“Wrong doing, abuse, mismanagement, embezzlement and forgery” in Pohnpei outer-islands medical referral program

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Category: News

Published: Monday, 30 November -0001 00:00

Written by Bill Jaynes

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By Bill Jaynes

The Kaselehlie Press

October 31, 2020

Pohnpei—A Management Advisory Report from State Auditor Ihlen Joseph written on October 6 on the Pohnpei Outer-Islands Medical Referral Program alleges “potential abuse, misuse and mismanagement” of the program funds.  The report was written to Wincener J. David, Director of Pohnpei’s Department of Health and Social Affairs (DoHSA) and was also forwarded to Pohnpei’s Acting Attorney General. A staff member of Pohnpei’s Office of the Public Auditor (POPA) forwarded a copy of the report to The Kaselehlie Press on Friday evening, October 30.

The Pohnpei Outer-Islands Medical Referral Program is entirely funded by the Pohnpei State Government and has no relationship to the MiCare health insurance plan.

It says that POPA received an anonymous call through its fraud hotline saying that an employee of the DoHSA had been receiving, forging, and cashing checks made payable to several Pohnpei outer islands medical referral patients without their consent or knowledge.  POPA referred the matter to its Compliance and Investigation Division (CID) to begin a Preliminary Review and Administrative Investigation (PRAI) on the subject. CID compiled a detailed PRAI that covered only fiscal years 2018 and 2019 and sent that report to the Attorney General.

Based on the results of the PRAI, POPA found that a total of $50,000 was appropriated to finance the program, $25,000 per fiscal year.  The funds were approved specifically to cover round trip sea and air transportation costs for outer islands medical referral patients and also to cover living allowances or stipends for eligible outpatients’ referrals while in Pohnpei undergoing medical attention.

The daily stipend rate is set at $2.14 or $64.20 per month for each eligible patient and is only applicable and payable to outpatients on a monthly basis.  In-patient outer island medical referrals are not eligible.

During the two fiscal years examined, the sum of $48,759.20 was disbursed from the $50,000 approved for the Outer Islands Medical Referral program funds. Most of the funds expended went to pay for

outpatients’ living allowances/stipends. The remaining lesser balance was spent to cover sea and air transportation costs, including reimbursements.

The PRAI summary said that there were no internal control systems in place to guide proper administration and management of the outer islands medical referral program.  As a result, auditors found strong indications of abuse, mismanagement, forgery, double payment and embezzlement of the program funds.

It provided six examples:

There were numerous instances where the DoHSA prepared and submitted payment requests to DoT&A without the necessary supporting documents, (i.e. Travel Authorization numbers, and doctor’s certification confirming that payees are eligible outer islands medical referral patients still undergoing medical attention in Pohnpei). DoT&A processed and issued payments without the required supporting documents during the two years examined.

Investigators found several instances where stipend checks were issued to patients after they had returned to their home islands.

There was one instance where stipend checks were prepared and issued to the mother accompanying her son who was the patient.

In several instances checks were issued as double stipend payment to patients for a total amount of $2,732.

 Investigators identified and contacted seven referral patients who were still residing in Pohnpei who confirmed that they had never received a total of over $1000 worth of checks issued to them and that they had not cashed them.

The investigators identified, contacted and interviewed a local store owner who confirmed instances where a DoHSA employee had cashed medical referral checks.

“…we conclude that the $50,000.00 appropriated for the Pohnpei Outer Islands Medical Referral Patients program was not properly administered and managed by the DoHSA and the DoT&A. Our PRAI disclosed strong indications of wrong doing, abuse, mismanagement, embezzlement and forgery of the program’s funds by the responsible DoHSA employee (s) during the two fiscal years examined,” the management advisory said.

The matter has been referred to the Acting Attorney General who at press time had not yet filed any criminal charges against the employee who was unnamed in the management advisory.