By DAMIEN FISHER, InDepthNH.org
Adults with disabilities who enter the workforce are getting overcharged for their medical care by the state agency that’s supposed to be helping them, according to a former employee who was fired and later ordered to be re-hired.
But the state has no interest in fixing the errors that result in hundreds of thousands of dollars getting taken from the bank accounts of these disabled adults, said former Department of Health and Human Services employee Donna Speass.
“I would call this fraud,” Speass told InDepthNH.org.
DHHS did not respond to a request for comment.
Speass got fired in 2020 after months of fighting to get the overcharging fixed. But she appealed the termination to the state Personnel Appeals Board.
According to the written PAB decisions in her appeal, Speass was subject to a hostile work environment after she spoke out, and after her supervisors did nothing to correct the overcharging errors.
Speass spent decades working in the banking industry before moving to the New Hampshire Department of Health and Human Services.
In 2018, she started working on the payment system for the state’s Medicaid for Empowered Adults with Disabilities, or MEAD. The program allows people with disabilities to pay for Medicaid health coverage when they enter the workforce.
The monthly payments vary depending on the individual from a couple of dollars a month, up to $200, she said.
In early 2019, Speass discovered a problem with the way the clients are billed for their medical coverage. The insurance costs for these clients can fluctuate depending on whether or not they are working, and whether or not they are getting medical coverage from their jobs.
Speass discovered the state’s new automated, “paperless” billing system was charging the clients for insurance premiums without deducting the credits they were owed through MEAD, effectively charging the clients and holding on to the money they are entitled to receive. No one, including the clients, seemed to realize there was a problem.
“They didn’t know they were getting overcharged. A lot of the clients don’t even open the mail,” Speass said.
In one month alone, the state was essentially taking and keeping a total of almost $9,000 from the clients. Speass said the credit balances were tracking for up to $200,000 in total per year.
According to letters Speass wrote to supervisors, and the Personnel Appeals Board decisions based on evidence presented at her hearings, Speass alerted first her supervisor in DHHS, Nancy Jefferson, about the problem, and that’s when trouble started for her. First, Jefferson told her to keep the information from the clients.
“According to one of my conversations with [DHHS supervisor] Tashia [Blanchard]. We are to send out only active MEAD member billing at this time. Anyone who has been closed for more than three months and we have not received payment, stop invoicing until further notice. Anyone we owe money to who is closed does not send out the billing,” Jefferson wrote in a February, 2019 email.
When Speass continued to push for alerting the clients, she started getting written up for failures to do her job, and excluded from meetings about the IT team who managed the system database.
Jefferson ordered Speass to not inform clients about the credit balances, and not to contact the IT department to get the payment database corrected. Jefferson and other staff in her unit were starting to make unaudited changes to the payment system’s database which were creating more payment errors, Speass said.
Still concerned that clients were getting overcharged without any appropriate notification, Speass wrote to Jefferson’s supervisors, Blanchard and Meredith Telus. Speass included printouts showing the client balances, though she did not include any private health information.
After not getting a satisfactory answer from Blanchard and Telus, Speass wrote to DHHS Commissioner Lori Weaver in the summer of 2020. Weaver responded there was nothing illegal about holding onto the client’s money for an indefinite period of time.
“The right thing to do would have been to give people their money back,” Speass told InDepthNH.org.
Speass was fired in October of 2020, with Jefferson citing her failure to follow orders, printing out the spreadsheet showing the credit balances, and having two prior letters of warning in her file.
According to the PAB ruling, the two prior letters of warning came after Speass started trying to get the credit balances problem fixed. Speass did not appeal the first letter, filed in September of 2019, because she missed the deadline.
She did appeal the second, January 2020 letter to the PAB, and the board dismissed that letter citing the fact Speass was disciplined, in part for not following contradictory orders from Jefferson.
In that decision, PAB members recommended Jefferson seek training on how to do her job.
“The Board recommends that (Jefferson) seek counsel from appropriate sources, such as supervisors, the Employee Assistant Program, or the training bureau on how to create a culture of trust, productivity, and independent performance,” the PAB’s letter of warning decision states.
As for Speass’s termination, DHHS was ordered to give her back her job with back pay. The board found Speass did not commit a violation for failing to follow orders since she made a good faith effort to correct what she saw as a major problem.
“[T]he Board took note of [Speass’s] many years of experience in financial services, her concerns over operational deficiencies which management did not address, her exclusion from critical meetings held to resolve the MEAD program’s technical issues, and the hostile work environment created by Mrs. Jefferson,” the board wrote in the termination decision.
While the board found Speass created a “security incident” in printing out the credit database, they noted she was careful about handling sensitive information, used secure email accounts to get the documents printed, and deleted any copies.
After years of fighting her termination, and winning, Speass was offered a position back in DHHS earlier this year. By then she was exhausted, unwilling to work with the supervisors in the agency, and ready to move on. The state ended up paying out $120,000 in February to make Speass whole.
But the clients Speass fought for may not even know, still, if they are owed money. Given the fact DHHS leadership maintained they have no legal obligation to inform the clients, they may never know.
“Where’s the money?” Speass said.