The Palm Beach County Health Care District board voted unanimously to cancel its contract with the county’s inspector general on Wednesday, after CEO Dr. Ron Wiewora said changes to federal law left little choice.
The independent investigator is being dismissed after just over a year on the job.
Board Chairwoman Carol Roberts also suggested that private health records could no longer be viewed by the inspector general because of new federal rules, putting the district’s contract with the IG in direct conflict. That’s simply not true, Inspector General Sheryl Steckler said in a phone interview after Wednesday’s meeting. The federal privacy law clearly allows outside auditing agencies to use medical records, she said.
She said the parting of ways had actually grown out of her office’s discovery that an allegation of theft, and other allegations, had not been properly referred to her office for investigation, as required under the district’s contract with the independent agency.
“There was an indication of something we would label as theft,” Steckler said. “We said to them, ‘That is an example of what should have been reported to us and wasn’t.’ ”
Steckler said she would have gladly discussed the issues with the health care district board during Wednesday’s meeting. But she said she had been misled that discussion of her contract would happen after 4 p.m. on Wednesday. Instead, Roberts raised it to much earlier, in the middle of a seven-hour strategic planning meeting that health care district staff had told Steckler she need not attend. The IG’s No. 2, Joe Doucette, arrived just before the board vote to cancel the contract.
Wiewora had told the board that changes to the medical record privacy law and the Affordable Care Act argued for cutting health matters out of Steckler’s contract. The federal laws now require, rather than recommend, that health agencies have a compliance officer, he said. A compliance officer’s job is to make sure that federal and state regulations are being followed.
Wiewora’s new compliance officer, Ellen Pentland, added that she felt it too risky for the district to outsource what was her responsibility.
Although compliance industry best practices call for officers like Pentland to report to the board, not directly to the CEO, Wiewora recently changed the chain of command to have Pentland report to him.
The board approved that change after paying out an $85,000 settlement in 2012 to Wiewora’s previous compliance officer, whom Wiewora had fired without seeking the board’s OK. She alleged retaliation for initiating an inquiry into the district’s information technology department.
Wiewora told the health care district board that the inspector general lacked staff with health care expertise, resulting in serious errors and an inability to perform. Last year, Steckler’s group found the district had overpaid its trauma surgeons and not followed an internal policy that required outside rate reviews.
Steckler said Wiewora was not correct on that score, either. The agency hadn’t followed its own policies, renewing the trauma surgeons’ contract without performing a pay study.
Wiewora’s arguments were persuasive enough to convince Palm Beach Gardens attorney Nancy Banner that spending the extra $300,000 a year on independent oversight of the district’s $260 million budget was a waste of money, and ultimately not in the district’s best interest.
“When we took on the IG, we knew there would be some duplication of effort. We did so with the hope of increasing public confidence in our organization,” Banner said. “We have ended up with the opposite. Things have been reported as noncompliance and overspending that were not noncompliance and overspending. We need to rethink the need for this relationship at all.”
Although he had not heard that discussion, Doucette later reminded the board that the IG’s findings had improved the district’s internal controls on multiple fronts. Asked whether the inspector general would be willing to leave health issues out of its purview, Doucette declined.
Such “carve-outs” from oversight were not allowed under the ordinance set in motion by voters in 2011, when 32 county municipalities were put under the IG’s oversight, Doucette said.
Although such special taxing districts as the health care district were not part of that referendum, the Children’s Services Council and later the health district had voluntarily contracted with the IG.
The health care district came reluctantly to Office of Inspector General in October 2011, though, after a series of stories in The Palm Beach Post provoked public outcry. The Post found that the health agency had handed $4 million over to a company owned by its own real estate agent to buy land for a nursing home, even though it could have built on free public land.
Then, the agency fired its own compliance officer after the district’s information technology director complained about being investigated. The Post also found the agency was using a former board member as its external auditor, and not switching auditors every five years as recommended by the state.
But the board members who eventually pushed for the IG oversight, Joseph Abruzzo and Benjamin Frank, have since left the district.
Abruzzo, now a Democrat state senator from Wellington, had agreed only reluctantly to include a 90-day cancellation clause in the contract between the district and the IG. It will now be exercised, with the oversight ended as of July 1.