CEO of Cardinal Gets a Raise – With Our Tax Dollars!

You could hear the outrage in the voices of some of the NC legislators (finally, for the love of God – our General Assembly has taken the blinders off their eyes regarding the MCOs) at the Joint Legislative Oversight Committee on Medicaid and NC Health Choice on Tuesday, December 6, 2016, when Cardinal Innovations‘, a NC managed care organization (MCO) that manages our Medicaid behavioral health care in its catchment area, CEO, Richard Topping, stated that his salary was raised this year from $400,000 to $635,000with our tax dollars. (Whoa – totally understand if you have to read that sentence multiple times; it was extraordinarily complex).

Senator Tommy Tucker (R-Waxhaw) was especially incensed. He said, “I received minutes from your board, Sept. 16 of 2016, they made that motion, that your 2017 comp package, they raised your salary from $400,000 to $635,000, they gave you a 0 to 30 percent bonus potential which could be roughly another $250,000 and also you have some sort of annuity or long-term package of $412,000,” said Sen. Tommy Tucker.

FINALLY!!! Not the first time that I have blogged about the mismanagement (my word) of our tax dollars. See blog. And blog.

Sen. Tucker was not alone.

Representative Dollar was also concerned. But even more surprising than our legislators stepping up to the plate and holding an MCO accountable (MCOs have expensive lobbyists – with our tax dollars), the State’s Department of Health and Human Services (DHHS) Secretary Rick Brajer was visibly infuriated. He spoke sharply and interrogated Topping as to his acute income increase, as well as the benefits attached.

As a health care blogger, I receive so many emails from blog readers, including parents of disabled children, who are not receiving the medically necessary Medicaid behavioral health care services for their developmentally disabled children. MCOs are denying medically necessary services. MCOs are terminating qualified health care providers. MCOs are putting access to care at issue. BTW – even if the MCOs only terminated 1 provider and stopped 1 Medicaid recipient from receiving behavioral health care services from their provider of choice, that MCO would be in violation of federal law access to care regulations.  But, MCOs are terminating multiple – maybe hundreds – of health care providers. MCOs are nickeling and diming health care providers. Yet, CEO Topping will reap $635,000+ as a salary.

The MCOs, including Cardinal, do not have assets except for our tax dollars. They are not incorporated. They are not private entities. They are extensions of our “single state agency” DHHS. The MCOs step into the shoes of DHHS. The MCOs are state agencies. The MCOs are paid with our tax dollars. Our tax dollars should be used (and are budgeted) to provide Medicaid behavioral health care services for our most needy and to be paid to those health care providers, who still accept Medicaid and provide services to our most vulnerable population. News alert – These providers who render behavioral health care services to Medicaid recipients do not make $635,000/year, or anywhere even close. The reimbursement rates for Medicaid is paltry, at best. Toppings should be embarrassed for even accepting a $635,000 salary. The money, instead, should go to increasing the reimbursements rates – or maintaining a provider network without terminating providers ad nauseum. Or providing medically necessary services to Medicaid recipients.

Rest assured, Cardinal is not the only MCO lining the pockets of its executives. While both Trillium and Alliance, other MCOs, pay their CEOs under $200,000 (still nothing to sneeze at). Alliance, however, throws its tax dollars at private, legal counsel. No in-house counsel for Alliance! Oh, no! Alliance hires expensive, private counsel to defend its actions. Another way our tax dollars are at work. And – my question – why in the world does Alliance, or any other MCO, need to hire legal counsel? Our State has perfectly competent attorneys at our Attorney General’s office, who are on salary to defend the state, and its agencies, for any issue. The MCOs stand in the shoes of the State when it comes to Medicaid for behavioral health. The MCOs should utilize the attorneys the State already employs – not a high-dollar, private law firm. These are our tax dollars!

There have been few times that I have praised DHHS in my blogs. I will readily admit that I am harsh on DHHS’ actions/nonactions with our tax dollars. And I am now not recanting any of my prior opinions. But, last Tuesday, Sec. Brajer held Toppings feet to the fire. Thank you, Brajer, for realizing the horror of an MCO CEO earning $635,000/year while our most needy population goes under-served, and, sometimes not served at all, with medically necessary behavioral health care services.

What is deeply concerning is that if Sec. Brajer is this troubled by actions by the MCOs, or, at least, Cardinal, why can he not DO SOMETHING?? Where is the supervision of the MCOs by DHHS? I’ve read the contracts between the MCOs and DHHS. DHHS is the supervising entity over the MCOs. Our Waiver to the federal government promises that DHHS will supervise the MCOs.

If the Secretary of DHHS cannot control the MCOs, who can?

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on December 8, 2016, in "Single State Agency", 1915 b/c Waiver, Access to Care, Accountability, Alliance, Behavioral health, Cardinal Innovations, CenterPoint, DHHS, Division of Medical Assistance, EastPointe, ECBH, Federal Government, Federal Law, General Assembly, Gordon & Rees, Health Care Providers and Services, Joint Legislative Oversight Committee on Health and Human Services, Knicole Emanuel, Legal Analysis, Legal Remedies for Medicaid Providers, Legislation, Managed Care, MCO, Medicaid, Medicaid Advocate, Medicaid Appeals, Medicaid Attorney, Medicaid Contracts, Medicaid Providers, Medicaid Recipients, Medicaid Reimbursements, Medicaid Services, Medicaid Spending, Mental Health, Mental Health Problems, Mental Illness, North Carolina, Provider Medicaid Contracts, Tax Dollars, Taxes, Taxpayers and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink. 12 Comments.

  1. yet they keep cutting the services and funding for the clients to where they are very limited in what they receive and can do. They hire more oversight and less benefits for the clients and care providers. The Care Providers make less than $10.00 an hour with no overtime or health benefits and a lot of the time they work with clients for No Pay at All. But the CEO gets a 30% increase…. Sad

  2. Thank you for writing this! Please keep on doing it! As a parent of a severely mentally handicapped child, I am very grateful.

  3. Every year parents of the disabled live in fear of a reduction of services. This year Cardinal cut our services almost 50%. It has created an avalanche of problems for our family.Fewer services has meant: Daysupport provider is working less hours and looking for employment elsewhere. The pay for our workers is criminal. This has caused an increase in behavior problems in our home because of schedule changes. parents are already burned out, stressed and praying just to get through a day. We are living in fear of further reductions if we speak out- our cuts could be deeper! What can we do ? Where are our true advocates??

    Mecklenburg County Parent

    • I want to know where the advocates are!! Families need to be heard and things need to change. Please don’t let this story die!! Change needs to happen!!!

  4. Sad indeed, what is also troubling is that there are only 3 comments on this article. The Cardinal board made this decision. Write letters to the board members. They are listed on Cardinals web page and meetings are open to public. Letters can be anonymous if fear is preventing you from expressing your concerns. Write, call, email your representative.

  5. We just merged with Cardinal (from Centerpoint) and my son’s budget was also cut about 50%. They put him a minimal need budget category when he has severe autism, severe IDD, is non verbal and has a formal behavior plan! I did file a grievance and was mailed the standard response to have your care coordinator submit a revision if you think he needs more hours. So in finding out the CEO of Cardinal got a huge pay raise with perks does make my blood boil. !I hope something can be done to stop these outrageous salaries for the MCO’s CEO’s.

  6. Andrea, Cardinal’s next meeting is in February. I have a Facebook Page for parents of kids on the Autism Spectrum. We need to get those who are frustrated to show up and make our voices heard!!

  7. Sheesh! Why am I in the trenches helping folks and doing direct care and just making ends meet when I could have been a smiling guy like Topping making big bucks by cutting services and being part of the crony capitalistic inner circle.

  8. This is outrageous!! Not how I want my tax dollars spent. Get the services out to those who need them. This is not private industry folks!! -Former CP board member-

  9. Having worked in both an adult and a pediatric psychiatry office, I have to say that this is reprehensible. I would also like to know why the MCO’s are even necessary and based on county? Why should services be available to those in some NC counties and not others? Some of the most vulnerable are in Foster Care or Group Homes outside of their “home county” and this division of Behavioral/Mental Health services places an undue burden on the agencies trying to facilitate care to this population, as well as, leaves some without adequate care.

    The contracts with providers vary from MCO to MCO and therefore, not all medical center/providers are willing to sign the contracts with some, as their terms are not acceptable. For example, a clause that indicates that they can opt not to pay for covered services and that the practices/providers can take no legal action! Seriously!!?!?!? Mental Health issues going untreated lead to a lot of the issues that people get so up in arms about, but yet they focus on “gun control” or “increasing the sentences for drug offenders” vs addressing the root cause-the mental illness that propelled some to use violence, drugs etc.

    Mental health needs to be de-stigmatized and using tax dollars to help educate, in addition to providing equal quality mh/bh care across the state, would be a much better use of the money than making a rich man richer!

  1. Pingback: Trump-caid: Medicaid Under the AHCA | medicaidlaw-nc

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