Tribes Overpaying for Medical Services

During just one three-month period in 2008, the Indian Health Service and tribes paid $14 million over the Medicare rate for medical services, according to a Health and Human Services Inspector General’s report released last week. The money for the services comes from the Contract Health Services program -- a program so cash-strapped every year that it cannot cover medical care for tribal members for a full fiscal year, giving rise to the wry admonishment frequently heard in Indian Country … “Don’t get sick after June.”

Between January and March last year, IHS and tribes paid above the Medicare rate for 22 percent of hospital claims, resulting in $1 million in overpayments. But most overpayments were for hospital outpatient claims. If IHS and tribal payments for non hospital claims were capped at the Medicare rate, they could have saved as much as $13 million between January and March 2008.

While 22 percent of hospital claims were paid above the Medicare rate, the resulting overpayments only accounted for 3 percent of the total $33 million that IHS and tribes spent on hospital claims between January and March 2008, according to the report. IHS and tribes paid above the Medicare rate for 71 percent of non hospital claims. Most of these claims paid above the Medicare rate were for physician services.

BIA Roads Program in Alaska “Rife with Mismanagement”; Poor Candidate for Stimulus Funds

Interior Inspector General Earl Devaney is warning Interior Department officials about distributing stimulus money to the Bureau of Indian Affairs Alaska Region Indian Reservation Roads Program. 

“We found that the Alaska region’s inattention to expenditures and failure to manage its programs has repeatedly jeopardized the success of the Alaskan Native community roads projects and caused millions of dollars to be wasted or unaccounted for,” Devaney wrote in is cover letter of a Flash Report. 

Among the findings in the report:

ü      Only $3 to $4 million of the $230 million in road projects administered by the Alaska BIA each year have any physical oversight or verification that work is completed.

ü      An Alaska Native community advanced more than $2 million to build and repair critical road areas used the money instead to perform unauthorized work on another road that was deemed unnecessary.

ü      Some wage-grade employees are earning more than $100,000 a year – far above the maximum pay for their grade -- without explanation 

Interior IG Accuses Trustee of Steering Lucrative Accounting Contract to Friend

In a report released yesterday, the U.S. Department of Interior Inspector General accuses a special deputy trustee with the Office of Special Trustee for American Indians in Albuquerque of pressuring members of a three-person team in 2005 to give a valuable risk-management contract to a friend, despite what some contractors called a superior and cheaper offer by another company.

The trustee’s friend was a partner in an Albuquerque accounting firm, which won the $987,000 contract. The contract was modified 14 times over nearly a two-year period and ultimately increased to $2.4 million. Read more about this in the Washington Post.

Students and staff endangered in structurally deficient BIA schools

Severe health and safety deficiencies at the Chinle Boarding School in Many Farms, Ariz., endanger the lives of close to 500 students and staff members, according to a report released by the Department of Interior Office of Inspector General.

Severe structural cracks and unstable foundations exerted pressure on natural gas lines, electrical wires and boiler room components. Escaping natural gas or electrical discharges from damaged pipelines or wiring could result in explosions and loss of life, the report said.

The report details the health and safety issues endangering DOI staff at a number of Department of Interior facilities around the country, including 13 elementary and secondary schools operated by the Bureau of Indian Affairs Bureau of Indian Education. Deterioration at the schools inspected by the OIG ranged from minor deficiencies like leaking roofs to major deficiencies like structural weaknesses, outdated electrical systems and inadequate fire detection and suppression systems. In fact, the BIE told the OIG that 69 of its 184 elementary and secondary schools and dormitories are in poor condition.

At the Shonto Preparatory School in Shonto, Ariz., inspectors found significant electrical deficiencies that increased the risk of fire and endangered the lives of the 550 students who attend classes there. Inspectors found duct tape placed over a circuit breaker to prevent it from tripping, electrical extension cords routed through brick walls and dangling from ceilings and fire alarm system that didn’t work. The school’s ongoing rodent problem poses a risk for hantavirus.

This latest report restates many of the same structural deficiencies cited last May when the OIG issued a Flash Report, Bureau of Indian Affairs and Bureau of Indian Education: Schools in Need of Immediate Action.

Despite the dire predictions in that report and recommendations for immediate step to mitigate the issues, the BIE FY 2009 school construction budget was cut by about $30.5 million from 2008. Included within this request amount is $115.4 million for Education Construction, a reduction of $27.6 million from the 2008 enacted level. The FY 2009 request fully funds the replacement of the Dennehotso Boarding School, a K-8 on-reservation boarding school in Arizona, and replaces buildings at the Chinle Boarding School. The Education Construction request also includes funding for facilities improvement and repair projects including $50.7 million for annual maintenance. In addition, employee housing is funded at $1.6 million.