Foreign Doctors and No Malpractice Insurance: CHCC's Recipe for Disaster
The Commonwealth Healthcare Corporation (CHCC) in the Northern Mariana Islands (CNMI) stands as a stark monument to government incompetence, fiscal malfeasance, and a reckless disregard for the health and safety of American citizens. A long-overdue 2019 audit, finally released in November 2024, reveals a cesspool of mismanagement, potential fraud, and a systemic failure to comply with federal regulations. This isn’t about accounting errors; it’s about the calculated misuse of American taxpayer dollars, compounded by a dangerous policy that prioritizes foreign doctors with potentially fraudulent credentials over the well-being of Americans. This comprehensive analysis, will expose the depths of CHCC’s corruption, detail the specific violations uncovered in the audit, analyze the perilous implications of the CNMI’s foreign doctor policy, and issue a clarion call to the America First Congress to take decisive action. The time for accountability is now. American lives and taxpayer dollars are at stake.
The Overdue Audit: A Deliberate Obstruction of Justice?
The five-year delay in the release of the 2019 CHCC audit is a scandal in itself. The Single Audit Act and the Uniform Guidance (2 CFR Part 200) unequivocally mandate that audits be submitted within nine months of the fiscal year-end. This egregious five-year delay is not a mere bureaucratic hiccup; it's a blatant violation of federal law, raising serious suspicions of a deliberate attempt to conceal CHCC’s financial misdeeds. This delay not only obstructed justice but also allowed potential problems to fester, exacerbating the fiscal and operational crisis and costing American taxpayers dearly. What was CHCC so desperate to hide?
A Web of Deceit: Unraveling the $2.7 Million in Questioned Costs
The Ernst & Young audit, while five years late, finally shines a light on CHCC’s financial morass, uncovering a staggering $2.7 million in questioned costs across multiple federal programs. This isn’t about misplaced decimal points; it’s about a systemic pattern of fraud, waste, and abuse that has hemorrhaged taxpayer money intended for vital healthcare services. Let's dissect the specific instances of malfeasance, remembering that these documented questionable cost totals in the tested samples, are likely just the tip of the iceberg:
6 YEARS LATE- THE AUDIT THAT SHOWS MASSIVE FRAUD OF HHS FUNDS:
Missing Subsidiary Ledgers (2019-001): This fundamental accounting failure, a violation of Generally Accepted Accounting Principles (GAAP) and the Single Audit Act, prevented verification of millions of dollars in patient accounts receivable and depreciable assets. The absence of these ledgers creates an impenetrable fog around CHCC’s finances, making it impossible to determine the true extent of the potential losses. This lack of transparency is unacceptable.
Unreconciled Beginning Balances (2019-001): Discrepancies between beginning fund balances and the prior year’s audited balances, also a violation of GAAP, further erode confidence in CHCC's financial reporting. This seemingly simple error can have cascading effects, distorting financial statements and obscuring the true financial health of the organization. It’s a basic accounting principle CHCC has failed to uphold.
Inaccurate Reporting on SEFA (2019-001): The submission of an inaccurate Schedule of Expenditures of Federal Awards (SEFA) is not a minor paperwork issue; it’s a violation of 2 CFR §200.512, which mandates accurate reporting of how federal funds are spent. This inaccurate reporting obscures the flow of taxpayer dollars, making it difficult to track how funds are being used and increasing the risk of misallocation and abuse.
Equipment and Real Property Management Deficiencies (WIC, 2019-004): CHCC’s failure to comply with 2 CFR §200.313, which requires proper management of federally funded equipment, potentially jeopardized $249,070 in taxpayer-funded assets within the WIC program. This negligence not only wastes taxpayer money but also hinders the program's ability to serve those who depend on it.
Allowable Costs/Cost Principles Violations (SED, 2019-005): The $16,190 in questionable costs within the SED program, intended to help children with serious emotional disturbances, raises ethical as well as fiscal concerns. This violation of 2 CFR §200.403 diverts resources from vulnerable children and undermines the program's effectiveness.
Matching, Level of Effort, and Earmarking Issues (SED, 2019-006): The lack of documentation for non-federal match, a violation of 2 CFR §200.306, calls into question CHCC’s compliance with matching fund requirements, potentially impacting millions of dollars in grant funding and hindering the program’s ability to achieve its goals.
Procurement Violations (SED, 2019-007): The $23,500 in questioned costs due to procurement violations within the SED program is a direct result of CHCC’s disregard for federal procurement standards outlined in 2 CFR §200.318 through §200.326. This not only wastes taxpayer money but also undermines the principles of fairness and transparency in government contracting.
Allowable Costs/Cost Principles Violations (Substance Abuse, 2019-008): The egregious $452,311 in questioned costs within the Substance Abuse program is a clear indication of a systemic failure to manage federal funds responsibly. This violation of 2 CFR §200.403 diverts crucial resources from those struggling with addiction and undermines efforts to combat this critical public health issue.
Cash Management Issues (Substance Abuse, 2019-009): The lack of documentation for subrecipient cash management procedures, a violation of 2 CFR §200.305, potentially jeopardized $175,000 in taxpayer dollars. This negligence creates an environment ripe for fraud and abuse, further eroding public trust.
Period of Performance Violations (Substance Abuse, 2019-010): The $97,710 in expenditures incurred outside the grant period, a violation of 45 CFR §75.309, demonstrates a flagrant disregard for grant terms and conditions. This misuse of funds undermines the integrity of federal grant programs and shortchanges those in need of substance abuse services.
Procurement and Suspension and Debarment Issues (Substance Abuse, 2019-011): The $183,926 in questioned costs stemming from procurement violations, a repeat offense violating 2 CFR §200.318 through §200.326, underscores CHCC's chronic inability or unwillingness to adhere to federal regulations. This continued noncompliance wastes taxpayer money and undermines the fairness and competitiveness of the procurement process.
Subrecipient Monitoring Deficiencies (Substance Abuse, 2019-012): The failure to properly monitor subrecipients, a violation of 2 CFR §200.332, put a staggering $468,864 in taxpayer funds at risk. This represents the single largest category of questioned costs in the audit and highlights CHCC's gross negligence in overseeing the use of federal funds.
Allowable Costs/Cost Principles Violations (Immunization, 2019-013): The $22,500 in questioned costs related to missing checks, lack of signatures, and undocumented personnel costs, a violation of 2 CFR §200.403, reveals a sloppy and irresponsible approach to financial management within the Immunization program. This mismanagement jeopardizes public health efforts and wastes taxpayer resources.
Period of Performance Violations (Immunization, 2019-014): CHCC’s continued failure to adhere to period of performance requirements, a violation of 45 CFR §75.309, resulted in $80,809 in questioned costs within the Immunization program. This pattern of noncompliance demonstrates a disregard for grant terms and conditions and undermines the effective use of taxpayer money.
Cash Management and Procurement Violations (Maternal/Infant, 2019-015 & 2019-016): The combined cash management and procurement violations in the Maternal/Infant program resulted in a shocking $584,908 in questioned costs. These violations, including late liquidations, lack of prior approvals, and missing procurement documentation, represent a grave breach of public trust and jeopardize the health and well-being of mothers and infants.
Diploma Mills and Medical Mayhem: The Foreign Doctor Debacle
The CNMI's decision to allow foreign-licensed doctors to practice in the CNMI without requiring American accreditation is not just fiscally irresponsible; it’s a reckless gamble with the lives of American citizens. Compounding this recklessness is CHCC's utter failure to secure malpractice insurance. This creates a perfect storm of liability, where American citizens are subjected to potentially unqualified medical practitioners with no financial recourse in case of negligence or malpractice. This is not just bad policy; it's a moral outrage.
Countries like China and the Philippines, as mentioned previously, are infamous for their "diploma mills," institutions that churn out fake degrees for a fee. Without rigorous vetting and American accreditation, how can we ensure that these foreign doctors possess the skills and knowledge necessary to provide competent medical care? The answer is simple: we can’t. And the consequences for American citizens could be devastating, leading to misdiagnosis, improper treatment, and even death. The CNMI's policy is a ticking time bomb, and the American people are the ones who will suffer the consequences.
The Buck Stops Here: Demands for Congressional Action
The CHCC debacle demands swift and decisive action from the America First Congress. This is a matter of national importance, impacting not only the health and safety of American citizens but also the integrity of federal grant programs and the responsible use of taxpayer dollars. Anything less than a full-scale intervention would be a dereliction of duty.
Here is a reiterated, detailed action plan for Congress:
Immediate and Total Freeze on Federal Funding: Congress must immediately freeze all federal funding to CHCC. Not another dime of taxpayer money should flow to this corrupt organization until a comprehensive independent investigation, including a forensic audit, is conducted and verifiable corrective actions are implemented. This financial freeze must remain in effect until CHCC can demonstrate a commitment to transparency, accountability, and responsible fiscal management.
Launch a Full-Scale Independent Investigation: A thorough, independent investigation, spearheaded by the Department of Justice and the Government Accountability Office, is essential. This investigation must go beyond the scope of the Ernst & Young audit, conducting a forensic audit to unravel the full extent of CHCC's financial mismanagement and identify any individuals involved in fraudulent activities. No stone should be left unturned in pursuit of the truth and accountability.
Implement Ironclad Oversight Measures: Congress must establish strict oversight measures to prevent future abuses. This should include:
Regular and Independent Audits: Mandate annual independent audits of CHCC's finances by a reputable auditing firm with no ties to the CNMI government.
Real-Time Financial Reporting: Implement a system for real-time reporting of CHCC’s financial transactions to a designated federal agency.
Independent Monitor: Appoint an independent monitor with full authority to oversee CHCC's operations, financial management, and compliance with federal regulations.
Demand Reversal of the Foreign Doctor Policy: Congress must exert its full authority to pressure the CNMI government to rescind its dangerous and irresponsible foreign doctor policy. American citizens in the CNMI deserve the same access to qualified, accredited medical professionals as any other American. This includes requiring CHCC to obtain malpractice and liability insurance for all healthcare providers, regardless of their country of origin. The safety of American citizens cannot be compromised.
Homeland Security Intervention: The Republican/America First Homeland Committee must immediately investigate the potential threats to American citizens posed by CHCC's reliance on foreign doctors and its lack of malpractice insurance. This investigation should include a thorough assessment of the quality of care at CHCC, patient safety protocols, and the credentials of all foreign medical professionals practicing at the facility. The committee should then recommend concrete steps to protect American lives and hold the CNMI government accountable.
Conclusion: A Defining Moment for America First
The CHCC scandal is a test for the America First movement. Will we stand by and allow American taxpayers to be robbed and American lives put at risk, or will we take decisive action to restore accountability, transparency, and integrity to government? The answer must be a resounding call for action. We must demand that our elected officials prioritize the well-being of American citizens and the responsible use of taxpayer dollars.
This is not just about the CNMI; it's about upholding the principles of America First and ensuring that our government serves the interests of the American people. The time for complacency is over.
The time for action is now.
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