Tester, Walsh call for investigation of local IHS

Billings Gazette

by Cindy Uken

The Billings Area Indian Health Service is coming under increased scrutiny, with U.S. Sens. Jon Tester and John Walsh requesting that the Government Accountability Office conduct a formal investigation of the federal agency.

“Issues have plagued the facilities in the Billings service area for years as patients endure poor to no services and extraordinary delays in seeing physicians or filling a prescription,” Tester and Walsh wrote jointly in a letter Friday to the GAO. “In one troubling case, we heard of a provider who only sees one patient a day.”

Tester, who is chair of the Senate Indian Affairs Committee, and Walsh said they have also heard concerns that IHS facilities are not seeking reimbursements from third-party insurers, thereby denying the service desperately needed capital.

Specifically, Tester and Walsh are asking the GAO to review:

 The timeliness and standard of care provided to patients in Indian Health Service facilities.

 The service’s oversight over area offices, including what measures they are using to track outstanding needs and successes and how this is communicated both internally and externally.

 The service’s efforts to fill longstanding vacancies in critical health care professional positions throughout Indian Country and the impact on purchased and referred care funding.

 The service’s third-party billing practices in their area offices and what has changed since the 2009 report, “Updated Policies and Procedures and Increased Oversight Needed for Billings and Collections from Private Insurers.”

 The service’s pain-management protocols and whether they are being followed at its health care facilities.

The senators’ request for an investigation was spurred in part by the Crow Tribal Legislature. It voted unanimously to ask Montana’s congressional delegation to “take all necessary and proper measures to investigate the Billings Area Office of the Indian Health Service.”

Walsh said reports from the Crow Tribe about delayed and low-quality care are troubling, adding that the United States has a trust responsibility to provide timely and effective health care to tribal nations.

“It is my hope that this investigation will uncover and address the issues that have prevented IHS from providing the services the Crow Tribe deserves,” Walsh said.

Calls for an investigation into the Billings Area IHS coincide with the resignation of Anna Whiting-Sorrell, who served as director of the embattled agency for less than 18 months. Whiting-Sorrell said challenges the agency faces are “great” and said she was concerned about the level and quality of service the agency provided.

Tester said he held a hearing earlier this year to review the IHS budget and has also had one-on-one meetings with IHS Acting Director Yvette Roubideaux and Health and Human Services Secretary Kathleen Sebelius.

“We all know that despite increased funding in the last couple of years, the agency remains tragically underfunded,” Tester told The Billings Gazette.

Tester has cosponsored bipartisan legislation, the Indian Health Service Advance Appropriations Act of 2013, which amends the Indian Health Care Improvement Act to require new budget authority for Indian Health Services.

The bill pre-funds IHS one year out. Because of the way the federal government works, agencies often aren’t given money until after they’ve spent it. This bill would use the same budgeting process for IHS that is currently used for the VA.

Allowing the agency to get its hands on the money a year in advance would allow them to strategically plan how they use their limited funds. Because the administration sets the budget for IHS, it also requires the president’s budget to estimate those advanced appropriations.

The bill has had a hearing in committee and is waiting for feedback from the administration to begin the voting process.

Tester will hold a field hearing in Billings on May 27 to determine the next steps to improve health care in the region. Details of the hearing are pending.

The GAO is an independent, nonpartisan agency that works for Congress. Often called the “congressional watchdog,” GAO investigates how the federal government spends taxpayer dollars. Its work is done at the request of congressional committees or subcommittees or is mandated by public laws or committee reports. GAO has a process it goes through to determine whether it begins work on a request and when. That process can take a few weeks.

Rep. Steve Daines, R-Mont., has discussed this issue with the Crow Tribe and recently spoke before the Legislature.

“Steve understands the seriousness of the health issues facing the Crow Reservation, and is looking into these issues for potential improvements in health care delivery in the Indian Health Service,” said Alee Lockman, Daines’ communications director.

On Friday, Daines sent a letter to IHS Acting Director Roubideaux asking that she “swiftly evaluate” IHS administration in the Billings area.