After a year's vacancy, a new Medicaid inspector general

Bill Gale confirmed without objection by Kansas Senate

0 | KDHE, KanCare, Medicaid-CHIP

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Bill Gale

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— After a year without one, Kansas once again has an official Medicaid inspector general.

The Kansas Senate last week with no objections confirmed the appointment of Bill Gale.

Background

Before taking the job, Gale was Sedgwick County's election commissioner from 2003 to 2011. Before that he was an accountant for Midway Baptist Church in Wichita from 2000 to 2003 and for Hudson Pharmacy in Wichita from 1990 to 1999. He also served on Wichita's city council from 1995 to 2003.

Gale, 42, earned his undergraduate degree in accounting from Wichita State University and is a certified inspector general by the Association of Inspectors General.

Gale began work in the inspector general's office in July. The previous inspector general, Nick Kramer, retired in 2011 as the Kansas Health Policy Authority was being merged into the Kansas Department of Health and Environment as the new Division of Health Care Finance.

The inspector general’s office was created by state law in 2007 to find inefficiencies, fraud or abuse in the state Medicaid program, SCHIP, MediKan, and the state employee health plan — all of which are administered by the health care finance division.

In five years, six audit reports have been released by the inspector general. The last was in August 2011:

Audit of the Medicaid Home Health Fee-for-Service Program (Oct. 2008)

Audit of Kansas’ Medicaid Claims Processing (Jan. 2010)

Audit of KHPA's Medicaid Contract Award Process (June 2010)

Audit of KHPA's Medicaid Pharmacy Program (Nov. 2010)

Audit of KHPA’s Medicaid Provider Enrollment and Terminations (April 2011)

Audit of DHCF’s Oversight of Medicaid Managed Care Entities (Aug. 2011)

Juggling resources

When the office was created, three auditors worked for the inspector general — now there is just one to assist Gale. Asked if he had sufficient resources given the breadth of his office's oversight duties, Gale acknowledged the challenge.

"That's one of the things we wrestle with," he said. "With the resources we have, (the question is) where and how can we be most effective? Obviously, we'd be remiss if we didn't spend time on KanCare."

Gale said the office also could devote its resources to ferreting out fraud, waste and abuse.

"We could easily spend all our time on that," he said. "So that's been the real challenge — trying to juggle that and figure out what we really focus on

Currently, he said the office is spending about half its time monitoring the transition to KanCare, which starting Jan. 1 outsourced management of the state Medicaid program to three managed care companies. Gale said he was looking for areas that could warrant auditing.

"I try to attend a lot of the meetings, the advisory council meetings, as well as the external workgroups. And we listen in on the (daily) KanCare phone calls. It consumes a fair amount of our time now," Gale said.

"In trying to find areas that we should be looking at...probably the top problem is in the area of personal care services," he said. "Namely, are there services being charged to Medicaid that are not being provided?"

Data trails

Gale said his office was best equipped to audit data trails.

"For instance," he said. It could "look to see if there's charges to Medicaid for somebody being in the hospital, while there's also charges for services provided to them at their home."

Any suspected cases of fraud identified by his office would then be turned over to the Medicaid Fraud Control Unit at the Attorney General's Office.

Gale said he also plans to work closely with the four people on staff at KDHE's KanCare lnteragency Coordination and Contract Monitoring unit, which oversees contract compliance by the three managed care companies.

"Their main focus is monitoring the MCOs and the contracts and compliance. We'll definitely want to, I guess, monitor their monitoring," he said.

He said among the things his office might investigate would be whether the companies were denying services they were under contract to provide.

A question of independence

The law under which the office was created stipulates that "the office of inspector general shall be independent and free from political influence and in performing the duties of the office."

Originally the inspector general reported to the independent Kansas Health Policy Authority board, but now will report to the KDHE secretary.

Asked whether his office could operate independently while nested within the agency it is meant to watchdog, Gale said he believed it could.

"I'm appointed by the secretary at KDHE as opposed to, say, the Division of Health Care Finance director or the Medicaid director — that would definitely be more of an issue. I think the way it's set up helps give that independence as much as possible within the department," Gale said.

"So far I haven't experienced any problems on that, but that is something to be mindful of in case it were to become a concern," he said.

If a concern did arise, Gale said, "A recommendation could be made to the Legislature, if there seemed to be any issues with that."

In 2009, following allegations by Robin Kempf, the first inspector general, of undue pressure from the health policy authority's executive director, then State Sen. Derek Schmidt pushed to have the office placed under the wing of the Legislative Division of Post Audit.

Schmidt — now the state's attorney general — could not be reached for comment.

In 2009, he said: “It just seems to me we’ve learned this structure is not optimal...I’m not prepared to say it cannot work. But I am prepared to say there are better ways to ensure the independence and that’s an important attribute for an inspector general."



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