SIC calls for Medicare info, but gets Medicaid instead


The Medicaid office director Niuatoa Andy Puletasi stressed at the start of his Senate Investigative Committee hearing yesterday that he was never involved with the federal Medicare program and all financial records pertaining to this program as well as the federal Medicaid program are maintained by the LBJ Medical Center business office.

Both programs are funded by the U.S. Center for Medicaid and Medicare Services (CMS). Niuatoa’s appearance before the SIC is part of the committee’s ongoing probe into the cause of the financial crisis faced by LBJ.

After Niuatoa was sworn in, he was asked by SIC chairman Sen. Lualemaga Faoa if he had brought along documents subpoenaed by the committee.

Niuatoa replied “no” and outlined the reasons, which included that all relevant billing documents and financial records for Medicare are maintained by LBJ; he is the director of the Medicaid program; and he is no longer an employee of the hospital.

He also said that he was suppose to testify on the over-billing of Medicare but he does not have such information, nor did he have any knowledge of how the over-billing problem came about.

Lualemaga quickly requested a written testimony outlining the issues the witness stated in his verbal testimony and asked to have it presented to SIC by the end of the day. Lualemaga also requested that the statement include Niuatoa’s current responsibility as director of the Medicaid office.

Lualemaga then called a brief recess and asked Niuatoa to return to the Senate gallery while the committee went into discussion — in the Senate chamber. Lualemaga held discussions with committee members and consulted briefly with Fono legal counsel Henry Kappel, who is present for all SIC hearings

About five minutes later Niuatoa was called back to the witness seat in the Senate chamber, where Lualemaga said the hearing will continue and SIC members will ask questions.

Niuatoa asked as to what would be asked of him — to which Lualemaga replied it would be the issues dealing with Medicaid. “Would I require another subpoena?,” asked Niuatoa, who pointed out that he was subpoenaed to testify on Medicare issues.

Lualemaga again consulted briefly with Kappel before the SIC chairman informed Niuatoa that the subpoena included Medicare issues and financial status of this program, to which Niuatoa reiterated that Medicare was never part of his responsibility and he is also no longer an employee of the LBJ.

Lualemaga said SIC cannot discontinue the hearing which will go on as scheduled and Niuatoa again replied that Medicare was not his responsibility.

The chairman replied that the hearing will continue with questions from senators, and if the witness does not know the answer, then say so.

Responding to Medicaid questions, Niuatoa explained that the Medicaid office was transferred last August from LBJ to the Governor’s Office under the leadership of Lt. Gov. Faoa A. Sunia. This was done to comply with federal regulations that a State Medicaid Agency may not also be a recipient of Medicaid.

He said it was a conflict of interest for LBJ to be the state Medicaid agency and also a major recipient of Medicaid funds. He said when American Samoa in 2007 started getting more than $5 million annually in Medicaid funding, the territory was required to have the Medicaid program administered by another entity, not LBJ.

In an Aug. 23, 2011 executive order, Gov. Togiola Tulafono established the State Medicaid Office and its duties and responsibilities, for the planning, implementation, maintenance and revision of the Territory’s State Medicaid Plan “to achieve measurable improvement in health outcomes, sustainable cost control, and a more efficient administrative structure.”

The order also places the office under the leadership of the Secretary of American Samoa, who is the Lieutenant Governor.

During the SIC hearing, Niuatoa also explained the difference between the Medicaid and Medicare programs.

Medicare, he said, is like a federal insurance program for those 65 years and older, who are recipients of social security benefits. Additionally, this program targets those with disabilities and recipients of this program are issued a Medicare card.

Medicaid, he said is “slightly different” and it’s not an insurance program but it’s meant for residents in the territory with incomes below the U.S. poverty level. In other words, this programs targets residents in local income brackets, he said.

The Medicaid office director also pointed out that the actual Medicaid population in American Samoa is unclear because they are not enrolled, unlike other U.S. jurisdictions that receive this federal aid.

As to the role of his office, Niuatoa said the Medicaid Agency applies for Medicaid funding with requests sent every quarter and when it’s received, these funds are then distributed to eligible recipients, such as the LBJ hospital (including the Emergency Medical Service), Department of Health and Department of Human and Social Services.

He said local matching funds are needed from each recipient in order to get Medicaid and all recipients submit to Medicaid an expenditures report.


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