[RANDY P]

WA STATE WILL PAY FOR YOUR SEX CHANGE AND CARE FOR THE ILLEGAL IMMIGRANTS.

CHECK OUT THE TAB!!

Audit faults $1 billion in Medicaid spending

BY BRAD SHANNON

THE OLYMPIAN

State auditors have issued another annual audit critical of the $6.2-billion-a-year state-run Medicaid program, saying they had questions about nearly $1 billion of the spending. The most politically sensitive expense was $28 million for the medical care of illegal immigrants.

While treatment of illegal resident children or adults in emergencies is covered by federal law, some spending on adults went for things such as dental care, according to the report.

Of the $1 billion in questioned spending, up to $32 million might have to be repaid to the federal government.

Auditors also found $326,000 in cosmetic procedures such as breast enlargements, which weren’t adequately documented as medically necessary, and $97,000 in disputed costs for sex-change procedures.

And the state paid anywhere from $48 to $5,061 per dose for one steroidal medication, Somatroin, used to treat growth disorders.

Spokesmen for the Department of Social and Health Services downplayed the bad news in the audit reports of the past two years, which cited 28 problems with Medicaid alone.

“This will sound bad, but this is a better audit than last year,” state Medicaid director Doug Porter said in an interview. Last year, $6 billion in spending was disputed or “disclaimed.”

Porter and his boss, DSHS Secretary Robin Arnold-Williams, said the audit reflects a changing relationship between their agency and the auditor.

“We share a common goal of ensuring the proper use of public funds,” Arnold-Williams said in a prepared statement.

The audit raises serious questions, State Auditor Brian Sonntag said, but he generally agreed that DSHS is moving in the right direction.

“What raises the alarm is the fact we are identifying a lack of documentation; we’re identifying coding errors, the kinds of things that should be answerable and resolved,” Sonntag said. “What reduces the alarm is that DSHS is very responsive to the auditing process, to the findings of this audit and the issues contained.”

That’s a sharp contrast to past years, when the two agencies clashed publicly over access to records.

Gaps in documentation

Still, the audit by Sonntag’s office found numerous deficiencies in the state’s grasp of payments in many programs — everything from the timeliness of Department of Health surveys of hospitals to the level of controls in place to ensure proper billing for such things as motorized wheelchairs or the care of developmentally disabled adults.

Some highlights:
• From $28 million to $32 million in nonemergency services might have been provided to illegal residents of the country, echoing findings of a year ago. Sonntag and Medicaid’s Porter both said it is the most serious audit finding.

“This is one of those areas where we’ll probably have a perpetual dispute,” Porter said, explaining that separate federal rules require the state to get a Social Security number from anyone seeking services, even though a separate rule won’t let the state deny services solely for lack of a Social Security card.

So while DSHS might help a person get a Social Security number, if eligible for one, the agency in the meantime is providing medical services that eventually get questioned by the auditor under the other rule, Porter said.

“We keep saying, ‘There will always be people for whom we don’t have a number yet, and we’ll get it,’ ” Porter said. “What the auditor wants to see is a level of perfection that our system will never afford.”

A new computer in 2007 might help cut down on some disputes, he added.

The agency also has been redrafting its rules defining an emergency situation to limit incorrect charges, DSHS spokesman Jim Stevenson said.

The federal inspector’s ongoing audit is due in September, Porter said, and it will be given to other federal regulators who can consider what the proper state action is. In past cases, no repayment has been required when the state shows it is reforming its practice, according to Porter.

• Medicaid’s oversight of payments for the care of the developmentally disabled was seen as lax. It included payments for $129.8 million to intermediate care facilities without adequate assurance that the care provided met federal standards, auditors said.

• The Department of Health failed to carry out adequate hospital surveys related to more than $583 million in state and federal payments for care. Only 50 of 102 participating hospitals had received the appropriate annual survey in 2004, and 73 percent of facilities were not surveyed on the new 18-month cycles that state law now allows. But DSHS said the Department of Health is on target to meet the new 18-month goal.

Sex-change surgery

State Rep. Bill Hinkle, R-Cle Elum, blasted DSHS over the audit, but he also ripped fellow lawmakers for not drafting laws this year specifically barring use of state funds for illegal or undocumented workers or for sex-change surgeries.

DSHS contends it has no evidence of purely cosmetic breast surgeries, finding the augmentations were done after breast cancer treatment, and breast reductions were done because the patient’s condition caused serious back pain or there were osteoporosis concerns.

As for sex-change surgeries, the agency does not allow them by policy. It has allowed two since 2001 only after an administrative law judge ordered them, according to DSHS; three other cases are pending, and the state is resisting payment in all three.

While Hinkle said the Legislature rejected his Republican caucus’ effort to outlaw payment for sex-change surgeries, Porter said states that did have run afoul of federal courts.

And Medicaid’s medical chief, Dr. Jeff Thompson, said Washington’s approach is following the lead of Iowa, which has passed muster with federal appellate courts. It recommends treatment with hormones and psychotherapy instead of surgery, finding them more effective for the patient, less costly and less risky than sex-change procedures; Washington argues that the approach is based on evidence compiled in a state-paid consultant’s report.

More accountability

Hinkle blamed the governor and lawmakers for not holding DSHS more accountable. The state needs its own Office of Inspector General who can take a step beyond what the auditor does and force agencies to comply with law, he said.

It’s fair to ask whether the state should mimic the federal Department of Health and Human Services by having its own inspectors, Porter said.

“I think it’s a fair public policy debate as to how many guard dogs you want guarding the hen house and how much you want to spend on auditors and oversight capacity,” Porter said.

Despite his criticism, Hinkle said he thinks Arnold-Williams is making progress in holding DSHS accountable. “The problem is that DSHS is like an 800-pound gorilla with a choke chain,” he said. “Who’s going to pull the choke chain?”

And who do we have to thank for WA State funding sex change operations?

http://159.54.227.3/apps/pbcs.dll/article?AID=/20060314/NEWS0402/60314059

Freking brilliant.

All Democrats must hang.