Category Archives: NCTracks Performance Audit
Another NCTracks Debacle? Enter NC HealthConnex – A Whole New Computer System To Potentially Screw Up
North Carolina is mandating that health care providers link with all other health care providers. HIPAA be damned! Just another hoop to jump through in order to get paid by Medicaid – as if it isn’t hard enough!
If you do not comply and link your health care practice to NC HealthConnex by June 1, 2019, you could lose your Medicaid contract.
“As North Carolina moves into data-driven, value-based health care, the NC HIEA is working to modernize the state-designated health information exchange, now called NC HealthConnex.” About NC HealthConnex website.
NC HIEA = NC Health Information Exchange Authority (NC HIEA) and created by N.C. Gen. Stat. § 90-414.7. “North Carolina Health Information Exchange Authority.”
North Carolina state law mandates that all health care providers who receive any State funds, which would include Medicaid, HealthChoice and the State Health Plan, must connect and submit patient demographic and clinical data to NC HealthConnex by June 1, 2019. The process could take 12 to 18 months. So you better get going. Move it or lose it, literally. If you do not comply, you can lose your license to participate in state-funded programs, including Medicaid.
If you go to the NC Health Information Exchange Authority (NC HIEA) website article, entitled, “NC HealthConnex Participant Base Continues to Grow,” you will see the following:
I highlighted the Session Law that, according to the above, requires that health care providers who receive state funds must connect to NC HealthConnex. See above. However, when you actually read Session Law 2017-57, it is untrue that Session Law 2017-57 mandates that health care providers who receive state funds must connect to NC HealthConnex.
If you follow the citation by NC HIEA (above), you will see that buried in Session Law 2017-57, the 2017 Appropriations Bill, is a clause that states:
“SECTION 11A.8.(e) Of the funds appropriated in this act to the Department of Health and Human Services, Division of Central Management and Support, Office of Rural Health, for the Community Health Grant Program, the sum of up to one hundred fifty thousand dollars ($150,000) in recurring funds for each fiscal year of the 2017‑2019 fiscal biennium shall be used to match federal funds to provide to safety net providers eligible to participate in the Community Health Grant Program, through the Rural Health Technology Team, ongoing training and technical assistance with respect to health information technology, the adoption of electronic health records, and the establishment of connectivity to the State’s health information exchange network known as NC HealthConnex.”
As you can plainly read, this clause only allots funds to provide training and assistance to providers eligible to participate in the Community Health Grant Program. The above clause certainly does not mandate that Healthcare providers who receive state funds connect to NC HealthConnex.
Session Law 2017-57, only mandates $150,000 for training and assistance for HealthConnex.
So what is the legal statute that mandates health care providers who receive state funds must connect to NC HealthConnex?
Ok, bear with me. Here’s where it gets complex.
A law was passed in 2015, which created the North Carolina Health Information Exchange Authority (NC HIEA). NC HIEA is a sub agency of the North Carolina Department of Information Technology (NC DIT) Government Data Analytic Center. NC HIEA operates the NC HealthConnex. The State CIO maintains the responsibility if the NC HealthConnex.
Supposedly, that 2015 law mandates that health care providers who receive state funds must connect to NC HealthConnex…
I read it. You can click on the link here. This subsection is the only section that I would deem apropos to health care providers accepting State funding:
“In consultation with the Advisory Board, develop a strategic plan for achieving statewide participation in the HIE Network by all hospitals and health care providers licensed in this State.”
What part of the above clause states that health care providers are MANDATED to participate? So, please, if any of my readers actually know which law mandates provider participation, please forward to me. Because my question is – Is participation REALLY mandated? Will providers seriously lose their reimbursement rights for services rendered for failing to participate in NC HealthConnex?? Because I see multiple violations of federal law with this requirement, including HIPAA and due process.
HealthConnex can link your practice to it if you use the following EHR programs:
- Ace Health Solutions
- Allscripts
- Amazing Charts/Harris Healthcare Company
- Aprima
- Athena Health
- AYM Technologies
- Casehandler
- Centricity
- Cerner
- CureMD
- DAS Health/Aprima
- eClinicalWorks
- eMD
- eMed Solutions, LLC
- EPIC
- Evident- Thrive
- Greenway
- ICANotes Behavioral Health EHR
- ICAN Solutions, Inc
- Integrity/Checkpoint
- Kaleidacare
- Lauris Online
- McKesson Practice Partners
- Medical Transcription Billing Corporation
- Medinformatix
- Meditab Software, Inc.
- Meditech
- Mediware-Alphaflex
- MTBC
- MicroMD
- Netsmart
- NextGen
- Office Ally
- Office Practicum
- Oncelogix Sharenote
- Patagonia Health
- Physician’s Computer Company (PCC)
- PIMSY
- Practice Fusion Cloud
- Praxis
- PrognoCIS
- PsyTech Solutions, Inc.
- Qualifacts – Carelogic
- Radysans
- Reli Med Solutions
- SET-Works
- SRS
- The Echo Group
- Therap
- Trimed Tech
- Valant
- Waiting Room Solutions
The law also requires:
- Hospitals as defined by G.S. 131E-176(13), physicians licensed to practice under Article 1 of Chapter 90 of the General Statutes, physician assistants as defined in 21 NCAC 32S .0201, and nurse practitioners as defined in 21 NCAC 36 .0801 who provide Medicaid services and who have an electronic health record system shall connect by June 1, 2018.
- All other providers of Medicaid and state-funded services shall connect by June 1, 2019. See changes in 2018 Session Law below.
- Prepaid Health Plans (PHPs), as defined in S.L. 2015-245, will be required to connect to the HIE per their contracts with the NC Division of Health Benefits (DHB). Clarifies that PHPs are required to submit encounter and claims data by the commencement of the contract with NC DHB.
- Clarifies that Local Management Entities/Managed Care Organizations (LMEs/MCOs) are required to submit encounter and claims data by June 1, 2020.
New from the 2018 Legislative Short Session, NCSL 2018-41:
- Dentists and ambulatory surgical centers are required to submit clinical and demographic data by June 1, 2021.
- Pharmacies are required to submit claims data pertaining to State services once per day by June 1, 2021, using pharmacy industry standardized formats.
To meet the state’s mandate, a Medicaid provider is “connected” when its clinical and demographic information pertaining to services paid for by Medicaid and other State-funded health care funds are being sent to NC HealthConnex, at least twice daily—either through a direct connection or via a hub (i.e., a larger system with which it participates, another regional HIE with which it participates or an EHR vendor). Participation agreements signed with the designated entity would need to list all affiliate connections.
Let’s just wait and see how this computer system turns out. Hopefully we don’t have a second rendition of NCTracks. We all know how well that turned out. See blog and blog.
Medicaid participation continues to get more and more complicated. Remember the day when you could write a service note with a pen? That was so much cheaper than investing in computers and software. When did it get so expensive to provide health care to the most needy?
The Nine Habits of a Highly Effective Secretary for DHHS
With the recent passing of the torch from Aldona Wos to Rick Brajer (see blog), I’ve been thinking about…
What are the qualifications of a Secretary of DHHS?
What exactly are the qualities that would make a great Secretary of DHHS? Remember, in Mary Poppins, when the children draft their requirements for a nanny? Or, better yet, what are the “Seven Habits of a Highly Effective” Secretary for DHHS? Or…in this case, the “Nine Habits”…
Here are my “Nine Habits of a Highly Effective Secretary of DHHS;” our Secretary of DHHS should have the following:
- A health care background
- A successful track record of his/her ability to manage large companies or agencies
- An understanding of the Medicaid system, and, maybe, even have first-hand knowledge of how the system affects recipients and providers
- A relationship with someone on Medicaid or a parent of someone on Medicaid
- A working knowledge of clinical coverage policies, reimbursement rates, and regulations surrounding Medicaid
- Both the capacity to listen and speak and do both eloquently and genuinely
- True empathy about the physical and mental health of Medicaid recipients and about providers, plus have the patience to handle all types of demographic differences
- An understanding that he/she is handling tax payers’ money, that redundancy in staff is excess administrative costs, and ability to trim the fat
- An ability to communicate with both the Senate and the House and to be frank with both
Let us analyze the qualifications of Wos that we came to witness over the last few years, as well as, review the qualifications of soon-to-be Sec. Brajer with information to which we are privy.
Let’s see if both, either, or neither have these “Nine Habits of a Highly-Effective Secretary for DHHS.”
- Health care background:
Wos: Yes. And, yet, maybe not. She is an M.D. Although I do not know whether she ever practiced medicine in North Carolina. According to Wikipedia, (which is never wrong) Wos “prides herself on her work in the field of preventing HIV and AIDS.” However, I was unable to find a single clinic in which Wos provided services. While, generally, an “M.D.” automatically bestows a certain aura of understanding health care, I question whether this “M.D.” automatically has a working knowledge of billing for and receiving reimbursements under Medicaid in North Carolina.
Brajer: Hmmmm. This one is more tricky. The two companies that Brajer owned, Pro-nerve LLC and LipoScience Inc., are health care related, in that Pro-nerve was an intraoperative neuromonitoring (IONM) company and LipoScience sold a diagnostic tool to health care providers. Arguably, both companies are health care related, at least, in an ancillary way. However, Brajer is not a health care professional, and, to my knowledge, has never rendered health care services. Furthermore, neither of Brajer’s companies was successful; quite the opposite is true, in fact. From my understanding, one company declared bankruptcy and the other was not far behind. Which brings us to the next category…
Answer: Both…kinda.
2. A successful track record of his/her ability to manage large entities:
Wos: Prior to acting as the Secretary to DHHS, Wos served as the Ambassador to Estonia until 2006. What she did besides political functions between 2006 and 2012, I do not know. Acting as an Ambassador does not entail managing large entities. The most managerial skills that I can find in her background, prior to being appointed Secretary, are related to political fund-raising. Since I would not call her brief reign as Secretary of DHHS a success, I give Wos a “two thumbs down” on this criterion.
Brajer: He managed two companies. We can bicker as to whether these companies should be considered large…neither employed 17,000 employees. Regardless, the “successful” criterion appears to be lacking.
Answer: Neither…pickles.
3. An understanding of the Medicaid system:
Wos: “You’re asking me without having all the data available to answer a question,” she told lawmakers on October 8, 2013. In her defense, she responded as such when asked whether the State was moving toward privatization for Medicaid. No one could know the answer, except, maybe, McCrory.
On the other hand, the implementation of NCTracks was nothing short of a catastrophe of epic proportion. See blog. See blog. Anyone with nominal knowledge of the Medicaid system would have, at least, paused to consider keeping HP Enterprises under contract during the switch to NCTracks or pushed back the go-live date.
Brajer: Unknown
Answer: Here’s to hoping that Brajer does. I’m cheering for you! Go! Fight! Win!
4. A relationship with someone on Medicaid or a parent of someone on Medicaid:
Wos: Unknown. If I were shaking a proverbial “8 Ball,” it would read, “Doubtful.”
Brajer: Unknown. Perhaps one of his former employees at Pro-nerve, LLC and LipoScience, Inc. is on Medicaid.
Answer: Gimme a ‘B’! B! Gimme a ‘R’! R! Gimme a ‘A’! A! Gimme a ‘J’! J! Gimme a ‘E’! E! Gimme a ‘R’! R! Whats that spell? Brajer!!
5. A working knowledge of clinical coverage policies, reimbursement rates, and regulations surrounding Medicaid.
Wos: Unknown. Whatever Wos’ knowledge of regulations and clinical coverage policies is or lacked, she, initially, made up for any knowledge lacked with the key hire and quick resignation of Carol Steckel. Unfortunately, Steckel’s experience was never replaced.
January 2013: “I am pleased to say that we are already taking steps to address some of these issues,” Wos said. “Now, the most important of this is that we have hired Ms. Carol Steckel, a nationally recognized — nationally recognized — expert in Medicaid to run our Medicaid program for the state. Carol is already moving ahead with systemic reviews of operations in this division. She is reviewing and establishing new policies and procedures.”
September 27, 2013: Steckel resigns. And blog.
Brajer: Unknown.
Answer: B! R! A! J! E! R! Let’s go, Brajer!
6. Both the capacities to listen and speak and do both eloquently.
Wos: Wos brandished an ability to speak publicly with ease. Listening, on the other hand….eh?
Brajer: Unknown
Answer: I think you can, I think you can, I think you can…
7. Genuine concern about the physical and mental health of Medicaid recipients AND about providers PLUS have the patience to handle all types of demographic differences
Wos: She seems to think so. Her country club does not discriminate.
Brajer: Unknown
Answer: Go! Go! Go! Go! Go, Brajer!!
8. An understanding that he/she is handling tax payers money and that redundancy in staff is excess administrative costs and trim the meat
Wos: “My obligation as secretary is to find the best possible team in order to get the job done.” Les Merritt served as CFO of DMA on a $300,000-plus contract. Joe Hauck was paid over $228,000 for 6 months of advise to Wos. Matt McKillip was paid $87,500 to serve as chief policy maker without any health care background. Ricky Diaz pulled in $85,000 as communications director. Id. Wos has handed out $1.7 million in pay hikes to 280 staffers, many with “no career or educational experience for the jobs they hold.” Id. The implementation of the MCOs also fell under Wos’ watchful eye. The MCO system has created thousands upon thousands of high-paying jobs with our Medicaid dollars. I believe that in the “trim the fat” category, Sec. Wos scores a goose egg.
Brajer: Unknown.
Answer: Please, Brajer! For the love of Pete!
9. Ability to communicate with both the Senate and the House and to be frank with both.
Wos: “Separation pay” v. “Severance pay?”
In April 2013: “I think the word transparency can get pretty dangerous,” Wos said. “Because what does transparency mean? If transparency means that we’re in a planning process and you’re asking us, ‘Tell us all the things you’re planning,’ well, my goodness, allow us to work, and then we’ll give you everything that you want.”
Brajer: Unknown
Answer: Brajer, Brajer, He’s our man! If he can’t do it…[gulp].
____________________________________________
It concerns me that so many of future Sec. Brajer’s core abilities/habits to run and manage DHHS and the Medicaid program in a highly effective manner are unknown. Nothing like placing all your money on red! But we have HIGH hopes for Brajer!!! Don’t let us down!!
The whole point of this blog is to pause and really contemplate what characteristics would comprise a great Secretary for DHHS. Obviously, the Governor has the full authority to appoint the Secretary, meaning that we taxpayers have little to no input as to whether we deem a person qualified, except in the indirect method of voting or not voting for the Governor.
Call this blog an exercise in examining what habits, if in existence, would make the most highly effective Secretary of DHHS and an opinion as to whether these habits exist in our former and future Secretaries.
We are cheering for Brajer! But…
One fact about the future is that it is unknown.
CMS Certifies NCTracks!!! NC Will Get 19 Million from the Feds!
As I am driving back to the office after lunch, I hear on the news that CMS has certified NCTracks! This is huge on so many levels, and I will have to add another blog about once I get more information. So after 2 years and almost 8 months after its go-live date, NCTracks is certified.
Had CMS not certified NCTracks, then NC would have lost millions of dollars in federal dollars to fund the computer program created by Computer Sciences Corporation (CSC).
I am going to look into the standards for the certification…I know there are over 600 criteria that must be met for certification…but what is the threshold? An ‘A?’ Or do you squeak by with a ‘D?’
In the meantime, NC will receive approximately $19 million from the federal government. NCTracks had replaced the decades-old computer system created by HP Enterprises back in the summer of 2013.
CSC is a named Defendant in a class action lawsuit filed on behalf of physicians across NC alleging that the computer system was fraught with errors when it went live, including erroneous denials and heavy administrative burdens.
See blog.
Remember, this was not NCTracks’ first rodeo with an attempted certification from CMS. Back in 2013, CMS did not certify NCTracks.
In 2013, NCTracks did not meet a federal certification deadline that could have saved the state more than $9 million in annual operation costs. See article.
NC State Auditor Releases New NCTracks Audit: Unresolved Risks Could Delay Federal Certification
This just in!!!!
Our State Auditor Beth Wood just released a new audit entitled, “Department of Health and Human Services-NCTRACKS-Federal Government Certification Status.”
More to come…
Medicaid Mishaps Cause Tempers to Flare
Here is an interesting article…
Article from Carolina Journal Online by Dan Way:
RALEIGH — With $2 billion in cost overruns the past four years, Medicaid continues to be North Carolina’s most volatile political conundrum, and now unanswered questions about its spending and growth threaten to delay passage of 2014-15 state budget adjustments before next Monday’s deadline.
Things got nasty in a Senate Appropriations Committee meeting last week, and one is left to wonder whether Gov. Pat McCrory and the state Department of Health and Human Services squandered political capital by snubbing budget writers struggling with alarming lapses in vital Medicaid data.
Medicaid “is the linchpin” to writing the 2014-15 budget, said an irritated Sen. Bob Rucho, R-Mecklenburg. “Would someone explain to me why we don’t have [Office of State Budget and Management] or staff people from DHHS here to help us get to an answer so that we can move this budget forward?”
If not a prairie fire, the meeting at least exposed the slow burn of senators handcuffed by a dearth of crucial budget numbers from DHHS. Capital press corps reporters instinctively asked one of their most oft-repeated questions: Is DHHS Secretary Aldona Wos to blame for yet another major Medicaid predicament?
Due to significant backlogs, DHHS cannot provide accurate Medicaid enrollment numbers, valid claims data, and categories into which new enrollees are entered. Without precise, up-to-date information for this fiscal year, drafting an accurate budget for 2014-15 is impossible.
That’s a tough corner to be backed into for McCrory and Wos, who have made Medicaid budget predictability a holy grail.
The exasperation of Sen. Tom Apodaca, R-Henderson, typified the level of lawmaker frustration.
“If push comes to shove,” he said, “we can always issue subpoenas and have the numbers come to us. So let’s not take that off the table.”
The irritability in Senate Appropriations was bipartisan.
“Will we ever know what we need to know?” Sen. Angela Bryant, D-Nash, asked incredulously. “Do we have to be completely at the mercy of executive branch agencies on an issue like this that is so critical to what we do?”
Senate leader Phil Berger, R-Rockingham, explained, in measured but heart-attack serious tones, why there is an elevated sense of urgency, and why he had wanted someone from the budget office at the Appropriations Committee meeting to explain Medicaid numbers that have swung from wildly varying to unaccounted for.
“Our feeling is we need to reach some understanding on the Medicaid number before we can realistically start talking about most of the other things,” including teacher pay raises and pay hikes for state workers, Berger said.
And then there was this jaw-dropping exchange between Sen. Joel Ford, D-Mecklenburg, and Susan Jacobs of the legislative Fiscal Research Division.
“Based upon the uncertainty and the lack of data, how can we say for certain that people are not being overpaid or underpaid?” Ford asked.
“We probably can’t say that,” responded Jacobs. She also dropped a bombshell that it could be “probably late next year” before all necessary numbers are completely and accurately obtained.
“To me that is a very disturbing scenario where we are taking taxpayer money with good intentions, but with no verification that we’re doing the right thing because of a broken system,” Ford said.
Whether he realized it, Ford’s characterization of Medicaid as a broken system oozed irony.
In one of their first official acts upon assuming office in January 2013, McCrory and Health and Human Services Secretary Aldona Wos lambasted the state’s Medicaid program as a chaotic, broken system. Eighteen months later and holding Swiss-cheese Medicaid reports, state senators are grumbling that the agency’s disarray persists.
Pressed by reporters, Berger stopped short of saying he has lost confidence in Wos’ leadership.
“I’ll leave it to others as to why they’re not able to provide that information,” he said, but he insisted this budgeting fiasco shows the need to remove Medicaid from Wos’ control and make it a standalone agency.
The Senate budget calls for $88 million more in Medicaid spending in 2014-15 than the House version. Berger said the Senate used higher, worst-case-scenario numbers.
Berger and his counterparts rightly expressed no appetite for once again using rosy projections only to find out halfway through the budget year that there is a whopping shortfall.
To make matters worse, Senate Majority Leader Harry Brown, R-Onslow, said Fiscal Research staff isn’t even confident the worst-case numbers are sufficiently high. “I think that’s important to make sure everyone understands it.”
Sen. Louis Pate, R-Wayne, co-chairman of the Senate Health and Human Services Appropriations Subcommittee, agreed with frustrated Fiscal Research staff that much of the problem with missing data stems from NC Tracks, the new but deeply flawed Medicaid billing system.
But he was quick to note that Republicans inherited the woefully underperforming computer system that was in development for years under Democratic administrations.
“I don’t know if they made up-to-date adjustments as they went along, and we don’t know if it was tested properly before it went live,” Pate said. Others, including State Auditor Beth Wood, warned last year that the nearly half-billion-dollar system was not ready to launch.
Wos lost control and never regained the upper hand in messaging after she defiantly promised she was going to drag the long-beleaguered NC Tracks over the July 1 finish line, and declared it sound when she did.
The bravado and exuberant can-do proclamations might have seemed politically appropriate for a new administration seeking to position itself as an intrepid change agent.
But Wos would have been wise to have tempered her rookie remarks with caveats about the huge challenges left behind by previous Democratic administrations, downplayed expectations, and more candidly acknowledged what IT skeptics already knew — the system was going to encounter plenty of rollout problems that would require a long time to correct.
Pate was among those declaring that the current Medicaid budgeting calamity further demonstrates the “critical necessity for reorganization” of the agency. But restructuring has been hampered by the unsteadiness of tectonic policy shifts.
Pate is among senators who continue to oppose the latest reform plan favored by McCrory and Wos, and now in bill form in the House. He said the proposal only tinkers around the edges of budget predictability and restraint.
This latest iteration is an accountable care model comprising networks of doctors and hospitals. It was rolled out after the administration’s stunning U-turn from months of championing full-risk managed care, and scoring a coup in recruiting Carol Steckel, a highly sought, nationally renowned expert on Medicaid managed care.
Steckel, former head of the National Association of State Medicaid Directors, left her $210,000-a-year job in North Carolina last September after only eight months working for Wos.
Whether there was a back-story to the swift departure of a highly heralded Medicaid reformer, much like what this year’s Medicaid numbers are, remains a guessing game.
NCTracks Derailed: Class Action Lawsuit Filed!
My law partner Camden Webb and I filed a class action lawsuit today alleging on behalf of medical providers who accept Medicaid in North Carolina.
Williams Mullen Medicaid Litigation Team Files Class Action Lawsuit Against NCTracks
Raleigh, NC. (Jan. 16, 2013) – This morning, Williams Mullen attorneys Knicole Emanuel and Camden Webb filed a class action lawsuit on behalf of Medicaid providers in North Carolina against NCTracks, the system that processes Medicaid claims.
The suit alleges that NCTracks was launched before it was ready to be implemented, and its poor design has resulted in catastrophic losses for health care providers. NCTracks had over 3,200 software errors in the first few months of operation, and payments to Medicaid providers were delayed, unpaid, or “shorted” by over half a billion dollars in the first 90 days. In some instances, providers have decided not to accept Medicaid patients or have even closed their practices, and some of North Carolina’s most needy citizens have suffered a reduction in the health care resources available to them.
“We’re filing on behalf of health care providers, but we’re also serving the low-income Medicaid recipients of North Carolina that rely on these providers to receive care,” said Knicole Emanuel, a Litigation Partner with the firm who handles Medicaid matters. “Since these providers have experienced financial hardship due to NCTracks, many of them are no longer able to serve the state’s most vulnerable population of health care consumers.”
About Williams Mullen
Williams Mullen is an AmLaw 200 law firm that blends the law, government relations and economic development to help grow the business of our clients and the economy of our region across North Carolina, Virginia and Washington, D.C. Our attorneys and consultants strive to help connect clients to opportunities and solutions they need. Putting our clients’ needs first has been the foundation of our approach since the firm was founded 103 years ago. Visit us at www.williamsmullen.com.
The Assassination of Caesar, the Utter Ineptness of NCTracks, and Ignored Warnings
“If we do not learn from history, we are doomed to repeat it.” George Santayana.
In William Shakespeare’s “Julius Caesar,” Caesar is warned to “Beware the Ides of March.” See Act 1, Scene 2. The “ides” of March is the fifteenth. Back when Caesar established the Julian calendar, he also instituted the “ides” of a month. Months have different “ides.” The ides of January, for example, is the thirteenth; the ides of March, May, July and October is the fifteenth.
Caesar:Who is it in the press that calls on me?
I hear a tongue shriller than all the music
Cry “Caesar!” Speak, Caesar is turn’d to hear. Soothsayer:
Beware the ides of March. Caesar:
What man is that? Brutus:
A soothsayer bids you beware the ides of March
Not really sure what the point of the “ides” was, but, regardless, in 44 B.C., March 15th was the “ides” of March.
When Caesar was warned to “Beware the Ides of March,” Caesar would have known that the soothsayer was warning him about March 15th…a date certain.
Similarly, the Department of Health and Human Services (DHHS) was warned that NCTracks was not ready for its July 1, 2013, “go live”date. Who was the soothsayer? The Office of State Auditor…Beth Wood.
In May 2013, prior to NCTracks going live, State Auditor Beth Wood published a Performance Audit that found hundreds of untested issues. The audit warned DHHS that NCTracks was not ready to go live. The May 2013 Performance Audit may as well have said, “DHHS, beware the first of July!”
Late in the day on March 15, 44 B.C., Caesar walked to the Theatre of Pompey, where he would be assassinated by more than 60 conspirators led by Brutus, his close ally…”Et tu, Brutus?” (Meaning…how could you, my closest friend, conspire against me?)
On his way to the theatre, Caesar sees the same soothsayer who had warned him of the ides of March. Caesar joked, “The ides of March have come,” meaning to say that the prophecy had not been fulfilled, to which the seer replied “Aye, Caesar; but not gone.” See Plutarch’s “Parallel Lives.”
I can only imagine the chill that ran down Caesar’s back when the soothsayer warned that the day was not over yet.
Yet, Caesar still walked to the theatre…despite the warning….
Despite the warnings in the May 2013, Performance Audit, DHHS still went live on July 1, 2013.
Since going live, NCTracks has run into a large number of system defects. Providers in NC have been in uproar. From not getting paid, to getting paid the wrong amount, to Medicaid/Medicare crossover issues, to taxonomy issues…the failures and defects of NCTracks have been felt by all Medicaid providers, despite the speciality.
About a month ago, NC General Assembly began demanding answers of DHHS and Computer Sciences Corporation (CSC), the entity that created NCTracks based on a $484 million contract. On October 8, 2013, DHHS and CSC appeared before the Joint Legislative Oversight Committees on Health and Human Services and Information Technology to answer questions about NCTracks issues.
Remember, Sec. Aldona Wos stated, during the committee meeting, that DHHS was not warned by an entity of the risk to go live with NCTracks. To which, Auditor Wood stated, “For the secretary to say there was no independent or anybody else that had given them a look at their risk readiness for going live on July 1 was not a true statement to the committee, and we felt like that the committee needed to know that information.”
State Auditor Wood is the soothsayer. “Beware the first of July!”
Just as the soothsayer did for Caesar, prior to NCTracks going live, Wood warned DHHS that NCTracks was not ready. Just like Caesar, DHHS did not stop NCTracks from going live (he went to the theatre anyway). Just like Caesar’s death, the failure and ineptness of NCTracks was forewarned and could have been prevented. Both DHHS and Caesar ignored the warnings.
So how bad is NCTracks?
According to the December 2013 Performance Audit, “the NCTracks system has encountered more than 3,200 defects.”
Here are the Audit’s findings:
FINDING #1: THE DEPARTMENT HAS AN INADEQUATE FRAMEWORK FOR THE TIMELY RESOLUTION OF NCTRACKS DEFECTS
Since going live, the NCTracks system has encountered more than 3,200 defects. More than 600 defects remain unresolved at the time of the audit.
FINDING #2: THE DEPARTMENT LACKS A COMPREHENSIVE MASTER ACTION PLAN TO ADDRESS NCTRACKS ISSUES
The Department does not have a comprehensive and cohesive master action plan to direct the remediation of technical and operational NCTracks issues.
FINDING #3: NCTRACKS GOVERNANCE CHANGES PRESENT BUDGETARY AND SYSTEM CAPABILITY RISKS TO THE STATE
Since July 1, 2013, there have been major updates to the approach the Department will take to implement required capabilities. These changes present budgetary and system functionality risks to the State.
FINDING #4: STATE GOVERNMENT’S ‘REVOLVING DOOR’ CREATES A PERCEPTION OF BIAS OR CONFLICT OF INTEREST
A former DHHS employee who served for more than four years as the NCTracks Senior Program Manager and Associate Program Director now works for the NCTracks vendor, CSC, as the NCTracks Executive Account Director.
From Finding #4, it appears that CSC, like Brutus, is working hand in hand with DHHS.
If we do not learn from history, we are doomed to repeat it. “Beware the ides of March!”
“Et tu, Brutus?”
December 2013 Performance Audit Finds NCTracks Has Encountered More Than 3200 DEFECTS!
Today State Auditor Beth Wood published the December 2013 “NCTracks Post-Implementation Performance Audit.” One of the key findings is that, since NCTracks went live, the NCTracks system has encountered more than 3,200 defects.
3200!!!
This is the second audit that Wood has conducted on NCTracks. The first audit was May 22, 2013, and expressly warned the Department of Health and Human Services (DHHS) that NCTracks was not ready to go live.
More to come in another blog…
Lawmakers Demand Accountability as to NCTracks Debacle (Finally) and the Action of Nonaction
Yesterday (11/20/13), State Auditor Beth Wood appeared before the Joint Program Evaluation Oversight Committee meeting. Lawmakers and Wood criticized NCTracks, its rollout, and the lack of accountability on the part of the administration. Sen. Stan Bingham, R-Davidson, even asked whether criminal charges could be filed against whomever was in charge of the NCTracks rollout.
Criminal charges!!
There is little disagreement that the rollout of NCTracks has been a complete CATASTROPHE. NCTracks went live July 1, 2013, and the past 143 days have been nothing short of a hair-pulling-out, feet-stomping, spit-wielding debacle for most providers. So lawmakers, as the health care providers have been asking for the past 143 days, ask, “Who is to blame?”
Who is to blame?
- The Department of Health and Human Services (DHHS)?
- Computer Sciences Corporation (CSC) (the company who designed NCTracks)?
- Independent Verification and Validation (IV&V) Contractor? (the third-party contractor hired for independent verification and validation of NCTracks)?
- Governor Pat McCrory?
- Secretary Aldona Wos?
No one in the administration is stepping up to accept accountability. The vendors are not accepting responsibility. It is as if the Department of Health and Human Services (DHHS) is just standing there…watching the debacle…doing nothing. I am reminded of Dr. T.J. Eckleburg. Anyone remember who Dr. Eckleburg is?
Dr. T.J. Eckleburg’s spectacled eyes are a powerful symbol in The Great Gatsby, one of my favorite novels of all time, written by F. Scott Fitzgerald.
Originally, the billboard was erected to promote Dr. Eckleburg’s optometry practice. The eyes are supposed to symbolize commercialism and the greed of America, but the billboard is neglected and the eyes remain throughout the story to symbolize God watching over Nick Carraway and the other characters. The eyes seem to be an all-knowing and all-powerful figure over the characters. The eyes frown down on the characters and judge their actions.
Wilson equates T.J.’s eyes to the eyes of God. He recounts to Michaelis what he says to Myrtle after discovering his affair, “‘and I said “God knows what you’ve been doing, everything you’ve been doing. You may fool me, but you can’t fool God!”” However, Michaelis tries to point out to him that “It’s just a billboard.”
Maybe it is not just a billboard.
Throughout The Great Gatsby, Eckleburg’s eyes watch. Yet, in the novel, God, symbolized by Dr. T.J. Eckleburg’s spectacles, seems to have abandoned America, leaving only Dr. T.J. Eckleburg behind to stare down with his empty eyes. Dr. T.J. Eckleburg never moves…never speaks. Yet, Fitzgerald creates this looming, unmoving billboard and characterizes the billboard as God. And who is more in charge than God?
Similarly, (not as to God, but as to Dr. T.J. Eckleburg), DHHS is supposed to be the all-knowing and all-powerful head of North Carolina Medicaid.
42 C.F.R. 1396a(5) requires the State Plan to “either provide for the establishment or designation of a single State agency to administer or to supervise the administration of the plan; or provide for the establishment or designation of a single State agency to administer or to supervise the administration of the plan.”
That single state entity is DHHS.
DHHS is charged with watching over all things Medicaid. DHHS is our Medicaid Dr. T.J. Eckleburg.
When State Auditor Wood was asked by legislators who is to blame, she answered, “The agency.” As in, DHHS. “Accountability comes at the secretary level, those that report to the secretary, and the governor.”
If DHHS is in charge and Secretary Wos is in charge of DHHS, then (going back to Logic 101) Wos is to blame for the NCTracks debacle. Right?
Before jumping up and down and blaming Secretary Wos for NCTracks, remember that it was the prior administration that began the whole NCTracks idea in the first place. Wos did not come to NC and say, “Hey, let’s change the Medicaid billing system. There is this company CSC that will be so perfect for the job. Let’s pay them a ton of money to revamp the entire system.” No, Wos came to NC with NCTracks already begun. The past administration started this little ball rolling. Wos stepped in when the ball was huge and its inertia kept it going…or should we say Wos did not stop the rolling ball.
Does that exonerate Sec. Wos from any accountability and/or blame for the current state of mess Medicaid is now in due to NCTracks? Absolutely not. It is without question that Sec. Wos is charged with managing DHHS. It is without question that Sec. Wos has not accepted the accountability of the NCTracks debacle. Shoot, she hasn’t even admitted there is a problem!! Isn’t admitting there is a problem the first step?
Someone at DHHS made a fatal flaw in implementing NCTracks. Someone told HP Enterprises to take a hike without ensuring that NCTracks would work. That is like walking a tight rope with no net! And that fatal decision is on this administration.
Like Dr. T.J. Eckleburg, DHHS is watching over Medicaid. And like Dr. T.J. Eckleburg, DHHS is unmoving and silent.
DHHS cannot be a billboard. Nonaction is not an option.
Senator Bingham asked whether we could fire anybody (whomever was in cgarge of the debacle). To which, Wood stated, in her normal, no-nonsense manner, “I don’t have a problem firing anybody.”
One News and Observor editorial wrote, “What Wos should have told lawmakers wasn’t that she’s pressing DHHS staff and its computer vendor to pay people who are owed. She should have said, “We thought we were being frugal and instead we were reckless and it has cost everyone a great deal. I take responsibility. I apologize. And I’m determined to keep learning from my mistakes to fulfill the mission of my department.” Instead, she told the committee, “I assure you that where necessary, I will hold people accountable.” Excepting herself, of course.”
Right now DHHS is just a billboard.
In fact, maybe the most important nonactions to note are what Sec. Wos is NOT doing. She has has NOT blamed CSC. She has NOT condemned CSC. She has NOT had heads rolling at CSC. Sec. Wos has NOT publicly spoken disparagingly about CSC’s implementation of NCTracks. She has NOT terminated CSC’s contract. To my knowledge, she has NOT asked for help from HP Enterprises. Right now, DHHS is nothing more than a billboard, a symbol of Medicaid, but doing nothing.
In fact, on Tuesday, DHHS representatives tried to tell the Joint Program Evaluation Oversight Committee that NCTracks was improving and its “trajectory is good.” Doing nothing…just watching…
In The Great Gatsby, Dr. T.J. Eckleburg’s eyes never change. They continue to watch. Unlike Dr. T.J. Eckleburg, Sec. Wos can move. She needs to move.
Yet, whereas Wood said that she doesn’t have a problem firing anybody, Wos stated on Tuesday “that, where necessary, I will hold people accountable.”
Where necessary??
Aren’t we to “where necessary” yet? 143 days after the catastrophic implementation of NCTracks and the mess is not fixed….don’t you think it is necessary to hold someone accountable??
Oh, and by the way, during these past 143 days since NCTracks’ implementation, who is getting harmed? The doctors, the dentists, the in-home health care providers who are not receiving proper Medicaid reimbursements. And then who suffers? The Medicaid recipients because providers stop accepting Medicaid. In a Medicaid system that already discourages providers from accepting Medicaid, NCTracks is certainly not helping. Counting business damages, loss of clinical time, and unpaid claims, can you imagine the invoice that the harmed providers should serve on DHHS?? Maybe the invoice sent to DHHS should give DHHS 15 days to request a reconsideration review.
One thing is for certain, DHHS (whether or not through Wos) must stop merely being a symbol of Medicaid, a billboard, and start acting… and be accountable.
Because after 143 days of this hair-pulling-out, feet-stomping, spit-wielding debacle for most providers, there aren’t many more hairs, stomps, or spit.
NC State Auditor, Beth Wood, Calls Out Inaccuracies Stated at the NC Oversight Committee Regarding NCTracks
After the October 8, 2013, Oversight Committee meeting regarding NCTracks, our State Auditor, Beth Wood, had some clarifying remarks. By clarifying, I mean, Wood points out the (we don’t want to use such a harsh words as “lies”) inadvertent mistruths that came to light at the October 8, 2013, Oversight Committee meeting. (Click the blue phrase to see a portion of the video of the actual meeting).
One inadvertent mistruth was as follows:
During the Oversight Committee, Senator Parmon asked Secretary Wos whether any professional opinion had been given to the Department of Health and Human Service (DHHS) warning DHHS that NCTracks was not ready to go live July 1, 2013.
Secretary Wos answered: “No, Senator.”
Was the State Auditor’s May 2013 Performance Audit explicitly stating that NCTracks was not ready to go live not enough???? Or maybe Secretary Wos did not consider the Performance Audit a “professional opinion.” She may have a point. Perhaps the Performance Audit should be considered “professional fact.”
It is important to remember that this $484 million contract (which price tag has been surpassed) is funded by our tax dollars.
Here is Beth Wood’s response to the Oversight Committee:
October 10, 2013
Honorable Justin BurrNC House of Representatives 300 N. Salisbury Street, Room 307A Raleigh, NC 27603-5925
Dear Representative Burr,
The Office of the State Auditor has several concerns about incomplete information provided to the Joint Legislative Oversight Committee on Health and Human Services during its committee meeting on October 8, 2013. We would like to clarify some of the information provided to the committee by officials from the Department of Health and Human Services.
1. When Senator Parmon asked Secretary Wos whether the Department of Health and Human Services had received any professional opinions indicating that that the NC Tracks system may not be ready to go-live on July 1, the Secretary responded “No, Senator.” This answer ignores the work of our audit issued on May 22, 2013, titled: “NCTracks (MMIS Replacement) – Implementation.” The State Auditor met and presented Secretary Wos with the findings and recommendations as early as March 27, 2013, to allow her department to begin addressing problems uncovered in the audit.
The audit findings from our report included that:
- Independent assessments regarding system readiness and testing were flawed and put system readiness at risk
- Access control and security environment were at risk on go-live
- No formal criteria framework existed to determine if NCTracks was ready for go-live
“The Department should re-evaluate its current “Go” decision for July 1, 2013, once final Go/No-go criteria is established and documented,” our audit recommended. “This assessment should incorporate the final user acceptance testing and production simulation testing results.”
2. In his presentation, Mr. Cooper referenced NCTracks testing procedures done by DHHS and its vendor, CSC, prior to the July 1 go-live date and indicated that the system had met their benchmarks. Our audit, however, found several shortcomings in the testing of the system.
Our findings indicated that:
- Out of 834 “critical” priority test cases affecting various Medicaid and provider business processes, 123 critical tests had failed and 285 critical test cases were not performed. The department itself defined which business processes were critical, and according to the department, “critical” test cases were absolutely required to be tested.
- Our audit stated, “If user acceptance testing is accepted without addressing these issues, a high risk exists that critical NCTracks functions could have major errors on go-live and possibly lead to a delayed CMS certification of the system.”
- Oversight over the production simulation testing process was inadequate. Our work found that the department allowed CSC to develop the acceptance criteria for its own work, one week prior to the end of the testing phase, and that the department lacked clear test benchmarks.
3. Mr. Cooper stated during this presentation that, “On February 28th we [DHHS] reached a point-of-no-return when the state had to cancel the HP contract.” This contradicts what Department leaders told state auditors during our NCTracks pre-implementation audit. During our audit, DHHS senior leadership repeatedly indicated that the termination of the contract with HP, the vendor for the Medicaid system that was replaced by NCTracks, should not be considered final acceptance of the project.
“According to the Department, the letter to HP does not constitute formal acceptance of the NCTracks system,” our audit states. “The Department has indicated that if the NCTracks system is not ready for go-live on July 1, 2013, HP will be willing to continue its services as long as needed. However, there is no guarantee that this continuation of services would occur or at what cost to the State as this is not in writing.”
The fact that Mr. Cooper and the Department now characterize the contract termination as a “point-of-no-return” indicates that the Department’s decision to go-live did not take into account the actual readiness of the system or the critical risks that were raised between February 28 and June 30.
Our full audit report on NCTracks can be viewed at http://www.ncauditor.net/EPSWeb/Reports/InfoSystems/ISA-2013-4410.pdf.
Our staff is available to answer any questions or concerns you may have about our work. If you wish to discuss this information with me, you can contact me at 919-807-7628.
Thank you for your work on behalf of the people of North Carolina.
Sincerely,
Beth A. Wood, CPA North Carolina State Auditor
