Rep. Barton: Wife's job at JPS not an ethics issue

25 May 2008 // Months after Rep. Joe Barton's wife was hired by the JPS Health Network, he voted to delay rules aimed at closing some loopholes in the Medicaid program that he had previously criticized.

Barton, R-Arlington, said he supported the bill because its Democratic sponsors agreed to include funding for oversight to help eliminate waste and abuse in the healthcare program for the poor. He said he sees no conflict in his wife working at JPS even though, as the ranking member of a U.S. House committee that controls Medicaid funding, he helps oversee issues that affect the Tarrant County public hospital.

"What would be the conflict? I have supported John Peter Smith [Hospital] since I became a congressman," he said during a recent interview. "My wife going to work for JPS was her decision. I didn't even know it until she accepted the position."

Some watchdog groups said they saw no conflict. And Barton had plenty of support for his vote to delay the proposed regulations until 2009. The nation's governors opposed the rules, and a majority of House Republicans joined Barton in voting for H.R. 5613, the Protecting the Medicaid Safety Net Act.

But the vote put the House at odds with some Senate Republican leaders and President Bush. It has also drawn fire from some conservatives in Washington. The Heritage Foundation said the bill ignores extensive evidence of states' manipulation of federal matching Medicaid funds.

In years past, Barton himself had been a vocal critic of the methods some states were using to maximize federal Medicaid dollars, while reducing their own share of Medicaid costs. More troubling, he had said, was that the money sometimes was not being used to help needy Medicaid patients.

In 2005, as chairman of the House Energy and Commerce Committee, which oversees
Medicaid funding, he launched an investigation into what he called "persistent state schemes," demanding records from 20 hospitals in 10 states. "Information gathered to date in this investigation suggests a troubling scope and prevalence of such mechanisms," he said in a January 2005 statement. Barton recently said he was unsure what resulted from that investigation since it was not completed when Democrats took control of the House in 2006.

A moratorium on the proposed regulations was folded into a spending bill passed in the Senate on Thursday 70-26.

While the regulations were to take effect today, Health & Human Services Secretary Michael Leavitt issued a statement last week that he would delay implementing them until Aug. 1 while the House and Senate hash out their bills.

A lawsuit filed in the U.S. District Court for the District of Columbia by several national hospital associations also seeks to block the new rules.

Hiring decision defended

Terri Barton was selected over 83 applicants in September to be director of network physician recruitment for JPS, a position that pays $82,299.

JPS officials said she was hired based on her experience.

"Terri was the most qualified candidate that I interviewed, and I was glad she accepted our offer," JPS Senior Vice President Kristin Jenkins said.

But in choosing Barton, JPS bypassed more than a dozen other applicants who had experience in recruiting physicians who treat patients, including several who currently recruit doctors. Physician recruiters at other hospitals typically must have several years' experience recruiting physicians. Parkland Health & Hospital System, Dallas County's public health system, requires its physician recruiter to be certified as either a professional in medical-staff management, provider-credentialing specialist or as a medical-staff recruiter.

Most recently Terri Barton worked as an outreach director for her husband's campaign at a salary of $57,759. Because of her role, her husband was among a number of federal lawmakers criticized in a 2006 report by a political watchdog group, Citizens for Responsibility and Ethics in Washington, for using campaign funds to pay relatives. Although it is legal to do so, the group said it found it suspicious that "so many family members are qualified to work on campaigns."

In the mid-1990s, Terri Barton worked with the American Lung Association of Texas as an assistant regional director, and in that role enlisted physicians to volunteer with educational programs on asthma, smoking prevention and lung-health issues, according to her résumé.

From 2000 to 2003, she helped recruit faculty as the admissions coordinator for the University of Texas at Austin's department of educational psychology, her résumé states.

Barton has a bachelor's degree in organizational communication from UT-Austin.

Barton told JPS that she learned about the job through Careerbuilder.com.

"I had a life before I ever met Joe. ......and I don't always mention that I'm Joe Barton's wife," Barton said in a recent interview. "I went to great lengths to do this on my own."

In her first six months on the job at JPS, Terri Barton has "recruited 29 incremental [new, not replacement] physicians and physician extenders to work at JPS," above the one-year goal of 16, according to Jenkins.

Barton, who has an office in Arlington but works at several JPS locations, is also designing

Web-based recruitment information, Jenkins said.

Some political watchdog groups say Terri Barton's JPS job poses no conflict for her husband because he does not vote on matters that directly fund her salary.

When he votes on healthcare funding bills "it benefits every other hospital employee and every other hospital in the country, so it is not just benefiting he or his wife," said Naomi Steiner, director of communications for Citizens for Responsibility and Ethics.

However, JPS has relied on Barton to advocate on the proposed Medicaid rules, as well as for other healthcare-funding matters.

Fund transfers at issue

A year ago, the federal Centers for Medicare and Medicaid Services, or CMS, had proposed several rules aimed at what it said were abuses of Medicaid funding. One rule targeted states' use of so-called intergovernmental transfers of money from local governments to pay the states' share of Medicaid. In Texas, public hospital districts, such as Tarrant County's, send money to the state to pay for Medicaid supplemental funds.

Because states then don't have to shoulder the increasing burden as Medicaid spending swells, they have been able to draw nearly unlimited federal matching funds, critics say. That has sent federal Medicaid spending skyrocketing.

For example, JPS transferred nearly $45 million to the state in 2006 for about $102 million in a Medicaid supplement known as Upper Payment Limit, state records show. In contrast, in 2001 JPS transferred little more than $1 million for $2.6 million in UPL money.

Another rule targets the way some states, such as Texas, have concentrated all their UPL money on a handful of hospitals. Those hospitals get more money than they spend on medical services to Medicaid patients. Concern has been that the hospitals may use the money for other purposes or bank it, as JPS has done.

The proposed rule would limit payments to a hospital's cost of providing Medicaid services.
Congress imposed a one-year moratorium on the rules after states and hospital groups protested the changes.

JPS receives hundreds of millions in Medicaid funding each year, amounts that have swelled in recent years as it has employed strategies, such as aggressive price increases, to boost payouts.

The rule changes, JPS officials have said, would have reduced funding to the county health system by about $18.5 million this year and cut future annual funding by $73 million.

Some Senate leaders have been outspoken about what they see as Medicaid abuses, in trying to persuade colleagues to support the new rules. "We can make these regulations go away, but there are still problems in Medicaid that need fixing," Sen. Charles Grassley, R-Iowa, said in a statement last month. "CMS still has a fundamental responsibility to combat fraud."
Barton said Congress can devise a better solution than the one proposed by CMS.

"I said, 'Let's use the interim period to study the problems and come up with something just as effective as these [CMS] regulations and go after the fraud that exists,'." he said. "Should we do things to prevent Medicaid fraud? Yes. Should we be sure the money is being spent where it is supposed to be spent? Yes."