid fraud he now tolerates thanks to “push back” from the health-care industry.

Jock Stender
Charleston, SC

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The New York Times
By NINA BERNSTEIN
Published: Monday, March 19, 2012
Page A1

Under Pressure, New York Moves to Soften Tough Medicaid Audits

[PHOTO]
James C. Cox, New York’s new Medicaid inspector general, has said he intends to pursue a less “adversarial” auditing strategy.

[PHOTO]
James G. Sheehan, who was dismissed as inspector general last year, helped recoup $1.5 billion in Medicaid overpayments.

New York State was paying for the medical care of dead people when Gov. George E. Pataki and the State Legislature created the Office of the Medicaid Inspector General to curb billions of dollars in fraud and misspending by health care providers.

The turnaround was startling. Within four years the state had recouped $1.5 billion in Medicaid overpayments, the highest recovery rate in the nation. Other states rushed to create inspectors general like New York’s.

But a backlash from the politically powerful health care industry has erased broad support for the crackdown. Last year, amid a crescendo of provider complaints of overzealous, nitpicking audits and unfair tactics, Gov. Andrew M. Cuomo quietly dismissed the state’s first Medicaid inspector general, James G. Sheehan, and directed Mr. Sheehan’s successor, James C. Cox, to collaborate with providers on changes to the agency’s policies and auditing methods.

In an interview, James Introne, Mr. Cuomo’s deputy secretary for health, expressed the state’s new view.

“An audit need not be an adversarial enterprise,” Mr. Introne said. “To the extent that an audit turns into an adversarial affair, it may not be conducted properly. An audit is successful when people agree.”

The Cuomo administration said that enforcement was as vigorous as ever, and that Mr. Cox was on target to avoid $1.1 billion in improper Medicaid spending this year, even more than his predecessor. But veterans of Medicaid policing pointed to important audits that were started by Mr. Sheehan but have not been released, and said the inspector general’s office was at a difficult crossroads, caught between the Legislature’s allegiances to campaign contributors from the health care field and the governor’s plans to cut Medicaid costs, which depend on the goodwill of nursing homes, hospitals and home health agencies.

“An industry that’s regulated doesn’t love the regulator unless the regulator isn’t doing much,” said Arthur A. Levin, the longtime director of the Center for Medical Consumers, a nonprofit advocacy organization, who admired Mr. Sheehan. “Asking the regulator and the regulated party to sit down and come to some sort of consensus on how the regulation should be — to me, it makes no sense.”

Michael A. Zegarelli, a past president of the national association of Medicaid oversight officials and a senior regulator in New York until 2003, said that by definition, an audit that found overbilling, fraud or waste was “going to be adversarial.”

“Sheehan’s successor will have a short leash,” Mr. Zegarelli said. “Will that be for the benefit of the program, or to keep Cuomo’s constituency happy?”

[continues…]

commented on South Carolina: The story behind the score 2012-03-19 17:58:10 -0500 · Flag
Outstanding reporting !!!

What can citizens do about state-level official governmental corruption?

I encourage citizens to contact their legislators (at http://www.scstatehouse.gov/legislatorssearch.php) to FULLY FUND the new Statewide Office of Inspector General (S. 257, 119th Session, Act. 105), signed by the governor on Feb. 2 (see https://www.youtube.com/watch?v=tszO1rNjKAk; full text at http://www.scstatehouse.gov/sess119_2011-2012/bills/258.htm).

Some 25 years ago Sen. Mike Rose (R-Dorchester) introduced statewide OIG legislation, and it was “pushed into the drawer” (not assigned to a subcommittee, therefore, no hearings) by the powerful Chairman of the Senate Judiciary Committee. More than a decade passed. Sen. Bill Mescher (R-Berkeley) introduced another OIG bill in 2002 with the same sorry result: “pushed into the drawer.”

Finally, the stars were in alignment (and the public was incensed at state government corruption), and in December 2008 Sen. Vincent Sheheen (D-Kerhaw) filed as primary sponsor S. 138 (full text at http://www.scstatehouse.gov/sess118_2009-2010/bills/138.htm), a comprehensive OIG bill, with bipartisan support from co-sponsors Sens. Campsen®, Leventis (D), Rose®, Davis® and Bright®. THAT bill was also “pushed into the drawer.”

In the next session, no. 119, Sheheen introduced, with a few minor changes, the exact same bill, assigned no. S. 257, and got three of the five original co-sponsors (Campsen, Davis, Rose) AND SEVEN OTHERS (republicans and democrats alike). THIS bill captured the attention of all legislators (both senators and representatives), all of whom, interestingly, face re-election at the end of this term — in November 2012.

The result of facing voters at the ballot box soon with the OIG bill S. 257?

Unanimous approval of S. 257 by the S.C. Senate on April 7, 2011 (Ayes – 44; Nays – 0) and the S.C. House on January 11, 2012 (Yeas – 112; Nays – 0).

S. 257/Act 105 calls for creation of a “waste, fraud and abuse telephone hotline” as follows:

QUOTE

Section 1-6-90. The State Inspector General must establish a toll-free public telephone number for the purpose of receiving information concerning fraud, waste, abuse, mismanagement, misconduct, violations of state or federal law, and wrongdoing in an agency. The phone number must be prominently posted by all agencies, in clear view of all employees and the public, and in a conspicuous location on the agency’s Internet website.

UNQUOTE.

However, it does not stipulate that the hotline be answered 24-7-365 by a “live” operator, which is recognized by the Association of Certified Fraud Examiners and the Institute of Internal Auditors as the “best practice.”

See the white paper at http://www.epforensics.com/files/Hotline_Whitepaper.pdf

Several state entities have fraud hotlines, but after business hours, they are answered by a voice machine. Try it yourself at say, the Dept. of Health and Human Services, http://www2.scdhhs.gov/site-page/medicaid-fraud-costs-taxpayers-millions, hotline 888-364-3224, where a polite answering machine will take your message after hours.

Similarly, at the state’s OIG, http://governor.sc.gov/Pages/InspectorGeneral.aspx, the hotline, 855-723-7283, is answered by a machine after hours. I understand that Jim Martin, the Inspector General, strongly believes in the efficiency and effectiveness of a 24-7-365 “live” hotline, and that his office is preparing a requisition for the B&CB’s State Procurement Office to produce an RFP for hotline providers.

CITIZENS SHOULD SUPPORT THIS NEW STATE AGENCY CREATED TO HELP ERADICATE WASTE, FRAUD AND ABUSE IN STATE GOVERNMENT BY FUNDING IT ADEQUATELY. 24-7-365 “LIVE” FRAUD HOTLINES PAY FOR THEMSELVES MANY TIMES OVER.

SOUTH CAROLINA’S NEW STATEWIDE INSPECTOR GENERAL NEEDS YOUR HELP!

Jock Stender
Charleston, SC
March 19, 2012

commented on South Carolina 2011-11-10 16:20:04 -0600 · Flag
This just in regarding DHEC, putative protector of our delicate wetlands:

“Sheheen Calls For Resignation Of SC DHEC Board”

at www.FITSnews.com

http://www.fitsnews.com/2011/11/10/sheheen-calls-for-resignation-of-scdhec-board/

QUOTE:

“Today’s decision by the DHEC board is a disaster for our state’s environment and our future economic growth,” Sheheen said in a statement. “Selling out on protection of our sensitive natural habitats and our own economy is a blunder that will cost us dearly in jobs and natural resources. The DHEC Board members should resign immediately and Governor Haley should replace them with knowledgeable individuals who will represent the best interest of South Carolina and who are not campaign contributors to Haley.”

UNQUOTE.

Amen to that.

Please resign, Board.