Secretary Aldona Wos, who leads the North Carolina Department of Health and Human Services, praised her team Tuesday afternoon at a committee meeting to review the department despite heavy criticism toward the end of the day.
Wos has been criticized in some circles for hiring people at high salaries who had limited experience.
Toward the end of Tuesday's session, Wos was asked directly about the salaries for some of her key employees, especially in light of the fact that state employees and teachers got no raises this year.
Sen. Tommy Tucker, a Republican from Waxhaw, asked, "What am I to tell a teacher who's making $30,000 a year if you were in my shoes? How the state can hire somebody for $85,000 or $65,000 or $314,000 or somebody work for one month and get money than a teacher makes in a year?
"I need to know how to respond to that. we're all on the same team and I can assure you, listening to these gentlemen talk, they all know who's in charge. … [But] We're getting killed over it."
"Senator, my heart goes out to you and to the teachers which you have mentioned. My obligation is towards the Department of Health and Human Services, towards the legislature and the citizens and the governor.
"My obligation is to be able to run in the most efficient, effective way, this enormous department. My obligation is to find the right person to do the right job.
"I have over 16,000 employees. I have hired over 1,400 people since January and am still hiring. The salary scale that the gentlemen received are not only in line with what their predecessors had – actually, it's less than that – their obligation far exceeds their predecessors, the amount of people reporting to them exceeds their predecessors, and the work they do is invaluable. I trust them. I trust them not only personally but I trust that the work they do for the state and for the citizens is monumental."
Tucker wasn't satisfied with her answer.
"Well, the example we set in that department and for the state is critical to all our constituents as well. I think it's a poor example," Tucker said. "I just disagree with that wholeheartedly. I don't know what else I can say except I'm disappointed. … All people see is what they see in the press. And then we get blamed for your actions. So in the future, if you could, just take that in mind."
Later, Democratic Sen. Martin Nesbitt criticized the DHHS for moving too quickly on NCTracks and NC Fast.
"If it looks like a duck and sounds like a duck, it's a duck," Nesbitt said.
And he added, "The ducks are a-quacking."
He also said he was concerned about some of what he heard Tuesday, including discussions involving mental health.
"You guys aren't talking," he said.
DHHS has made headlines for months over its hiring decisions, and Wos has rarely spoken with the media about her leadership of the department.
Asked about the scrutiny of her department, Wos said, "My obligation as the secretary is to find the best possible team in order to get the job done. I entered a department that as you have heard on Jan. 7 that during the first few days to the first few weeks, three deputy secretaries were no longer there. There was never a CIO, never a CFO, no head of HR, no head of communications. Several people had left of that choice and that happens when you have a turnaround.
"All our leadership team, as you see, is new. As I entered a department lacking leadership and my goal, and my obligation, is to get the proper team in order to get the job done. And that's exactly what I have done within the law that governs us."
Mark Gogal, the head of human relations for DHHS, said the department followed all state guidelines in making hires. Some hires, he said, did not require a job posting, and the job could be filled by the preference of the department leadership. He said all personal services contracts complied with state guidelines.
He concluded by saying, "I have worked for numerous organizations and many leaders in the past 20 years or so. In my HR background, this leadership team at the Department of Health and Human Services is one of the strongest I have been associated with."
Many of the questions at the end of the afternoon involved specific parts of policy, with Sen. Tommy Tucker, a Republican, asking a variety of questions. In one, he pointedly asked, "Are we or are we not looking at privatizing Medicaid in the state?"
Wos said it wasn't possible to answer that without more information, which she thought she might have next month.
"It's just not a question that should be answered without full data," she said.
Still, tempers flared at parts of the hearing. One senator defending DHHS called all the calls for information about DHHS "a witch hunt" and asked Wos about all the Freedom of Information Act requests coming to the department from the media.
"It's becoming impactful," Wos said. "We have several people that work on this full-time and we have attorneys (who review the requests). "It's very time-consuming for us."
But Nesbitt, in response, said, "It's not a witch hunt to try to find out what's going on."
WNCN.com is livestreaming Tuesday's meetings
Wos, in her remarks Tuesday, said her initial focus when she took over DHHS was to develop "a strong leadership team."
"We are reorganizing the department to increase accountability of staff, eliminate duplication and streamline services we provide," she said.
"These efforts will pay off in the long run by making our department more efficient and helping us provide better service to North Carolina."
Mark Payne, her chief of staff, followed up by praising Wos for assembling "an outstanding team" who have "a passion for serving the state of North Carolina."
DHHS is a massive department, with 18,000 total positions and 16,500 employees.
WNCN.com will update with more information as the afternoon session unfolds.
Morning session concludes with sharp language
The morning session of a review of the Department of Health and Human Services ended with some sharp questions from Democratic Sen. Martin Nesbitt for Secretary Aldona Wos.
Nesbitt, in a forceful voice, asked, "When can we expect this to be resolved?"
Wos, in a defensive tone after three hours of the hearing, said, "As we heard during the last three hours, this is an enormously complicated system. It is our obligation to make sure everyone is paid appropriately. This is what we work on 24 hours a day. Every day we are solving issues. There are 76,000 providers. We are working at this point with each of them one on one. This takes time. This takes patience."
But Nesbitt continued to press.
"I need to know when we can expect these problems to be solved. When can our providers be paid on time?" he asked.
Joe Cooper, the chief information officer and sitting next to Wos, responded, "We expect all providers by the end of November to be successfully submitting claims. But we will have problems for months to come."
Wos opened the oversight committee hearing Tuesday morning by defending her department, saying progress had been made, but saying she was willing to listen to how DHHS could improve.
After Wos spoke, multiple medical providers testified, expressing frustration with the new North Carolina Tracks program and their inability to get answers and to get paid.
WNCN.com is livestreaming Tuesday's meetings
Wos opened the hearing Tuesday morning with comments about her department, saying she had been willing to ask tough, but necessary, questions, and that she welcomed feedback. She also defended the performance of DHHS, saying, "We are already operating more efficiently and more effectively."
"I know that together, we are tackling the hardest issues," Wos said. "No system is perfect."
But she said North Carolina had an obligation to help those in the greatest need.
"We must be good stewards of the taxpayer resources to do that," she said.
Health care providers detail concerns
But the extent of the problems became clear quickly as other people began to speak. Sandra Jarrett of Salisbury, speaking for the North Carolina Medical Group Managers, said the launch of North Carolina Tracks has put medical professionals under "a severe strain."
She said medical providers "just weren't getting paid." She said one person was so fed up with the system she drove two hours to DHHS and said she wouldn't leave until she got help.
She said calls to NCTracks were met by wait times of at least an hour, and when a customer service person finally answered, they rarely had an answer.
"The regular response was, 'I'm going to escalate this issue and you'll get a call back," Jarrett said.
But calls back rarely came, she said, and the impression she got was few people involved with NCTracks really knew the answers.
"These communication problems really worry me," she said.
Susan Fountain, who works at a radiology practice in Jacksonville, said, "This has been a challenge. It's really been a challenge."
She pointed to problems with Medicaid and Medicare crossovers and lack of reimbursement for a small provider like hers that serves a rural community.
"For a big practice, $500 a day might not be much. ..." she said. "In our case, we are facing closing our doors."
Lisa Arnold of Triangle Physicians for Women in Cary detailed how the practice has an outstanding balance of $21,000 for ultrasounds for Medicaid patients.
"We can't seem to find anyone who will assist us with getting those through the system," Arnold said.
Sandra Williams, chief financial office for Cape Fear Valley Health System in Fayetteville, detailed how her hospital system works to help those in need. But she said the problems with NCTracks have put a major financial strain on the hospital. She said the hospital has had $4 million in denials since NCTracks began July 1.
When will problems be fixed?
Cooper, the chief information officer for DHHS, said the new system had tremendous potential and added, "Our goal is to pay every provider for the work they do."
He acknowledged the challenges but said, "We are confident that NCTracks will serve the state with excellence for years."
Asked how long it would take to correct the problems, Cooper said, "We have a mix of defects that need to be resolved. It's probably another three to six months before we have them all addressed."
He also said there would continue to be "enhancements" to NCTracks but said, "That will be a very long process over probably years. But the key here is the ones that have the highest priorities, the ones that impact providers are the ones we are focusing on."
Mike Gaffney of Computer Sciences Corp. defended the use of the programming language COBOL in building NCTracks, which some has suggested is outdated. Gaffney said COBOL is commonly used in business and that his company has fully understands it. He also said there have been no "system issues with performance" of NCTracks so far.
Gaffney said there were 60 people in the call center when it opened July 1 and that now, "We have over 100."
Nesbitt, the Democratic senator, said if there was a problem that needed to be fixed, "then do it."
"We're 90 days out now. I don't know how long these people can hang on," Nesbitt said.
Jarrett, Fountain, Arnold were part of the first round of discussion, which focused on why problems have continued since the July 1 rollout of new Medicaid billing system called NCTracks and the implementation of NC FAST, which is designed to enroll residents for government assistance programs.
Background on the problem
Hundreds of doctors and hospitals are still struggling to file successful reimbursement claims for treating Medicaid patients through NCTracks, while backlogs in food stamp applications as NC FAST was expanded to include Medicaid enrollment have forced the hungry to flood private food banks for help.
NC FAST - which stands for North Carolina Families Accessing Services through Technology - and NCTracks cost hundreds of millions of dollars each to build or operate, with 10 or 20 percent of the cost being footed by the state, depending on the program. Medical providers also will give testimony about their struggles with NC Tracks, which have led some to take loans or delay salaries while waiting for reimbursement checks to clear. A representative with Computer Sciences Corp., the company hired by DHHS to make and run NCTracks, also was slated to speak.
DHHS has responded to requests from legislators to help their constituents with NCTracks and NC FAST issues, such as approving food stamp applications. They've also held regular conference calls open to legislators or their staffs. About 30 lawmakers or their aides have attended, department spokesman Ricky Diaz said last week.