“CMS” is the acronym for the Centers for Medicare & Medicaid Services, the agency responsible for managing the massive federal Medicare and Medicaid programs. In North Carolina, an unfolding scandal with allegations of Corruption, Money and Sexual misconduct may give a whole new meaning to “CMS.”
The saga involves that state’s Democratic Governor (Roy Cooper), his hand-picked director of the state’s Department of Health and Human Services (Dr. Mandy Cohen), and at least one Republican state legislator.
The political backstory to this tale begins with Cooper surprising the pollsters and his opponent — incumbent Republican Gov. Pat McCrory — in November 2016 by winning a narrow victory. Through deft sleight-of-hand, and taking advantage of a quirk in state law, Cooper arranged an early swearing-in for himself just minutes after midnight on January 1, 2017. That legerdemain allowed Cooper just 12 days laterto appoint Cohen, at the time Obama’s Chief Operating Officer of Medicaid, to head the North Carolina DHHS before Barack Obama left office.
Thus was set the stage for the Cooper Administration to bring to a screeching halt what had been one of his predecessor’s top priorities — rolling back years of reckless spending by North Carolina Democrats. One of McCrory’s main targets had been Medicaid spending in the state; which had come to swallow nearly $15 billion of North Carolina’s $23 billion annual budget.
The runaway Medicaid spending had placed North Carolina in a financial bind, with little cash for anything else. Thus, in 2015 McCrory and the Republican state legislature passed a law that would limit Medicaid spending, remove management of the program from the state Health Secretary and contract it out to private companies, and prohibit further expansion of the program; all steps permitted under federal law.
A week later, and not by coincidence, the Obama Administration declared it would expedite approval of Cooper’s expansion. The very same day, Cooper announced he would name Cohen who, as the responsible CMS official in the Obama Administration, hadjustapproved Cooper’s illegal Medicaid expansion request.
The only speed bump encountered by the Cooper-Cohen team was the result of quick thinking by North Carolina Senate President Phil Berger and House Speaker Tim Moore, leading to a federal court order blocking the scheme until the Trump Administration took office and shut it down. Undeterred, Cooper set out to expand Medicaid anyway; by undercutting the Republicans’ 2015 law.
Any good corruption story needs money, and here there was plenty to be found. As the newly minted state Health Secretary, Cohen cleverly rebranded the state law from Medicaid “reform” (read, “reduction”) to Medicaid “transformation” (that is, “expansion”). This “transformation” magically expanded Medicaid coverage and services via more than 13 new concepts.
The next step for Cohen was to gain access to the vast Medicaid money then being managed not by the government bureaucracy she now ran, but by an independent Managed Care Organization (MCO). The MCO in question here, Cardinal Innovations, had been created under state law by Republicans, to more efficiently administer the program and to prevent Democrats from endlessly expanding it. Cardinal had done just that; so well, in fact, that in 2016 the Charlotte-based MCO was recognized as one of the best Medicaid health plans in the country for its quality of care and low cost to taxpayers. That success notwithstanding, Cohen set out to take control of Cardinal.
First, Cohen needed to clear out Cardinal’s CEO, Richard Topping, a former George W. Bush appointee, who is considered to be one of the GOP’s few experts in Medicaid. Next, Cohen used the power of her state post to disband the Cardinal board and pack it with Democrats loyal to her and Cooper. The new and compliant leadership included Carmen Hooker-Odom, who had been health Secretary to disgraced former Governor Mike Easley; and Bryan Thompson, a lawyer who had twice been charged with defrauding the elderly.
So much for the corruption and the money. The allegations of sexual misconduct come in through a side door, via a Republican supporter of Cohen, State Sen. Tommy Tucker. Tucker’s distaste for Cardinal was apparent at a March 26, 2018 news conference he attended and referred to Topping as a “rat.” The reason for such animosity comes into focus upon digging a bit deeper.
Tucker’s presence at the news conference reminded people that Cardinal was formerly was known as Piedmont, a healthcare provider that treated patients in Tucker’s district. In 1999, Tucker served on Piedmont’s board. In December of that year, he became embroiled in allegations of sexual misconduct involving a female board member. Tucker was an elected official; the woman a local government employee. As Alice in Wonderland observed, things become “curiouser and curiouser.”
The Chairman of the Cardinal board ousted by Cohen, Lucy Drake, was also on that Piedmont board with Tucker. It was Drake who had challenged Tucker on the sexual misconduct allegations, and demanded that he be removed from that board. In January of 2000, Tucker was notified by Richard Stone, another elected official, that if Tucker did not resign, Stone would hold an open meeting on the allegations against him. On January 31, 2000, a mere 56 days after having been reappointed to the Piedmont board for a second term, Tucker resigned.
As this saga continues to unfold in the courts, and in the political arena, the real losers are the people of North Carolina; both those who rely on the Medicaid safety net for vital care, and the state’s taxpayers who once again are funding expansionist spending by conniving Democrats uncaring about laws or ethics.