Published: September 21, 2008 09:39 pm         

Weeks wants Medicaid program federally audited

For most of his one term as a state senator, Russ Weeks antagonized the Department of Health and Human Resources.

Now that he’s running for governor, little has changed in his relationship with the agency.

There is one big exception.

Weeks finds himself armed with a new issue — a controversial Medicaid redesign that has left a wedge between the DHHR and a number of providers who are irate over non-payment and what they see as the exclusion of behavioral patients because of a feeble public relations program.

In the simplest terms, what the DHHR did was split the Medicaid program in half. Many behavioral patients didn’t get into the elevated program out of a misunderstanding of where and how to enroll, providers say.

And that omission, they contend, and Weeks agrees, poses a sticky situation, possibly even acts of violence by behavioral patients.

“There is a definite danger,” Weeks says. “Say someone is going off his medicine who is schizophrenic and his staff is removed from him. The staff would ensure that he took the medicine or did what he is supposed to do. But if you had no one around like that, then you have caused a problem that society is going to have to take care of. Whereas, just a little bit of common sense in the first place would stop this.

“If they get off their medication for one reason or another, there’s no support staff. Next thing you know, they’re out here on the streets and they become a police problem.”

Weeks battled the DHHR his entire term, largely over what he perceived as criminal acts in the operation of Pinecrest Hospital in his hometown, and at one stage, he and Sen. Donna Boley, R-Pleasants, teamed to seek an audit since the agency hadn’t been scrutinized in seven years. That request came in 2004, and noting was done.

“It’s been over 10 years now, and nothing has happened,” he said. “You’re talking about an average of about $2 billion a year spent by Medicaid. That money is out there being spent somewhere by someone on some things we don’t know about. We have no idea.”

If elected, Weeks vowed to clean house in the agency and demand that federal auditors give the books a thorough going-over, along with independent auditors.

“The DHHR needs to better handle the money they’ve got,” he said. “I will call in federal auditors to look at Medicaid and any other federal funds that we receive. State accounts, too. That will be done by outside, independent auditors.”

Weeks sees a disturbing parallel between the on-going controversy over the redesign and the snafu that haunted general health care providers a few years ago when the DHHR contracted with Unisys Corp. to act as its billing agent. Providers were up in arms over non-payment for services provided. Some were teetering on the brink of financial ruin.

“This is Unisys all over,” he says of the redesign. “Unisys bankrupted Medicaid providers because they just would not pay their bills. They could up with (excuses), ‘you know, you didn’t put a dot at the end of this sentence, so you’ve got to do it all over.’”

Once he became involved and called DHHR, the former senator said, a provider would get a check for $250,000.

“But there would be no indication in there as to what accounts they would be credited to,” he said.

Weeks faulted the DHHR in the redesign, saying it failed to provide behavioral patients an adequate explanation of the change, and, consequently, many are falling through the cracks.

“These systems they put in place are not well thought out,” he said.

“These are third-party systems that they are using like Unisys, a billing system to replace the one that the government provides.”

Weeks said many receiving DHHR services can neither read nor write and simply are unable to comprehend the changes ushered in by the redesign.

“How in the world can someone who supposedly is as educated as (DHHR Secretary) Martha Walker expect people like this to comply with all the rules and regulations?” he asked.

“No smoking? Go on a diet? Some of these people can’t comprehend what a diet is. They can’t do it. And the state is holding them responsible for the state’s incompetence.”

— E-mail: mannix@register-herald.com