To understand the present it is important to look at the past. Sometimes this means going all the way to the beginning of things. Reassessing events within a historical perspective and the distance of time helps appreciate what others have done and brings new light to events that at one point were misinterpreted It is important therefore, to put things into perspective to appreciate the progress that has been made at this time.
The headline of the Tallahassee Democrat for September 11, 2001 reads: Secretary of Elder Affairs wants state control over programs. The subtitle adds: Legislators and service providers oppose the plan. The article goes on to explain how Secretary Hernandez of the Department of Elder Affairs wanted to hold service providers more accountable for the state and federal monies. She is quoted as questioning private providers using their political influence and not meeting their contract requirements with the State. The article mentioned that Secretary Hernández was scheduled to testify that afternoon in front of Representative Carole Green’s committee which demanded Hernández justify her actions.
Quotes from Representative Green opposing Secretary Hernández’ plan and opposing the plan because, according to Green, Hernández was instituting changes the legislators opposed were frequently mentioned in the article. Secretary Hernández’ statement to the reporter supported the fact that her testimony was going: 1) to present evidence of poor accounting practices and overcharges to state budgets by private providers, 2) introduce steps to correct the situation and to avoid the continuation of public supported monopolies, and 3) bring the State of Florida in compliance with Medicaid waiver regulations. The fact that the testimony was scheduled for September 11, 2001 at 1:30 P.M. at the State Capitol needs no further explanation as to why it was never presented. Perhaps, if the testimony had been presented with all the attachments and documents the public would know more than they do now and the waiting list for services would be much shorter than it is today.
The testimony was never to be given and two boxes of documents supporting the need for more accountability, compliance with Medicaid laws and investigation of unit cost methodologies were never to see the public light. It has been said that all the documents were shredded and records erased. Within days of September 11, public officials influenced by powerful agencies, the same few powerful agencies that were to be embarrassed by the exposure of their business deals, sent letters to the politicians asking for the removal of the Secretary. This is the Secretary who wanted to bring more accountability, choices and transparency to the business of government.
The Secretary’s plan and course of action as interpreted by Carole Green, Ken Pruitt and others as being in violation of legislative approval was to be quietly implemented behind closed doors as the media and the public stopped looking. Even within days of Secretary Hernandez’s departure the Governor was quoted in the Miami Herald as saying “I don’t know if what she was doing required legislative approval or not”. The famous “pilot projects” that became the focus of the media and the lighting rod used by non complaint agencies to demand the removal of the Secretary were implemented as planned in Pensacola outside the public eye. The same accountability issues Secretary Hernández exposed began to be silently addressed so the legislators that had been so publicly in support of powerful providers would not be embarrassed. The same legislators that took leadership roles in stopping the exposure of malfeasance diverted additional monies away from the open budget process to allow the Pensacola Area Agency on Aging to become a case management entity.
Now, almost three years later, the famous 2001 pilot has been fully implemented and has generated the results Secretary Hernández predicted they would. Now, almost three years later the lack of accountability Secretary Hernández tried to address is finally in the open but with a new twist. The twist is that the mechanism and monitoring changes left behind by Secretary Hernández are being praised by the Office of Program Policy Analysis and Government Accountability better known as OPPAGA in a report released December 2003, but the changes have been adjudicated to others.
Within a month after Secretary Hernández’ departure, OPPAGA published Report 01-66 titled: Justification Review, in which it lists very similar deficiencies in accountability that Secretary Hernández wanted to bring to the public arena. OPPAGA’s report identified in black and white accountability problems among Area Agencies on Aging and other service providers. It recommended stronger financial controls and suggested that private agencies be closely monitored by the Department. OPPAGA’s Report 01-66 could have been written by Secretary Hernández and unequivocally contradicts public statements made by Representative Green and Senator Pruitt in their respective comments to the media and to the Governor. However, no one, with the exception of a very limited number of people, has read the report and connected the dots.
With the distance of time we tend to forget unless something reminds us of past events and how they connect to the present realities. OPPAGA published Report 03-69 titled: Progress Report Services to Elder Program highlights the improvement on accountability and oversight the Department has accomplished. Without the historical piece left behind by papers like the Tallahassee Democrat (9/11/01) headline, The Sun Sentinel, Steven Goldstein’s editorial (9/23/01), Peter Wallsten’s column for The Miami Herald (9/22/01) and Julie Hauserman St Peterson Times (9/20/01, 9/29/01) we would not be able to publicly connect the dots. Report 03-69 starts by connecting dots for us by stating “In response to the 2001 Report “ The testimony of 9/11 is the piece that has been erased forever, unless of course you happen to be one of the journalists that received a copy of the documents.
Secretary Hernández’ role in uncovering the historical weakness of the Department and the historical strength of politically well connected providers is also well documented in the Auditor General’s Report 02-047.
It took courage to break the wall and to leave behind a plan that has generated the results predicted. It took a strong sense of morality and caring for frail elders to expose and challenge the status quo. There are things that still remain to be done, like the way private providers “charge” for services. This is again documented in the latest OPPAGA Report # 03-69 and in the Auditor General Report # 2004-032. The Auditor General’s report mentioned that capitated rates exceeded projected costs. In laymen’s terms this means that some providers exceeded their budget allocation and are charging more for the same services. One possible explanation for the over expenditure of the same powerful providers is the fact that according to OPPAGA’s latest report some Medicaid waiver providers are being paid $800 more per month per client than what both OPPAGA and two independent consultant think they should be paid.
This issue of capitated payments that exceed what the services should cost is a piece of Secretary Hernandez’s original plan that is still untouched and unmentioned in the majority of progress reports. Why are we ignoring the obvious? As long as private agencies continue to use their political connections to prevent reducing the capitated rate or prevent the investigation of capital improvement grants for buildings that were never built, this accountability piece will not be addressed. By now it should be clear to every one that no politician is willing to cut the funding to his or her political benefactors especially if they are running for Congress. This is why, despite findings of two independent reports, done after Secretary Hernández departed, this payment issue remains both unsolved and ignored
I have to admit that the few providers that used creative methods to enrich their coffers are always one step ahead of the media and one step ahead of the public. They are already positioning themselves for the next move: Lumping of the entire Medicaid waivers program into the Medicaid Block grant. They are also positioning themselves in case OPPAGA and the Auditor General suggest that the Department stop funding agencies with billing irregularities or stop supporting the geographical expansion of agencies that have faced fines for billing “errors”. These providers are ready. They have already hired new lobbyists with an inside track to represent their case in private to the Secretary and the Deputy Secretary making the presentation more powerful and targeted than before.
The present gains are connected to the past, and if we follow the dots and connect the dots one by one, it will give you a new and fresh look at events ignored before.
Dr. Gema Hernández
