My good friend and great attorney, Steve Hampton, called this article to my attention. Connections has been a disaster for Delaware. We must demand more transparency and accountability!
Excerpts from the Article:
Despite years of lawsuits and agreeing to pay more than $15 million to settle charges that it improperly billed federal programs and lacked proper recordkeeping for narcotics, Connections Community Support Programs was continuously shielded from scrutiny by the state of Delaware.
It remains a mystery why.
State officials continue to block public access to any records that may shed light on how it oversaw the largest provider of mental health and substance abuse services’ spending of tens of millions in tax dollars.
Records turned over in a Freedom of Information Act request seeking audits of Connections’ contracts with the Department of Health and Social Services offer little oversight of the nonprofit’s operations or compliance.
A shroud of secrecy was further cemented by state officials including contract language that explicitly blocked the public from accessing any records reviewing the nonprofit’s compliance with the contract. The state continues to keep taxpayers in the dark by dodging questions about how Delaware oversees contracts.
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State agencies contracting with Connections relied on the nonprofit self-reporting financial issues and non-compliance with state and federal regulations to ensure millions of state tax dollars were spent appropriately.
If any independent oversight was exercised, state officials have been reticent to say, avoiding specific questions about scrutiny of vendor contracts.
While auditing and oversight requirements for Connections as well as state authorities are outlined in several contracts the health department had with the nonprofit, the state did not provide any records of “independent peer reviews” – an oversight measure outlined in a Division of Substance Abuse and Mental Health contract with Connections that expired in March this year.
DHSS spokeswoman Jill Fredel in an email in response to a list of detailed questions, said, “provider management is an important priority” for the department.
“Contract monitoring requirements may vary based upon the division procuring the service, type of service, funding source, or federal requirements,” she said in the emailed statement. “Across the department, we have recognized the need for strong contract monitoring and have been working to centralize business operations to maximize our resources, maintain consistency across our divisions, and ensure accountability.”
After this article was published Thursday to DelawareOnline.com, DHSS provided answers to some follow-up questions.
The department defended including provisions within Connections’ contracts to prevent the release of records to the public.
“These complaints remain confidential due to the compelling state interests in keeping informants and complainants protected, ensuring the integrity of its investigatory functions, and the provision of a robust and frank opportunity for complainants to reported alleged misconduct,” Fredel said, citing a provision within state public records’ access that allows department’s to withhold “investigatory files.”
When asked why officials couldn’t redact identifying information so the public could access contract compliance audits, Fredel said they are “abiding by what the courts have ruled.”
John Flaherty, a member of Delaware Coalition for Open Government, said the department could easily redact any names and identifying information. It’s the substance of the audit or complaint that the public is interested in, he said.
“I would say that the state is obstructing what should be the legal dissemination of public documents here by making up this mythical investigatory files,” he said. ‘If that’s the case, then everything they provide could be an investigatory file, it could be potential litigation and it goes on and on and on.”
Limited oversight was initially baked into the contract Connections had with the Department of Correction to provide mental health, substance abuse and physical health services to Delaware’s prisoners.
That practice hasn’t changed, even despite a 2019 Delaware Online/The News Journal investigation revealing the lack of oversight in relation to claims that Connections falsified medical records.
“To the extent permissible under 29 Del. C. 10001, et. Seq., the parties of this agreement shall preserve in strict confidence any information, reports or documents obtained, assembled or prepared in connection with the performance of this agreement,” a confidentiality clause baked into a contract awarded to Connections for adult withdrawal services in Kent and Sussex counties reads.
When Connections first took over healthcare in Delaware’s prisons in 2012, the contract signed with the Department of Correction restricted the state’s ability to watch what the nonprofit was doing, preventing the department from using data or information that Connections had already covered in its own reviews.
Quality assurance audits that DOC was required to do were abandoned shortly after the contract was signed, leaving the only scrutiny of Connections operations to be conducted by the nonprofit itself. These “peer review reports” conducted by Connections, however, are blocked from public scrutiny, according to DOC’s denial to release the records in April 2019.
At the time, DOC Healthcare Services Chief Marc Richman said he didn’t know why the state would limit its own auditing operations and acknowledged that future contracts could remove or alter those provisions.
2019 INVESTIGATION: Prison contractor falsified records to conceal inadequate addiction treatment, sources say
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Yet, other state departments followed suit, crafting contracts with Connections that included language to keep any records and reports related to evaluating the nonprofit’s performance confidential.
Delaware is not known for accountability and oversight, nor for transparency. Independent studies have consistently ranked the state among the bottom nationwide for government transparency and accountability.
The First State’s Freedom of Information Act has several carveouts that government entities use to block access to public records, including any documents part of an “open investigation” or pending or potential litigation, police personnel records and arrest reports. FOIA also allows agencies to charge requesters exorbitant fees for reviewing records to ensure they are responsive to the request.
These FOIA exemptions give government agencies an “out” to deny a request, but it is not a requirement. The language in the Connections’ contracts makes it a requirement to not release the information.
The health department initially demanded a nearly $2,000 payment to search for all financial audits and program reviews of Connections’ contracts. Its FOIA coordinator ignored requests to have a conversation about the records to help par down the request, ultimately leading to the news outlet appealing the decision to the state Attorney General, who ruled in the state department’s favor.
It took several months of back-and-forth with state health officials and FOIA coordinators to gain access to any responsive records, and questions regarding how those records show the state’s oversight of Connections still linger.
State departments have broad and varying interpretations of what records are publicly accessible, said Flaherty, the open government advocate. For example, a records request Flaherty sent to seven different agencies yielded seven different responses, he said.
John Flaherty, a board member for the Delaware Coalition for Open Government, weighs in on the state’s oversight of Connections Community Support Programs contracts. “Each agency interprets the law as they see fit, and in most cases they err on the side of secrecy because they don’t want embarrassing admissions to become public,” Flaherty said of Delaware’s approach to transparency and public records release. “Just because it embarrasses state officials, doesn’t mean they can hide from public disclosure.”
The only state oversight gleaned from the provided documents is from a late-2020 desk review conducted by the Division of Substance Abuse and Mental Health on a recovery services program for men.
At the time, the contract compliance officer reported Connections could not provide any documentation nor the clients or employees to confirm $71,301 in charges to the state in December 2019.
“Non-compliance was determined when no documentation was submitted that supported the invoiced amount,” wrote Teena Nelson, the officer who reviewed Connections’ operations, in a Nov. 23, 2020 letter to then-CEO Bill Northey. “Connections was unable to provide documentation that services were rendered to clients.”
Nelson recommended a unique corrective action plan that would address the billing discrepancies, according to the letter acquired through a FOIA request. Another desk review of the adult withdrawal management services in Kent and Sussex counties conducted by Nelson in February 2021 found no issues with those charges.
When asked why there were no desk reviews conducted prior to 2020, DHSS reiterated its previous response that it was working to improve oversight of its contracts. The department has never indicated desk reviews were performed prior to then.
Delaware lawmakers recognize the need to strengthen the state’s oversight of outside vendors’ stewardship of tax dollars but have made few moves to tackle the issue legislatively.
“We believe strongly in the need for the state of Delaware to constantly and vigorously re-examine whether tax dollars are being spent appropriately and efficiently, particularly when those resources are being directed to third-party vendors for services so many of our neighbors depend on,” state senators Sarah McBride and Kyle Evans Gay wrote in a joint, emailed statement in response to News Journal requests for interviews with the lawmakers.
They said they are “confident – based on our ongoing conversations – that the executive branch is engaging in a thoughtful and thorough review to determine where those oversight responsibilities fell short.”
Gov. John Carney’s office declined to comment for this story, redirecting reporters to the emailed statement from the health department, which answered hardly any of the News Journal’s questions.
It’s unclear what, if anything, Carney’s administration has done to strengthen oversight of third-party contracts.
Flaherty said recent moves in Delaware government suggest the state continues to shift further away from transparency.
He pointed to a public-private entity created to develop recommendations for increasing efficiency and effectiveness of state government, called the Government Efficiency and Accountability Review Board as well as the Delaware Prosperity Partnership as examples of quasigovernment entities that lack transparency.
“It seems like both of them were formed to shield the public from prying into the activities of how these groups work,” Flaherty said. “That is not a good sign. We need to have more disclosure, not less.”
“At a minimum, we expect organizations and their staff to comply with the requirements under the False Claims and Controlled Substances Acts,” U.S. Attorney David Weiss said.
Despite Connections Community Support Programs settling with the federal government in September over fraud and improper narcotics recordkeeping charges, Cathy McKay, its former CEO, continues to face charges of her own along with former CEO Bill Northey and Connections’ attorney Steven Davis.
And the contracts Connections had with the state spelled out the nonprofit’s obligations and responsibilities, including providing access to financial and patient records to state representatives to review contract compliance; submitting timely invoices to the state for reimbursement; and ensuring adequate and appropriate staffing, among others.
“The services performed by vendor under this agreement shall be subject to review for compliance with the terms of this agreement by Delaware’s designated representatives,” one Connections contract stated, adding: “It is understood that Delaware’s representatives’ review comments do not relieve vendor from the responsibility for the professional and technical accuracy of all work delivered under this agreement.”
But Connections didn’t provide internal oversight and quality assurance. Instead, the nonprofit relied on the state alerting them to any issues.
A patient care ombudsman appointed to review Connections operations during the bankruptcy proceeding discovered it “relied on the state to provide feedback as to whether the debtor was in compliance.” The ombudsman concluded the nonprofit’s reliance on the state to ensure compliance was a “significant and material deficiency in the overall operations” of Connections.
The contracts allowed Delaware to withhold funding if Connections failed in its obligations or neglected to provide required records.