Cansler’s Deposition
June 4, 2010 - by
Last summer, for reasons that aren’t quite clear, Secretary Lanier Cansler and his Deputy Secretaries, Assistant Secretaries and aides trooped over to the General Assembly and told legislators they had a report that absolutely, conclusively, without a doubt proved 45% of the Medicaid patients who were receiving in home care were chiselers.
Of course, legislators promptly told Cansler to have nurses examine the patients and get the chiselers off Medicaid. A simple solution to the problem.
Now, by Cansler’s own estimation, doing what the legislators told him would have saved taxpayers $131 million – if, in fact, the patients were chiselers like he said. So, with money tight and red ink piling up, you’d have thought Cansler would have rushed to do the examinations. But he didn’t. Seven months passed and he didn’t have a single patient examined.
Now, why not?
Well, last February, Cansler was deposed in a lawsuit and testifying under oath he didn’t stick to that 45% claim at all.
(Lawyer’s Question to Cansler:) You know, do you not, Secretary Cansler, that the 45.4% not qualifying for PCS [Home Care] is not an accurate percentage?
(Cansler, under oath): I don’t know anything about that for a fact because I didn’t prepare the report and I don’t know how it was established.
(Lawyer:) Do you not agree, Secretary Cansler, that if this report is given out to legislators showing 45.4% not qualifying for PCS services, and if you have information knowing that that’s not an accurate percentage, wouldn’t it be your responsibility to let legislators know that?
(Cansler:) If I had the information that said that that was not the accurate percentage, yes, it probably was. But I don’t have that information.
(Lawyer:) If this is not an accurate percentage, don’t you think that it would be incumbent on you as Secretary to –
(Cansler:) Again, I don’t know how the report was prepared. I don’t know what all was considered. I have no evidence …
(Lawyer:) Okay. Well, we just looked at a DMA [the Department of Medical Assistance, which reports to Cansler] document where it says to refer to them as not qualified would not be accurate.
(Cansler:) That’s a DMA document, and I don’t recall that I’ve ever seen this document before…
(Lawyer:) So you don’t really have any information that 45.4%, based upon the CCME reviews, were not qualified for PCS?
(Cansler:) Say that again.
(Lawyer:) You don’t have any information that 45.4%, based upon the CCME reviews between April 2007 and March of 2009, were not qualified for services?
(Cansler:) You know, CCME did the review. DMA reviewed that. You know, that’s all I know…
So, why didn’t Cansler have the patients examined as legislators instructed? Because he didn’t have absolute, certain proof the patients were chiselers and he wasn’t about to take the chance he’d be proved wrong.
What did Cansler do? He came up with a scheme to cut the ‘chiselers’ without examining them. How? He fed the patients records into a computer and used what he called an algorithm to determine who got cut. Which sounded safe enough – except it backfired. Because Cansler’s own program only showed 3% of the patients were chiselers ineligible for care.
How did Cansler solve that problem?
He dodged it. By announcing 45% of the patients weren’t complete chiselers, like he’d originally said, but, well, 85% were partial cheaters who were getting more care than they needed. So, still without examining a single patient, he set out to cut their care – which promptly got him sued (because you can’t tell how much care a patient needs without a physical examination), and a judge stopped Cansler’s computerized cuts dead in their tracks.
Which left Cansler back where he’d been a year before – having to do individual examinations.
So, months behind schedule, he set his former client CCME to work (after giving them a $24 million state contract) to examine patients.
The result?
Sixty days later Cansler is telling legislators he now has absolute, certain proof 45% of the patients are complete chiselers and another 40% are partial chiselers.
And what’s his documentation? No one knows. No one has any idea how many patients have been examined and Cansler isn’t saying. In effect, he’s saying Take my word for it.
So, has Cansler cut all those chiselers? No.
He has the power and he says the proof (since he’s examined the patients) 85% of the patients are chiselers – but he hasn’t cut them. Instead, he’s lobbed the ball to the legislators and told them, first, before he cuts the chiselers he needs the General Assembly to change the eligibility requirements.
So, according to Cansler, the chiselers were cheating under the old requirements – but he needs a new set of requirements to cut them. What kind of sense does that make?
The whole thing’s a study in how government works. So, what’s really going on here? Who knows? But it does look like, this time, someone would ask Cansler, Mr. Secretary, you’ve been telling us these folks are chiselers for over a year – this time let’s see your proof.
Cansler’s Deposition
June 4, 2010/
Last summer, for reasons that aren’t quite clear, Secretary Lanier Cansler and his Deputy Secretaries, Assistant Secretaries and aides trooped over to the General Assembly and told legislators they had a report that absolutely, conclusively, without a doubt proved 45% of the Medicaid patients who were receiving in home care were chiselers.
Of course, legislators promptly told Cansler to have nurses examine the patients and get the chiselers off Medicaid. A simple solution to the problem.
Now, by Cansler’s own estimation, doing what the legislators told him would have saved taxpayers $131 million – if, in fact, the patients were chiselers like he said. So, with money tight and red ink piling up, you’d have thought Cansler would have rushed to do the examinations. But he didn’t. Seven months passed and he didn’t have a single patient examined.
Now, why not?
Well, last February, Cansler was deposed in a lawsuit and testifying under oath he didn’t stick to that 45% claim at all.
(Lawyer’s Question to Cansler:) You know, do you not, Secretary Cansler, that the 45.4% not qualifying for PCS [Home Care] is not an accurate percentage?
(Cansler, under oath): I don’t know anything about that for a fact because I didn’t prepare the report and I don’t know how it was established.
(Lawyer:) Do you not agree, Secretary Cansler, that if this report is given out to legislators showing 45.4% not qualifying for PCS services, and if you have information knowing that that’s not an accurate percentage, wouldn’t it be your responsibility to let legislators know that?
(Cansler:) If I had the information that said that that was not the accurate percentage, yes, it probably was. But I don’t have that information.
(Lawyer:) If this is not an accurate percentage, don’t you think that it would be incumbent on you as Secretary to –
(Cansler:) Again, I don’t know how the report was prepared. I don’t know what all was considered. I have no evidence …
(Lawyer:) Okay. Well, we just looked at a DMA [the Department of Medical Assistance, which reports to Cansler] document where it says to refer to them as not qualified would not be accurate.
(Cansler:) That’s a DMA document, and I don’t recall that I’ve ever seen this document before…
(Lawyer:) So you don’t really have any information that 45.4%, based upon the CCME reviews, were not qualified for PCS?
(Cansler:) Say that again.
(Lawyer:) You don’t have any information that 45.4%, based upon the CCME reviews between April 2007 and March of 2009, were not qualified for services?
(Cansler:) You know, CCME did the review. DMA reviewed that. You know, that’s all I know…
So, why didn’t Cansler have the patients examined as legislators instructed? Because he didn’t have absolute, certain proof the patients were chiselers and he wasn’t about to take the chance he’d be proved wrong.
What did Cansler do? He came up with a scheme to cut the ‘chiselers’ without examining them. How? He fed the patients records into a computer and used what he called an algorithm to determine who got cut. Which sounded safe enough – except it backfired. Because Cansler’s own program only showed 3% of the patients were chiselers ineligible for care.
How did Cansler solve that problem?
He dodged it. By announcing 45% of the patients weren’t complete chiselers, like he’d originally said, but, well, 85% were partial cheaters who were getting more care than they needed. So, still without examining a single patient, he set out to cut their care – which promptly got him sued (because you can’t tell how much care a patient needs without a physical examination), and a judge stopped Cansler’s computerized cuts dead in their tracks.
Which left Cansler back where he’d been a year before – having to do individual examinations.
So, months behind schedule, he set his former client CCME to work (after giving them a $24 million state contract) to examine patients.
The result?
Sixty days later Cansler is telling legislators he now has absolute, certain proof 45% of the patients are complete chiselers and another 40% are partial chiselers.
And what’s his documentation? No one knows. No one has any idea how many patients have been examined and Cansler isn’t saying. In effect, he’s saying Take my word for it.
So, has Cansler cut all those chiselers? No.
He has the power and he says the proof (since he’s examined the patients) 85% of the patients are chiselers – but he hasn’t cut them. Instead, he’s lobbed the ball to the legislators and told them, first, before he cuts the chiselers he needs the General Assembly to change the eligibility requirements.
So, according to Cansler, the chiselers were cheating under the old requirements – but he needs a new set of requirements to cut them. What kind of sense does that make?
The whole thing’s a study in how government works. So, what’s really going on here? Who knows? But it does look like, this time, someone would ask Cansler, Mr. Secretary, you’ve been telling us these folks are chiselers for over a year – this time let’s see your proof.