On November 20, 2013, 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.