Did Central Health reformers celebrate too soon?

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Commissioner Ann Howard’s proposed resolution, if adopted, would significantly reduce the scope of work for an independent performance audit and let major providers go unexamined

When on July 26th the Travis County Commissioners Court voted unanimously to require that Central Health undergo a performance audit, it smelled like victory for those seeking accountability for $35 million a year—$280 million to date—that’s going to the University of Texas Dell Medical School instead of being used for indigent healthcare services.

But whether that performance audit will be conducted as originally conceived is very much in doubt.

Margaret Gomez
Margaret Gomez
Ann Howard

That’s because Commissioners Ann Howard and Margaret Gomez, the Commissioners Court’s subcommittee, did not come to agreement on the scope of work for the performance audit.

That means Travis County Judge Andy Brown, along with Commissioners Brigid Shea and Jeff Travillion, will have to pick sides. Either that or wrangle agreement between the resolution drafters. This matter is Item 32 on the agenda for the Commissioners Court meeting that starts at 9am tomorrow.

Commissioner Shea in a Sunday interview told the Bulldog that it sounded like Howard’s resolution would leave it to the county purchasing staff and Central Health to work out the content of the scope.

Howard’s resolution states, “That Central Health with the Travis County Health and Human Services and Travis County Purchasing Office shall take steps to procure…an independent performance audit to be reimbursed by Central Health….”

Brigid Shea
Brigid Shea

“That was not what I intended,” she said. “I don’t want it under the auspices of Central Health. I don’t want them drafting the scope.”

Upping the pressure to decide this tomorrow is that Shea said she will be leaving August 6th for a long delayed trip to Tanzania. The trip was originally planned for 2020 but was put off due to the pandemic, she said. “We couldn’t put it off any longer.”

What Howard’s resolution would ignore

Gomez’s resolution for the scope of work contains every element of the original draft, while Howard’s version omits several key details. If Howard’s resolution carries the majority vote at Tuesday’s meeting of the Commissioners Court, it will leave out:

Integrated delivery system—Whether Central Health, Dell Medical School, and Community Care Collaborative used their staff and resources effectively and cost-efficiently to establish an integrated healthcare delivery system. Howard’s resolution only asks for the “current status of the strategy to create an integrated system of care.”

Key provider details—Whether Central Health, Ascension Seton and Dell Medical School have effectively and efficiently provided indigent healthcare services.

Financial accounting practices—Whether abnormal or irregular financial activity might be found in Central Health and its nonprofit subsidiary Community Care Collaborative’s activities during the years 2018 through 2022.

Compliance with laws—Whether Central Health’s performance is evaluated for compliance with applicable city, state and federal laws.

Howard’s resolution, in effect, would ask auditors to wear blinders and ignore the past performance of Central Health and its major partner organizations.

The one exception to that is that both Gomez and Howard’s resolutions call for getting details about what medical services Dell Medical School has provided to Central Health’s Medical Assistance Program enrollees and other eligible patients. But Howard’s resolution omits mention of the $280 million in annual $35 million payments that Central Health has given to Dell Medical School for this purpose.

The bottom line is that Howard’s resolution would only skim the surface of what reform advocates say is needed.

Reformers’ report is crucial

Groups including NAACP AustinTexas LULAC District VII, and Travis County Taxpayers Union supported the call for a performance audit of Central Health. They presented a 40-page report that goes into deep-dive detail about the agency’s shortcomings, including its failure to account for Dell Medical School’s use of $280 million in funding, amounting to an unconstitutional gift of public funds.

The report claims Central Health lacks sufficient accountability and public visibility for money paid to third-party providers CommUnityCare, Community Care Collaborative, and Ascension Seton. Further, the report states Central Health has failed to implement meaningful improvements in accessibility and equity for the healthcare of poor Travis County residents.

Fred Lewis

Attorney Fred Lewis, who wrote the LULAC report and had a hand in shaping the draft order for Central Health’s independent performance audit, said that Commissioner Howard’s resolution, “allows Central Health to partner with the county in selecting the auditor and managing the audit. That’s a bad idea.”

“If that’s allowed,” Lewis added, “the performance audit will be neither independent nor comprehensive, and therefore pointless.”

The Commissioners Court should realize that Howard’s resolution has no specifics where it matters, he said. “That’s not an accident. They must be awfully scared about what a real audit would show.”

Is Central Health’s attorney influencing Howard?

One has to wonder why Howard wants auditors to ignore the performance of major players such as Ascension Seton and blow off a review of accounting controls.

Is it because her campaign treasurer happens to be the attorney representing Central Health and its president in a lawsuit against the healthcare agency?

Beverly Reeves

Beverly Reeves is cofounder and partner in the Austin law firm Reeves & Brightwell. She is one of Central Health’s attorneys in Birch et al v. Central Health et al (Case No. D-1-GN-17-005824).

The lawsuit seeks a declaratory judgment that defendants may expend funds only on items related to furnishing medical aid or hospital care to indigent and financially needy Travis County residents for a statutorily authorized purpose. It also seeks a temporary or permanent injunction to enjoin defendants from expending funds on anything not related to those purposes.

Plaintiffs filed a First Amended Original Petition March 21st. Attorney Fred Lewis said discovery in that suit has been completed and he expects the case to proceed to trial this fall.

As to the question of whether Reeves wrote the resolution, or whether the commissioner had her review it, Howard responded via text message to say, “Wrote it myself. Haven’t talked to Bev in months.”

Photo of Ken MartinTrust indicators: Ken Martin has been doing investigative reporting in the three-county Austin metro area since 1981. His aggressive reporting twice garnered first-place national awards for investigative reporting. Both of those projects resulted in successful criminal prosecutions. His 2011 investigation of the Austin City Council triggered a 20-month investigation by the Travis County attorney that resulted in the mayor and council members signing deferred prosecution agreements to avoid being charged, tried, and if convicted serving one to six months in jail and forfeiting their elective offices. He’s been investigating and reporting on Central Health since 2018. See more on Ken on the About page. Email [email protected]

Who funds this work? This report was made possible by contributions to The Austin Bulldog, which operates as a 501(c)(3) nonprofit for investigative reporting in the public interest. You can help support this independent coverage by making a tax-deductible contribution.

Related documents:

Ann Howard’s campaign finance report filed January 18, 2022, naming Beverly Reeves her treasurer (1 page excerpt).

Ann Howard’s Resolution, Supplementing and Amending the 2017 Order of the Travis County Commissioners Court Amending the Travis County Healthcare District Financial Policies (4 pages)

Beverly Reeves record from the State Bar of Texas (2 pages)

Draft order of Travis County Commissioners Court requiring an independent, third-party performance audit of the Travis County Healthcare District (4 pages)

LULAC Texas District VII report on Central Health, July 13, 2022 (40 pages)

Margaret Gomez’s Resolution Amending the 2017 Financial Order regarding Central Health (5 pages)

Plaintiffs’ Original Petition, Birch et al v. Travis County Healthcare District dba Central Health et al, defendants (Cause No. D-1-GN-17-005824) (7 Pages)

Plaintiffs’ First Amended Original Petition, Birch et al v. Travis Count8y Healthcare District dba Central Health et al, defendants (Cause No. D-1-GN-17-005824) (10 Pages)

Related Bulldog coverage:’

Commissioners order Central Health performance audit, July 27, 2022

Central Health critics ramp up pressure ahead of vote on audit, July 25, 2022

Commissioners to order Central Health’s performance audit, July 14, 2022

Central Health’s $35 million payments to Dell Medical School an unlawful ‘gift of public funds’ that exceed statutory authority, June 30, 2022

New documentary takes aim at diversion of indigent healthcare funds, November 15, 2021

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