Pago Pago, AMERICAN SAMOA — The Territorial Audit Office (TAO) Performance Audit of the American Samoa Medicaid State Agency found that the Agency “has not documented transfers of cell phones and laptops to other ASG departments” and recommends the need to “better document and justify” transfers of such equipment. 

This is one of the TAO findings for the audit of the Medicaid Agency — commonly referred to as the ASG Medicaid Office — for fiscal years ending Sept. 30, 2022. Part five of the Samoa News reports on this finding, in which TAO points out that the “unique set up” of the Agency in American Samoa and its flexibility to request waivers and modifications, places the Agency in an exclusive position to formulate and implement the most practical management strategies to best use resources to deliver the highest quality and standard of service for all eligible people of American Samoa.

TAO cited the Medicaid director as saying that the “Agency is performance-driven with a strong reliance on technological advancements to deliver key functions.”

During the audit, TAO said it noted the undocumented gifting of ASG assets as part of management strategies to foster a good working relationship with other ASG departments working alongside the Agency to deliver services for the public and more importantly to meet ASG commitments to its external stakeholders, specifically service providers.

According to the audit report, TAO discussions with the Agency’s head of the Administration Division, confirmed that two iPhones — 14 Pro max — were given for free to a Treasury employee and a Budget officer. These two officers helped to complete payments for the Agency as part of their official duties.

Similarly, 3 MacBook Laptops were given to Immigration officers to use during COVID-19 operations and were never returned or followed up to be returned to the office. Furthermore, the Agency purchased eight additional iPhones 14 pro max and these were given to four employees with each receiving two phones.

“The Agency was unable to provide a satisfactory justification for these exchanges. Without a valid justification, the Agency is exposed to the potential risk of violating ASG laws on the use of government assets purchased using federal and local funds to gain or influence a public servant and/or as a disallowable incentive to employees, causing tension amongst other work colleagues,” said TAO.

And TAO recommends the Agency have adequate controls in place to ensure all asset movements are recorded. Additionally, all transferred assets leaving the Agency shall be documented with appropriate narrations and supporting documentation.

In its response, Medicaid management agrees and provided an additional explanation, saying that the Medicaid Agency relies heavily on the use of technology and web applications in the efficient performance of its work.

“Staying current with equipment and systems upgrades is a fundamental and necessary protocol to ensure performance, timely and accurate reporting as required by the federal government,” Medicaid explained.

“With the growth and demands on the Medicaid agency, it is necessary for Medicaid to efficiently manage the volume of patient data that the program processes and manages — to include real time tracking and sharing of data,” they said.

As a condition of the 600% increase in Medicaid's funding in 2019, Medicaid said, it is required to provide rigorous reporting on data and individual enrollment efforts.

Thus, Medicaid's internal policies are to ensure it can manage data and information efficiently and stay relevant with changing technology and building redundancies into its operations to ensure that Medicaid services are not disrupted, according to management.

For example, MedEvacs (medical evacuations); since Medicaid created the Medicaid off-island referral program in 2018, this required Medicaid to directly coordinate patient, logistics and reimbursements for referral services.

“Specifically, our functions and workflows have changed because MedEvacs require the Medicaid senior staff to be on call 24/ 7-after hours and weekends,” and noted that MedEvac requests are received 24 hours, 7 days a week from LBJ Medical Center or the Health Department.

Additionally, Medicaid not only pays for MedEvacs to New Zealand and Hawaii; it also pays for MedEvac charters on Samoa Airways to retrieve patients from Manu'a.

“MedEvacs can happen any hour of the day. Medicaid senior staff are required to be on call 24/7 to monitor and respond to MedEvac requests,” the response said.

Therefore, the Medicaid Director required the senior staff to be able to work remotely, be accessible 24/7, to efficiently respond to MedEvacs and thus, are required to carry two phones, one with Bluesky and one with ASTCA, as a redundancy to ensure that Medicaid has 24/7 connectivity to communicate 24/7.

“Medicaid also recognizes, that to execute the mission of its office, it helps those other agencies that Medicaid works with, [so that they] can also respond efficiently,” management pointed out. “The Medicaid mission is better implemented when Medicaid's partner agencies are also equipped properly with the tools they need to perform at a high level.”

Furthermore, Medicaid provides allowable donations or cost share of supplies or equipment to government agencies that are directly involved in the administration of the Medicaid program.

“Partner agencies and staff must provide evidence of a clearly defined function in the administration of the Medicaid program,” said Medicaid management.