The Commissioner of Social Services verbally wanders around some more, and goes back to the fraud cases against home health aides that were identified, investigated and prosecuted. He makes it sound like a substantial portion of the target group has engaged in fraud. Again, I snap, “Ten out of six hundred!”
Tina slides Ric’s comments over to me:
1 Horse pucky!!
2 Was it getting too hot for him?
3 One bad apple
4 Right. Go getem Annie!
5 I bet they’re sorry they came now
6 Same old same old
7 Company line
Barrie asks her questions again and doesn’t get them answered again. The conversation bounces around the room, then comes to Tom, the attorney-legislator. He asks the Commissioner, “Can you walk me through this? Can you show me how this used to be done, how it is done now, and what changed to precipitate this?”
No, the Commissioner can’t, so Sally states that the consumer-directed program is about seventeen years old, and I explain that first, the aide fills out the timesheet and signs it, then the supervisor—that is the consumer/client—audits the timesheet and signs off on it. Lastly, it goes to the agency where the manager again audits and signs off.
Tom again asks the Commissioner why they instituted the telephone call-in system, followed by the Medicaid Fraud Unit checks. What happened to necessitate this? In a county that is struggling for financial survival, why has money been spent on this?
And the Commissioner, through the mists of diversion, finally answers two questions.
First, they bought the computerized check-in system because the consumer-directed system had gotten so large. Apparently the rationale is simply this: if the peasants get together in too big a group, you gotta control them. Nobody did anything wrong. It was just that the consumer-directed program worked so well that a lot of people signed up for it. So the county had to control it.
Second, the reason they are only monitoring the consumer-directed program is because they can. People in the consumer-directed program only have one or two aides. In traditional aide programs, for-profit agencies send aides randomly to clients. In the course of a month a dozen different aides may be sent to a single client. In order for the computerized check-in system to work, all a Medicaid client’s aides have to come in and be voice-recorded. It was too big a job. They are only keeping people in the consumer-directed program under surveillance because it’s a relatively small enough group so that they can.
At this point Barrie starts flipping through some papers relevant to the county’s contract with the computer company. She is the only person in the room who has come prepared with this. She starts quoting from sections she has highlighted and points out that the county—the Dept. of Social Services—the Medicaid Fraud Unit—do not have the right of oversight. They have contracted it out. If there’s a problem, the only thing they have a right to do is keep the contractor under surveillance.
Barrie says, “You cannot institute a police action against the citizens.”
The Commissioner says, “It’s not a police action. It’s just some people calling from the Dept. of Social Services.”
I say, “The phone rings and a man says, ‘I’m an Investigator!’”
By now Sally is anxious to move us on to the point in the agenda that says “Proposals for Resolutions.”
The czar notes that he has long been working with management at Arise and Enable and that goes well. “Bullshit,” I think. I’ve talked to management at Arise and Enable. They go along with the czar because he controls the money. It is politically necessary for them to give the appearance of cooperation. Their private attitudes about this little tyrant are something different.
The Commissioner and the czar want to have a committee. They want to meet with management and ‘selected others,’ and I know darn well I will be selected out. They don’t want to work with people who aren’t afraid to get in their faces and keep hammering away at the truth. They want to work with people who will play the proper political games of deception, diversion and delusion.
The way you get something done is by putting government guys in the same room with statesmen, politicians, lawyers and somebody with a bazooka who fires random shots at them. It helps keep them focused. Most people can’t handle the weapon because of the kickback. I can, so I am the bazooka lady. All members of the body of Christ have different jobs, and that’s mine. But once the government guys start forming committees, Bazooka Lady isn’t allowed in the room.
So we hash around on committees for a while, and most people decide it’s a good thing. Me—I don’t do group-think, but it’s clear that a committee is going to be set up.
Then Barrie makes a simple proposal to the Commissioner. “Government committees being what they are,” she says, “it will take months for any resolutions to evolve. During the time of study and discussion, will you suspend the Medicaid Fraud Unit’s investigations?”
The Commissioner replies with a couple inaudible syllables. Barrie’s response causes me to ask, “Are you saying that effective immediately you will suspend the Fraud Unit’s investigation of people in the Consumer Directed Personal Assistant Program?”
He says, “Yes.”
I say, “Thank you.”
And the people (especially those in wheelchairs) say HOO-RAH!
We all muddle around while it sinks in. We just won! The Commissioner is shutting down the czar!
A committee of sorts will be half-formed and meet a few times, then the issue will be allowed to die without the Commissioner losing any more face. Caught between the Civil Rights director and the legislator-lawyer, with me taking shots at his head, the Commissioner knew he’d lose and therefore resigned from the battle.
Afterwards, Barrie asks if she can nominate me for the board of the ACLU; I say yes.
On the bus on the way home, Michael says, “’Ten out of six hundred.’ That’s what I keep hearing in my head: ‘Ten out of six hundred.’”