For tens of millions of Americans, October 10th, 2016 is simply a day off from work or school. Banks and the federal government call the day “Columbus Day.” In New York City, the day is celebrated by Italians as a sort of national heritage day. Few know, however, that Columbus Day is also Indigenous Peoples’ Day. You know, the Native Americans. The people who were here long before most of our ancestors settled in the New World. On this day, we examine the Indian Health Service, the federal agency charged with looking after the healthcare needs of Native Americans and Alaska Natives.
Earlier this week, the U.S. Department of Health and Human Services issued two reports on the Indian Health Service. As expected, the reports found widespread problems.
The Indian Health Service (IHS) is charged with providing care to 567 recognized tribes. It operates 28 acute-care hospitals. Unfortunately, the care is often inadequate.
One report found that many of the quality issues were due to lack of oversight. There just isn’t enough staff to monitor all the hospitals. (I spoke with an IHS physician in Montana who says there isn’t enough clinical staff either.)
Finding money for more healthcare probably isn’t going to happen in the near future. The need is certainly there, unfortunately there just isn’t the political willpower to make it happen. Finding some money for better monitoring may be a bit easier.
Without regular reviews and oversight and without meaningful performance metrics, the environment becomes conducive to fraud. Fraudsters are like rats; they operate best in the dark. With no staff to monitor contracts or performance, we believe the IHS is rife with fraud. (We also believe the Service is rife with whistleblower opportunities… more on that below.)
The current report echoes reports going all the way back to 1928. Despite continued findings of poor quality care, things seem to get worse. Just when we need more oversight, we get less. Of the 8 regional IHS offices charged with oversight, the report says that 5 saw significant staff decreases in the last decade. 2 said they lost more than 50% of their staff.
Bad moral, outdated equipment, staffing issues and no oversight is the ideal climate for fraud.
Healthcare fraud costs taxpayers tens of billions of dollars each year. It also means lower quality healthcare. In the case of the Indian Health Service, the problems are beyond critical. In many areas of the country, the quality of care offered by IHS is deplorable. The system can’t afford to lose a single penny to fraudsters.
When we criticize the IHS system, it is not meant as a criticism of the many dedicated men and women who work there. The criticism is really aimed at Congress for its failure to fulfill its legal duties and properly fund the Service.
Indian Health Service and Whistleblower Awards
Because the IHS operates so few hospitals and must care for 1.9 million American Indians and Alaskan Natives, much of its care must be outsourced. Federal law requires that hospitals providing care to IHS and tribal patients not exceed Medicare billing rates. A 2009 audit, however, found that 22% of those claims exceeded allowable rates.
It’s not always outside providers that are ripping off tribal the Indian Health Care system. In April, 2009 the ex-governor of the Passamaquoddy Tribe, Indian Township, was sentenced to a 60-month prison term for conspiring to misappropriate more than $1.7 million in restricted Federal funds, including approximately $500,000 from the Department of Health and Human Services and the IHS (including funds awarded to the tribe’s Health Center). Although Ex- Governor Robert Newell apparently didn’t line his own pockets, an appeals court sustained his conviction because he misappropriated the funds to pay his family, friends and political supporters.
Under the federal False Claims Act, a whistleblower with inside information about fraud involving federal funds or programs is eligible to receive an award. Awards are between 15% and 30% of whatever the government recovers from the wrongdoer. Because the Indian Health Service relies on federal funds, whistleblower awards are available.
We suspect that there are plenty of whistleblower award opportunities both on and off the reservations. Be it an IHS hospital, outpatient clinic or outsourced services, we believe that fraud and fiscal mismanagement is rampant.
Getting someone to come forward is probably more difficult than ferreting out the fraud. Thankfully, the False Claims Act contains powerful whistleblower anti-retaliation provisions. That may not be enough, however, to convince some people to come forward. (We also understand the deep mistrust that some Native Americans have to the federal government.)
The whistleblower lawyers of MahanyLaw are committed to helping all whistleblowers – Native American or not – eliminate fraud and greed, restore integrity to healthcare programs, fight illegal retaliation and to receive the largest whistleblower awards allowed by law.
Poverty, poor healthcare, greed and fraud are problems we all must face together. Using the False Claims Act, we can work collaboratively to insure that our precious healthcare dollars are spent wisely and not used to line the pockets of fraudsters.
Need more information? Our consultations are always without obligation and without cost. All inquiries are protected by the attorney – client privilege and kept confidential (even if you don’t later hire us). If we accept your case, we only get paid if we are successful.
MahanyLaw – America’s Whistleblower Lawyers