Audit ordered on August 2unknown But the final scope of work must be approved
“It’s not over until it’s over” is an oft-repeated phrase first uttered by American baseball legend Yogi Berra. When he said he coached the New York Mets in 1973, his team was far behind in the pennant game. The Mets then went on to win the National League pennant.
As it turns out, the same situation applies to a major order unanimously passed by the Travis County Commissioner’s Court on Aug. 2unknown,if Bulldog report. The motion requires an independent third-party audit of Central Health and the health care providers employed by the agency to provide health care services to Travis County residents at or below 200 percent of the federal poverty level.
After that vote, all the staff needed was to finalize the scope of work approved by the commissioners. The county will then issue a request for proposals to find qualified auditors and hire them.
But, as it turns out, things are not over yet.Although the draft order was approved on August 2, the final scope of work has not yet been formally approvedunknown and the September 27th draftth are similar.
That’s why the Court of Commissioners had to look into the matter again on September 27thwhen a new and improved version is back on the agenda.
Advocates back performance audits again
September 27 to support the new version of the orderth In a public comment on Aug. 2 of nearly the same role advocating for performance auditingunknownMost notable of these is retired state Senator Gonzalo Barrientos, who in 2003 co-authored SB 1905 with Jeff Wentworth (R-San Antonio). The legislation would provide statutory authority to allow voters to authorize the creation of the Travis County Hospital District. Their bill did not pass, but its provisions became part of House Bill 2292, which passed.
“When we passed legislation nearly two decades ago, my intent was to pay for health care for those who couldn’t afford it,” Barrientos said. “It did frustrate me, it took me a long time to get to this point.”
Others calling for approval of the order include longtime political adviser Peck Young (on behalf of NAACP Austin Chair Nelson Linder); Frank Ortega, former director of LULAC’s Seventh District; retired Travis County auditor Susan Spataro; and Cynthia Valadez, a Travis County-appointed member of the Central Health Management Board.
Attorney Fred Lewis, who was in North Carolina at the time, spoke by phone to the Court of Commissioners to encourage approval. He said the proposed performance audit order was effective because it required auditors to focus on the financial controls that Central Health had or did not have with its providers. This is a key point because Central Health is not a health care provider itself, but a property-tax-funded agency that contracts and pays for care provided by others.
“These financial controls are critical to ensuring that taxpayer funds are used effectively and efficiently in accordance with the law,” Lewis said.
“The problem is that Central Health has a lot of very unusual contracts with its suppliers. I’m saying this as someone who has seen a lot of insurance contracts. I was in charge of insurance in the Attorney General’s office. Central Health contracts didn’t pay the medical school Human protection, but also lower than normal for other providers.
Lewis said records he obtained through discovery in his lawsuit against Central Health show the agency has transferred $233 million to the University of Texas Dell School of Medicine through fiscal 2021. These records show that “73% of the money was spent on administration and only 3.8% was spent on clinical (nursing) … These are the UT School of Medicine’s own descriptions of how they use these funds.” (see Attachment.)
“That’s why we need an audit where people can find the facts from a neutral party and they can decide whether these expenditures are consistent with Central Health’s legal mission and purpose.”
Central Health honcho supports performance audits
The last to address the commissioners on the issue was Central Health President and CEO Mike Quisling. He said before his speech that his management committee had not had the opportunity to consider the scope of work involved and that anything he said would be subject to the board’s rearrangement. He said he had simply reviewed the proposal but wanted to make recommendations to extend (not replace) the requirements in the order under consideration. He calls for:
2018 Assessment Scorecard—”[E]Make sure that the independent third party does provide a scorecard that measures how we are doing relative to our last performance review,” Geeslin said, referring to the Central Health Performance Review Executed by Germane Solutions and Whitecap Health Advisors, completed January 2018. Bulldog As reported on February 14, 2018, the final results were submitted to the Central Health Management Board by Tracy Kulik, Vice President of Germane Solutions. Even then, the leaders of the Central Health Authority were told that the agency lacked financial control. Regarding where the money is going, “more mechanisms are needed to show a return on investment,” Kulick said.
Whether to perform the task— “Second, the (auditors) who (performed) the independent performance review are qualified and able to look at some of the health care equity programs, community needs assessments, and related work that we have done and are currently doing. Because we want a third party to review our previous Is the execution and ongoing work consistent with creating a high-functioning healthcare system. In other words, executing our mission.”
Compare with peers— Geeslin wants Central Health compared to other hospitals and healthcare districts.
“It’s part of being better. It’s part of fulfilling our mission. We look forward to working on this project and doing what we can to legally assist and support and ensure it’s successful,” Quisling said in closing. .
Commissioner approves again
To consult with attorneys at the Court of Commissioners, the commissioners participated in an enforcement session that lasted more than three hours.Commissioners make changes to draft order during closed-door meeting This was posted with the agenda. Then, after reconvening a public meeting, the Court of Commissioners voted unanimously to approve the redacted order. (The final version of the order, which must be individually signed by each member of the court before it can be filed with the county clerk, was not public at the time of publication. It will be uploaded and linked when available.)
What can Central Health do “legally”?
Geeslin’s closing remarks indicated that there may be legal limits to what auditors can do when performing performance review work.
To learn more about what Geeslin means, Bulldog Email Central Health on September 28th“What legal hurdles does Central Health foresee potentially involved in conducting this performance audit?”
Central Health VP of Communications Ted Burton replied via email on Sept. 29th“We will do everything we can to make the audit successful as the law allows.
“We believe the Court of Commissioners shares our commitment to creating a functional health care system for those in our communities who rely on a central health unit for the best care. We cannot afford to ignore this vision.”
to which Bulldog Reply: “Since you know you didn’t answer the question, I guess that’s what you said?”
Burton reiterated, “Yes, this is our response.”
What is the order?
draft order Detail what the audit will accomplish and develop a timeline.until November 15thth, a list of audit firms qualified to do the work will be submitted to the Court of Commissioners.until December 13thth A service contract will be prepared for court approval.
Central Health will pay for the performance audit, offsetting the cost by canceling the assessment scheduled to be overseen by Central Health itself in 2023. Auditors will now report directly to the Court of Commissioners. They have full access to necessary records, but must keep privileged records confidential.
The auditor’s qualifications are specified in the order, including no conflict of interest that may arise from his work for or relationship with any of the organisations involved.
The scope of work will include assessing:
- How providers are meeting the healthcare needs of the medically indigent in Travis County,
- Integrated delivery healthcare system,
- Central Health’s Health Equity Program,
- Central Health’s financial accountability procedures and controls,
- Central Health’s public transparency,
- The amount and type of health care services provided by Dell Medical School to the medically indigent in exchange for $35 million in annual transfers from Central Health — $280 million through fiscal 2022.
- The appropriateness of the records maintained by Dell Medical School in relation to the financial responsibility and statutory compliance of these funds.
- Comply with applicable laws.
Auditors should immediately report to the Commissioner any ongoing violations of law or non-cooperation in the conduct of performance audits.
When the work is complete, the auditor will provide a written report reporting findings and recommendations to correct any problems in accounting, operations, management or other practices. This will include identifying material deficiencies in internal controls that adversely affect Central Health’s ability to meet its statutory responsibilities and comply with the law.
Central Health will be required to submit quarterly reports to the Court of Commissioners over two years on its progress in implementing the recommendations.
All reports prepared by auditors will be made public.
trust indicator: Ken Martin has been conducting investigative reporting in the Austin tri-county metro area since 1981. His positive reporting has twice won the nation’s No. 1 spot in investigative reporting. Both projects were successfully criminally prosecuted. His 2011 investigation into violations at Austin City Council public meetings sparked a 20-month investigation by Travis County prosecutors, leading the mayor and council members to sign deferred prosecution agreements to avoid charges, trial, and if convicted , serve 1 to 6 months in prison and have their electoral positions confiscated. Find out more about Ken on the About page.e-mail [email protected].
Related documents:
Central Health Performance Assessment, January 2018 (42 pages)
Travis County Commissioner’s Court (Draft) Order for Independent Performance Audit of Travis County Health Care District, September 27, 2022 (3 pages) [This will be replaced by final version, when it’s available, signed by the commissioners date-stamped by Travis County Clerk.]
Related Bulldog reports:
Central Health’s demands for medical school accountability blocked by 2014 agreement, August 5, 2022
Commissioners opt for tougher central health audit, 3 August 2022
Central health critics ramp up pressure ahead of July 25, 2022 audit vote
On June 30, 2022, Central Health’s $35 million payment to Dell Medical School was an illegal “gift of public funds” beyond statutory authority
New Documentary Aims to Divert Poor Healthcare Funding, November 15, 2021
Lawsuit challenges central health spending, October 18, 2017