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GOOD MORNING
CHAIRPERSONS ALLEN AND PATTERSON AND OTHER MEMBERS OF THE COUNCIL: I APPRECIATE THE OPPORTUNITY TO APPEAR BEFORE THE COMMITTEES ON HUMAN SERVICES AND GOVERNMENT OPERATIONS TO TESTIFY CONCERNING THE OFFICE OF THE INSPECTOR GENERAL'S INVOLVEMENT IN EXAMINING SELECTED ASPECTS OF THE DISTRICT OF COLUMBIA'S MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES (MRDD) PROGRAM. THE PURPOSE OF MY PREPARED TESTIMONY FOR TODAY'S HEARING IS TWOFOLD. FIRST, I UNDERSTAND THE COMMITTEES ARE SEEKING INFORMATION CONCERNING SPECIFIC ACTIONS TAKEN BY DISTRICT AGENCIES AND OFFICIALS TO ADDRESS THE MOUNTING PROBLEMS ASSOCIATED WITH THE CARE AND TREATMENT OF THE DISTRICT'S MENTALLY CHALLENGED POPULATION. THEREFORE, I WILL PROVIDE YOU WITH A BRIEF CHRONOLOGY SETTING FORTH THE NATURE OF OUR INVOLVEMENT IN THE DIFFICULTIES AT THE MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES ADMINISTRATION (MRDDA) THAT HAVE BECOME PUBLIC KNOWLEDGE THROUGH A RECENT SERIES OF NEWS ARTICLES OVER THE PAST YEAR. SECOND, I WOULD LIKE TO POINT OUT A NUMBER OF AREAS WHERE I BELIEVE PROGRESS HAS BEEN MADE. WE ALL RECOGNIZE THAT A BREAKDOWN OCCURRED IN THE COMPLEX AND OFTEN UNCOORDINATED SYSTEM OF PRIVATE, DISTRICT, AND FEDERAL ENTITIES THAT PROVIDE AND OVERSEE THE CARE GIVEN TO THE RESIDENTS OF THE CITY'S GROUP HOMES. FORTUNATELY, MANY AGENCIES, INCLUDING MY OWN, HAVE TAKEN STEPS THAT I BELIEVE WILL LEAD TO SIGNIFICANT IMPROVEMENTS IN THE OVERSIGHT PROVIDED TO THOSE RESIDENTS OF GROUP HOMES IN THE FUTURE. BEFORE SETTING FORTH THE CHRONOLOGY OF OUR INVOLVEMENT IN RECENT MRDDA PROBLEMS, IT IS IMPORTANT TO NOTE THAT MY OFFICE HAS INVESTIGATED A NUMBER OF MATTERS BROUGHT TO OUR ATTENTION INVOLVING THE DISTRICT'S GROUP HOMES. THESE INVESTIGATIONS BEGAN LONG BEFORE THE STORIES OF NEGLECT OF RESIDENTS AND UNINVESTIGATED DEATHS SURFACED. SEVERAL ARE UNDERWAY NOW. FOR INSTANCE, MY INVESTIGATIONS DIVISION HAD BEGUN INVESTIGATING, IN CONJUNCTION WITH THE FEDERAL BUREAU OF INVESTIGATION (FBI), CONTRACTUAL ARRANGEMENTS BETWEEN THE DISTRICT AND A PARTICULAR GROUP HOME PROVIDER FOR MENTALLY DISABLED DISTRICT RESIDENTS. BECAUSE THIS MATTER HAS BEEN PRESENTED TO A FEDERAL PROSECUTOR, IT WOULD BE INAPPROPRIATE FOR ME TO PROVIDE FURTHER COMMENT AT THIS TIME. HOWEVER, IT IS IMPORTANT TO NOTE THAT FINANCIAL IRREGULARITIES ARE OFTEN THE FIRST SIGN THAT GROUP HOME PROVIDERS ARE NOT DELIVERING THE SERVICES EXPECTED OF THEM. I WILL NOW PROVIDE THE CHRONOLOGY OF EVENTS. MARCH 16, 1999 WHILE THE MAJORITY OF THE STORIES OF GROUP HOME RESIDENTS BEGAN TO SURFACE IN DECEMBER OF 1999, MY OFFICE AGAIN BECAME INVOLVED ON MARCH 16, 1999, WHEN WE RECEIVED TWO MEMORANDA FROM MS. WILLIAMS. THE FIRST MEMORANDUM REQUESTED AN INVESTIGATION REGARDING COMMUNITY BASED SERVICES FOR PERSONS WITH MENTAL RETARDATION. THE NATURE OF THIS REQUEST WAS NOT SPECIFIC. HOWEVER, IT DID MENTION THAT A FORMER EMPLOYEE, MR. ARNETT SMITH, MISUSED HIS POSITION AT MRDDA FOR PRIVATE GAIN AND THAT HE HAD A PERSONAL RELATIONSHIP WITH A GROUP HOME CONTRACTOR. AT THE TIME MS. WILLIAMS INFORMED US ABOUT MR. SMITH, WE ALREADY HAD BEGUN AN INVESTIGATION INTO HIS ACTIVITIES. JUST THIS WEEK, MR. SMITH WAS FOUND GUILTY IN U.S. DISTRICT COURT OF THE VERY CHARGES THAT RESULTED FROM OUR LENGTHY INVESTIGATION. THE SECOND MEMORANDUM FURTHER REQUESTED THAT MY OFFICE CONDUCT A FINANCIAL AUDIT OF ALL PROGRAMS THAT PROVIDED SERVICES TO PERSONS WITH MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES. MARCH 23,1999 IN RESPONSE TO MS. WILLIAMS' REQUESTS, WE MET WITH MR. JESSE GOODE, THEN GENERAL COUNSEL FOR THE DEPARTMENT OF HUMAN SERVICES (DHS), TO ASCERTAIN SPECIFIC ALLEGATIONS OF CRIMINAL ACTIVITY WHICH WOULD ENABLE THIS OFFICE TO INITIATE AN INVESTIGATION. AT THIS MEETING, MR. GOODE ADVISED US THAT HE WROTE THE MARCH 16 LETTER TO THE OIG AT THE REQUEST OF MS. WILLIAMS, WHO REQUESTED THAT THE OIG INVESTIGATE POSSIBLE WRONG DOING WITHIN THE MRDDA. HE ADVISED US THAT THIS LETTER WAS PROMPTED BY THE RECENT WASHINGTON POST ARTICLES ABOUT DHS AND THE PROBLEMS OF ABUSE, NEGLECT AND MISMANAGEMENT IN THE CITY'S GROUP HOMES FOR THE MENTALLY RETARDED. DURING THE MEETING, MR. GOODE MADE REFERENCE TO HOMES THAT WERE OPERATED BY A CONTRACTOR WITHOUT A LICENSE OR PROPER CERTIFICATION. MY OFFICE WAS FAMILIAR WITH THIS PARTICULAR CONTRACTOR. IN FACT, WE HAD PREVIOUSLY OPENED AN INVESTIGATION PREDICATED ON ALLEGATIONS THAT EMPLOYEES WERE FAILING TO PROVIDE SUFFICIENT FOOD AND THE PROPER MEDICAL SERVICES TO CLIENTS, AND WERE CARELESS IN PROTECTING CLIENTS' PERSONAL FUNDS. DESPITE THIS MEETING, MR. GOODE DID NOT ARTICULATE ALLEGATIONS OF ANY OTHER POTENTIAL CRIMINAL MATTERS REGARDING THREATS OR DANGER TO RESIDENTS IN GROUP HOMES THAT NEEDED TO BE INVESTIGATED. INSTEAD, HE SUGGESTED THAT MY OFFICE MIGHT WANT TO CONDUCT AN AUDIT OF MRDDA' S CONTRACTING PRACTICES. MR. GOODE ADVISED US THAT HE UNDERSTOOD THAT HIS REQUEST WAS GENERAL 1N NATURE, AND SUGGESTED THAT WE TALK WITH THE NEW MRDDA ADMINISTRATOR, WHEN APPOINTED. OUR INVESTIGATION WAS LATER TERMINATED DUE TO THE MAYOR'S ACTION TO CLOSE THIS CONTRACTOR'S HOMES. MARCH 31, 1999 MR. GOODE CALLED MY INVESTIGATIONS DIVISION AND APOLOGIZED FOR FAILING TO FOLLOW UP ON THE MARCH 23RD MEETING IN WHICH HE AGREED TO PROVIDE INFORMATION ABOUT THE SPECIFIC TYPE OF INVESTIGATIVE ASSISTANCE DHS WOULD SEEK FROM MY OFFICE. HE REQUESTED THAT WE HOLD OFF ON DOING ANY WORK AT HIS AGENCY UNTIL THE MRDDA ADMINISTRATOR WAS REPLACED. AT THAT TIME, HE WOULD MEET WITH US TO DISCUSS THE PLANNED SCOPE OF INVESTIGATION. APRIL 7, 1999 MY INVESTIGATIVE STAFF AGAIN MET WITH THE DHS GENERAL COUNSEL AND THE CHIEF FINANCIAL OFFICER TO DISCUSS THE SPECIFIC AREAS OF CONCERN. AGAIN, AT THIS MEETING, NO INVESTIGATIVE ISSUES WERE DISCUSSED. INSTEAD, DHS OFFICIALS SHIFTED FROM A REQUEST FOR AN INVESTIGATION TO AN EXAMINATION OF HOW CLIENT FUNDS WERE BEING USED. SINCE THESE OFFICIALS WERE INTERESTED IN THE SAFEGUARDING AND USE OF CLIENT ACCOUNTS, MY STAFF ADVISED DHS PERSONNEL TO SUBMIT IN WRITING THEIR REQUEST FOR AN AUDIT - INSTEAD OF AN INVESTIGATION. THEY DID NOT DO SO UNTIL AUGUST 30, 1999. MAY 4, 1999 IN RESPONSE TO A WASHINGTON POST ARTICLE ANNOUNCING A GROUP HOMES PROBE BY THE DEPARTMENT OF JUSTICE (DOJ), MY EXECUTIVE STAFF FELT COMPELLED TO REVISIT THE ROLE THAT MY OFFICE SHOULD PLAY. WE TOOK THIS ACTION FOR SEVERAL REASONS. FIRST, ANY DOJ PROBE COULD HAVE A SIGNIFICANT IMPACT ON OUR INVESTIGATIVE INTERESTS. WE WERE ALSO CONCERNED BECAUSE WE HAD NOT RECEIVED ANY DEFINITIVE REQUEST - OR EVEN HEARD FROM DHS PERSONNEL, AS PROMISED DURING OUR APRIL 7TH MEETING. WE CONCLUDED THAT MORE SPECIFIC INFORMATION WAS NEEDED FROM MS. WILLIAMS TO ENABLE US TO CONDUCT A THOROUGH INVESTIGATION AND TO ESTABLISH AN APPROPRIATE AUDIT SCOPE. CONSEQUENTLY, WE AGREED TO INVITE MS. WILLIAMS AND MEMBERS OF HER STAFF TO MEET WITH US. MAY 10,1999 A MEETING WAS HELD WITH MS. WILLIAMS AT OUR OFFICE TO DISCUSS HER REQUEST AND TO DEFINE OUR SPECIFIC INVESTIGATIVE ROLE. IMMEDIATELY AFTER THIS MEETING, WE CONFIRMED OUR BELIEF THAT MS. WILLIAMS' CONCERNS COULD BE BEST ACCOMMODATED BY AN AUDIT RATHER THAN AN INVESTIGATION. IN OUR OPINION, AN AUDIT WAS MORE APPROPRIATE SINCE HER CONCERNS DID NOT INVOLVE ALLEGATIONS FOCUSING ON SPECIFIC ACTS OF CRIMINALITY. INSTEAD, THEY PERTAINED TO PROGRAM OPERATIONAL PROBLEMS. MAY 17, 1999 AT THE REQUEST OF THE INSPECTOR GENERAL FOR THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, MY AUDIT STAFF ATTENDED A MEETING TO EXCHANGE PRELIMINARY INFORMATION REGARDING THE POSSIBLE SCOPE OF THE AUDIT. MS. WILLIAMS WAS ALSO PRESENT AT THIS MEETING. SINCE MS. WILLIAMS HAD REQUESTED THAT THE HHS INSPECTOR GENERAL ALSO BE INVOLVED, EXISTING PROTOCOL DICTATED THAT WE COORDINATE AUDIT EFFORTS. DURING THIS MEETING, SHE SPECIFICALLY REQUESTED THE HHS OIG TO EXAMINE HOW ALLEGATIONS OF NEGLECT AND ABUSE WERE HANDLED BY DHS AND MRDDA. JUNE 18, 1999 AUDITORS FROM HHS BEGAN THEIR AUDIT AT THE DISTRICT'S DEPARTMENT OF HUMAN SERVICES. HHS AUDITORS DECIDED TO EXAMINE ABUSE AND NEGLECT IN D.C. GROUP HOMES AS PART OF A NATIONWIDE AUDIT ALREADY IN PROGRESS. AT MS. WILLIAMS' REQUEST, HHS AGREED TO SEPARATELY REVIEW HOW MRDDA AND DHS HANDLED INCIDENT REPORTING. IN OTHER WORDS, THEY FOCUSED ON THE SYSTEM IN PLACE TO RECEIVE, REVIEW, TRACK, AND RESOLVE REPORTED INCIDENTS FOR PEOPLE RECEIVING SERVICES FROM MRDDA GROUP HOMES. WHILE IT WAS AN APPROPRIATE DECISION FOR DHS TO PURSUE THIS MATTER AT THE TIME, I WANT TO REMIND THE COUNCIL THAT THE NEWLY CREATED MEDICAID FRAUD CONTROL UNIT (MFCU), WHICH HAS BEEN ESTABLISHED IN MY OFFICE, WILL BE ABLE TO ADDRESS SIMILAR MATTERS IN THE FUTURE. JUNE 30, 1999 WE SENT AN ENGAGEMENT LETTER TO MS. WILLIAMS INFORMING HER THAT AN AUDIT WOULD BE CONDUCTED OF THE MRDD PROGRAM. JULY 21, 1999 MY AUDIT STAFF MET AGAIN WITH HHS OIG AUDIT STAFF TO CONFIRM THE SCOPE AND OBJECTIVES OF WORK THAT WOULD BE PERFORMED TO ENSURE THAT NO DUPLICATION OF EFFORT OCCURRED. AUGUST 4,1999 MY AUDIT STAFF CONDUCTED AN ENTRANCE CONFERENCE WITH MRDDA PERSONNEL AND INFORMED THEM THAT THE OIG WOULD FOCUS ITS AUDIT ON COMPLIANCE WITH CONTRACT TERMS AND PROVISIONS AND THE BILLING PROCESS. AUGUST 30, 1999 WE RECEIVED MS. WILLIAMS' REQUEST THAT WE EXPAND OUR AUDIT TO INCLUDE A REVIEW OF THE MANAGEMENT AND SAFEGUARDING OF CLIENT BANK ACCOUNTS. THIS WAS A REPLY TO OUR APRIL 7TH SUGGESTION THAT DHS NOTIFY THE OIG IN WRITING OF ANY ADDITIONAL AREAS THAT THEY BELIEVED SHOULD BE EXAMINED. SEPTEMBER 8, 1999 WE NOTIFIED MS. WILLIAMS THAT OUR AUDIT WAS EXPANDED TO INCLUDE A REVIEW OF CLIENT ACCOUNTS. IT WAS ON THIS DATE THAT WE BEGAN WORK ON THE MRDD PROGRAM. NOVEMBER 23,1999 WE ISSUED OUR REPORT OF INVESTIGATION REGARDING PROCEDURES WHICH WERE NOT FOLLOWED, RESULTING IN NEGLIGENT CARE WHICH CAUSED THE DEATH OF A GROUP HOME RESIDENT. AS YOU MAY RECALL, MR. PATRICK DUTCH, A SEVERELY RETARDED PERSON, WAS FOUND DEAD IN THE BACK OF A VAN ON JULY 9, 1999, DURING THE SEVERE SUMMER HEAT. OUR INVESTIGATION SUBSTANTIATED THE ALLEGATIONS OF NEGLECT. THE MEDICAL ASSISTANCE AGENCY OF THE DEPARTMENT OF HEALTH AGREED TO TAKE ACTION ON OUR RECOMMENDATIONS TO IMPLEMENT GUIDELINES FOR TRANSPORTING AND ACCOUNTING FOR GROUP RESIDENTS WHILE IN TRANSIT. DECEMBER 8, 1999 SUBSEQUENT TO A MEETING WITH MS. WILLIAMS AND DR. IVAN WALKS TO DISCUSS OUR AUDIT OF THE GROUP HOME PROGRAM, I NOTIFIED THE MAYOR OF THE OIG'S INVOLVEMENT WITH THE MRDDA PROGRAM. NOW I WOULD LIKE TO DIRECT YOUR ATTENTION TO OUR ONGOING EFFORTS PERTAINING TO THE MRDDA. WE HAVE CHANGED THE SCOPE AND OBJECTIVES OF OUR AUDIT IN ORDER TO RESPOND TO MS. WILLIAMS' REQUESTS AND TO AVOID DUPLICATION OF EFFORTS, ESPECIALLY AMONG MEMBERS OF THE MRDDA FEDERAL TASK FORCE. AS YOU KNOW, THE MEMBERS INCLUDE THE HHS OIG, THE FBI, THE UNITED STATES ATTORNEY'S OFFICE, AND THE INSPECTOR GENERAL'S OFFICE OF THE SOCIAL SECURITY ADMINISTRATION. WE ARE ALSO COORDINATING OUR AUDIT EFFORTS WITH THE INTERNAL REVENUE SERVICE. COORDINATION AMONG AGENCIES IS ESPECIALLY IMPORTANT TO ENSURE THAT WE AVOID COMPROMISING ONGOING INVESTIGATIONS BY ALL PARTIES INVOLVED. TO THIS END, MEMBERS OF THE TASK FORCE CONTINUE TO MEET REGULARLY TO COORDINATE THE PROGRESS EACH OF US IS MAKING, WHILE PURSUING OUR INDIVIDUAL AREAS OF INTERESTS. WHILE I CANNOT COMMENT ON THE STATUS OF PENDING CRIMINAL INVESTIGATIONS, I AM PLEASED TO INFORM YOU OF PROGRESS WITH RESPECT TO OUR AUDIT. MY AUDIT STAFF HAS BEEN FULLY ENGAGED IN THE AUDIT OF THE MRDD PROGRAM. OUR AUDIT IS FOCUSED ON FOUR PRIMARY AREAS: 1) COMPLIANCE WITH THE PROVISIONS OF PROVIDER AGREEMENTS AND CONTRACTS AND WHETHER THE INTENDED SERVICES ARE BEING DELIVERED; 2) QUALIFICATIONS AND CERTIFICATION OF SKILLS OF DIRECT CARE WORKERS; 3) INTEGRITY OF THE PAYMENT PROCESS TO ENSURE THAT PROVIDERS AND CONTRACTORS ARE NOT OVERBILLING OR BEING OVERPAID FOR SERVICES PROVIDED TO INDIVIDUALS WITHIN THEIR CARE; AND 4) ADEQUACY OF SAFEGUARDS AND THE PRACTICES USED TO PROTECT CLIENT FINANCIAL INTERESTS. WE EXPECT TO VISIT 30 HOMES OF 16 PROVIDERS AND CONTRACTORS. WE BELIEVE THAT SUCH AN EXAMINATION WILL PROVIDE US WITH SUFFICIENT INFORMATION TO IDENTIFY WHETHER SYSTEMIC PROBLEMS EXIST IN THESE AREAS. AS MENTIONED EARLIER, MY OFFICE HAS IN PLACE A MEDICAID FRAUD CONTROL UNIT (MFCU). I WOULD LIKE TO STRESS THAT, UNTIL RECENTLY, THE OIG COULD NOT INVESTIGATE ISSUES INVOLVING THREATS TO LIFE AND SAFETY. THESE MATTERS WERE HANDLED BY THE METROPOLITAN POLICE DEPARTMENT, THE FBI AND RELEVANT OVERSIGHT AGENCIES - NOT THE OIG. IN FACT, THE WRITTEN POLICY AND PROCEDURES MANUAL OF DHS SPECIFICALLY MANDATES THAT ALL REPORTS OF UNUSUAL INCIDENTS THAT ARE CRIMINAL IN NATURE BE REFERRED TO THE METROPOLITAN POLICE DEPARTMENT. NOW, THE MEDICAID FRAUD CONTROL UNIT (MFCU) SHARES AUTHORITY TO INVESTIGATE THESE MATTERS. EVEN THOUGH THE UNIT IS FAIRLY NEW, OUR INVESTIGATORS ARE CURRENTLY HELPING TO ADDRESS THE PROBLEMS IN D.C. GROUP HOMES. FOR EXAMPLE, WE HAVE ASSIGNED AN INVESTIGATOR WITH AN EXTENSIVE HOMICIDE BACKGROUND TO REVIEW AND ANALYZE FILES RELATED TO THE 197 DEATHS AT GROUP HOMES SINCE 1991. IN THIS REGARD, HE WILL WORK CLOSELY WITH PERSONNEL FROM THE METROPOLITAN POLICE DEPARTMENT, THE U.S. ATTORNEY'S OFFICE, AND MEDICAL EXPERTS. FURTHERMORE, THE MFCU WILL INVESTIGATE ALLEGATIONS OF FINANCIAL FRAUD IN CONNECTION WITH THE MEDICAID PROGRAM. WE ARE ALSO WORKING WITH MAA ON WAYS TO FACILITATE AND HASTEN THE FLOW OF INFORMATION FROM THAT AGENCY TO THE MFCU. IN THIS REGARD, WE ARE EXPLORING METHODS THAT WILL PROVIDE THE MFCU, THROUGH COMPUTER LINKS, WITH DIRECT ACCESS TO MAA'S CLAIMS DATA BASE. THIS WOULD GREATLY ENHANCE OUR ABILITY TO PURSUE THE INDICATIONS OF POTENTIAL HEALTH CARE FRAUD BY ALLOWING FOR AN ALMOST INSTANTANEOUS FLOW OF INFORMATION DURING THE COURSE OF AN INVESTIGATION. DESPITE THE MFCU'S BRIEF EXISTENCE, MAA HAS ALREADY REFERRED SEVERAL MATTERS FOR FRAUD INVESTIGATION. AS YOU CAN SEE, THIS OFFICE CONTINUES TO BE RESPONSIVE TO THOSE ISSUES THAT CONCERN WASTE AND MISMANAGEMENT OF TAXPAYERS' DOLLARS, AS WELL AS ALLEGATIONS OF FRAUD OR CRIMINAL ACTIVITY WHICH HAVE BEEN BROUGHT TO OUR ATTENTION. WE WILL CONTINUE TO WORK - INDEPENDENTLY AND COOPERATIVELY - TO ENSURE THAT ALL DISTRICT RESIDENTS BENEFIT FROM THE BEST SERVICES POSSIBLE. THIS CONCLUDES MY STATEMENT. WE ARE PREPARED TO ANSWER ANY QUESTIONS THAT YOU MAY HAVE AT THIS TIME. |
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