Deeper Than the Headlines: Tribal Program Requirements According to the HHS

Many Tribal programs receive funds from the Department of Health and Human Services (HHS). Have you ever wondered if you’re meeting all the requirements to protect that revenue stream and the beneficiaries it’s intended to serve?

If yes, you might want to attend the OIG’s upcoming training on May 15-16 at the University of Central Oklahoma in Edmond, OK.

The key “take-home” messages, according to the OIG, will include:

• Understanding the importance of internal controls and single audits
• Identifying key elements for ensuring quality of care
• Learning about compliance programs and other tools for combating fraud, waste, and abuse; and
• Understanding the role of the Office of Inspector General (OIG) and how it works with the Indian Health Service (IHS) and Tribes.

The OIG has designed the training program for officials and employees of IHS and any Tribal organization receiving HHS funds whose responsibilities include:

• serving beneficiaries,
• protecting program funds,
• ensuring compliance with applicable regulations and laws,
• submitting claims to the Federal Government,
• internal auditing and/or maintaining documentation, and/or
• overseeing the quality of services provided to beneficiaries.

Remember, there’s been an uptick in enforcement seen within the HIS space. For example, the OIG reported enforcement actions related to grants in their most recent semiannual report to Congress. In the audits of two tribes, the OIG identified improper administration of Low Income Home Energy Assistance Program (LIHEAP) grant funds. Grant funds totaling $1.2 million for one tribe and almost $600,000 for the other tribe were not administered in compliance with Federal laws, regulations, and guidance. These funds could have been used to provide additional benefits to eligible LIHEAP beneficiaries. Errors occurred because of insufficient internal controls, and in some cases, because staff circumvented existing internal controls. (See OIG reports on the Three Affiliated Tribes, A07-16-04230, and the Turtle Mountain Band of Chippewa Indians, A-07-16-04233.)

Also, in 2017 the Confederated Tribes of the Colville Reservation (CCT) and the United States of America, acting through the U.S. Department of Justice (DOJ) and on behalf of the Office of Inspector General of the Department of Health and Human Services (OIG-HHS), announced a voluntary settlement agreement reached by the parties relative to allegations that the Colville Tribes submitted false claims to Medicaid seeking the reimbursement of mental health counseling services that were purportedly provided by the Tribe’s Behavioral Health Unit – Youth Counseling services.

The CCT is a federally recognized, sovereign Indian tribe, with tribal offices located in Nespelem, Washington, on the Tribes’ reservation. The Secretary of HHS and the CCT entered into a Title I Contract and Annual Funding Agreement, on a government-to-government basis, to provide health and social services to tribal members and other eligible individuals. Thus, the CCT is entitled to bill federal health care programs for provided services.

Under the agreement, the Confederated Tribes of the Colville Reservation have agreed to pay $245,860 to resolve false claims allegations arising out of the Tribes’ billing irregularities that occurred from January 2010 through August 2010.

During that time, the CCT contracted with an independent mental health contractor to provide youth counseling services. The contractor submitted invoices to the CCT for payment of child mental health encounter sessions. The CCT used these invoices to generate claims that it submitted to the Washington State Medicaid Program for reimbursement. Medicaid administered the payment of these encounter session claims with federal funds.

In 2010, the Federal Bureau of Investigation (FBI), along with the Medicaid Fraud Control Unit (MFCU) and the U.S. Attorney’s Office, began an investigation into allegations that the contractor falsely documented weekly billing invoices for alleged encounter sessions, which the contractor submitted to the CCT for child mental health counseling sessions which were either not provided or were not medically indicated or necessary.

The investigation found that the contractor conducted a 10-week summer group course, with the same curriculum, year after year, and for the same children. The contractor allegedly submitted invoices to the CCT indicating mental health sessions had been individually provided to each of the children. As alleged, the CCT submitted claims for payment of these false individual counseling sessions to Medicaid based on the falsified invoices.

The investigation determined that the group sessions were not clinically directed, did not address the patients’ diagnoses, and had little to no clinical value. The CCT was allegedly complacent in its supervision and review of their counseling contractor’s work.

While the CCT did not admit any wrongdoing, the Office of Inspector General for the U.S. Department of Health and Human Services (OIG-HHS) and the CCT agreed to a settlement that provides for performance of a Voluntary Tribal Compliance Agreement (VTCA), on a government‐to‐government basis, not only aims to enhance the health care services provided to CCT’s tribal members, but also supports CCT in fulfilling its’ obligations under applicable federal law. Per the VTCA, among other things, the CCI will designate a compliance officer and committee, will have an annual review performed by an independent review organization, will establish internal policies and procedures, and will annual reports with the OIG-HHS.

“This settlement shows both our commitment to protect taxpayer dollars and the Colville Tribes’ commitment to providing quality and responsible health and health education services for its’ members,” said Michael C. Ormsby, United States Attorney for the Eastern District of Washington.

“Fraudulent schemes such as those alleged here drain scarce Medicaid dollars and jeopardize the program’s ability to provide necessary medical care,” said OIG-HHS’s Special Agent in Charge Steven J. Ryan. “Today’s settlement with CCT will help protect tribal children and the program upon which they depend.”

If you are involved in tribal healthcare or are a tribal organization which receives grants from IHS or HHS, attending this OIG training might be something you should seriously consider.