Ineffective, Reward Failure, Punish Success - Audit and Compliance CareOregon Employee Review

CareOregon was a fantastic place to work until the new "leader" took over in 2017. Everyone respected the previous leader, and staff members went above and beyond for him. Many of the issues within the CareOregon operation can be attributed to the current "leaders" lack of ability to inspire staff members in the same way as the previous "Leader." I worked for CareOregon for seventeen (17) years. It should be mentioned that CareOregon "eliminated" my position and the position of another colleague in the Audit and Compliance Department on June 2, 2023. Due to unmet promotion promises and a lack of support from senior management within the audit and compliance function, four (4) of the department's seven (7) highly experienced members had their positions "eliminated" or left the company in October 2021. My suspicion is that our jobs were "eliminated" as a result of my team's exposure of operational inefficiencies and non-compliance, and that senior management at CareOregon opted to "shoot the messenger" rather than deal with the issues that arise. These days, wise individuals are silenced in order to so that stupid people won’t be offended. Moreover, intelligent people aren’t just silenced. They are ignored because they don’t tell people what they want to hear. As of July 2015, the senior management positions at CareOregon included the following: There are nine (9) directors, two (2) executive directors, and four (4) chief officers. The current organizational structure of CareOregon, which has 42 Vice President positions, 72 Director positions, 7 Chief Officer positions, and 4 Senior Vice President positions, is a prime example of mismanagement. Furthermore, it doesn't appear that senior management understands or makes use of "economies of scale" for operational processes to increase operational efficiencies and effectiveness. CareOregon and its affiliated entities' member counts have not increased significantly enough to warrant this drastic increase in senior management positions. During my time at CareOregon, I witnessed firsthand the extreme top-heavy nature of the organization. Additionally, staff members also saw these positions being created and questioned why there were so many senior management positions. Is the goal in employing a disproportionate number of senior managers to try and create the impression that the company is "bigger" than it actually is and that the current "leader" is in charge of a much larger enterprise deserving of a higher salary? Approximately 550,000 members of the Oregon Health Plan are served by CareOregon, which employs 1,350 people. Why does running a health insurance plan require this many senior management staff members? In June 2021, a third party hired the "individual" to whom I reported in the Audit and Compliance department. Our department's staff members believed—and still believe—that this individual is wholly unfit for the job. His arrogant management style (e.g., an attitude of superiority manifested in an overbearing manner or in presumptuous claims or assumptions) and his "leadership" skills are either nonexistent or lacking. It is easier for people to trick others into believing they are more capable than they actually are when they are self-deluded about their own abilities. This demotivates the remaining employees and results in low employee retention, which may lower overall productivity. Even though our opinions come from staff members with over fifteen (15) years of experience in compliance and internal auditing health insurance, this "individual" shows no respect for them. He interferes in the running of internal audits to the point where he is stepping into the role of the auditor-in-charge. Furthermore, if someone else's professional judgment results in a different conclusion than his, he disregards it. Everything I valued and enjoyed about working at CareOregon and in my Audit and Compliance role has been adversely impacted by this one individual. It appears that senior management employees at CareOregon are not entirely qualified for the operations they are responsible for. Additionally, certain "leadership" employees lack the expertise needed to carry out the task for which they were employed. As a result, in essence, managers and supervisors are "training" their superior for the position for which they were employed. Furthermore, a lot of the senior management people I've met with have egotistic management styles that demotivate the remaining staff members and result in low talent retention. It is noteworthy that audits conducted by external parties have found instances of ineffective leadership, as evidenced by the finding in one audit that "subject-matter expertise is lacking at various senior leadership levels." Senior management hires people with the mentality of "throwing bodies at problems" for management and staff roles rather than making sure operational procedures were as effective and efficient as possible. Despite CareOregon's claims to the contrary, the company does not hold onto talented workers. Skilled workers are either "forced out" or quit on their own volition. Promotions to higher positions are rare for employees who are successful in their current roles; on the other hand, the company has no problem elevating staff members who have performed poorly in every role they have held. Employees know what this means…….. The double-talk going on in this organization is unbelievable. Let's see. During the February 2023 CareOregon All-Staff Meeting, a chief officer said, "We have too many position descriptions of 650 or so. An organization our size should have 200-250 position descriptions.” I found it “ironic” as the next presenter went on to state, "We are going to be posting for three (3) new Director positions in the Human Resources department.” The fact that the management of CareOregon keeps coming up with new titles and roles astounds me. Examples include: 1) Knowledge Management Analyst; 2) Chief of Staff; 3) Workforce Optimization Analyst; 4) Buyer; 5) Transgender Health Program Manager, etc. Buzzwords/Flavors of the Month • Accelerated Process Improvement • LEAN • Green Belt • Plan/Do/Study/Act • Leadership – this word is constantly being used; however, few personnel at the senior management level have demonstrated "leadership." However, I do see ‘Leadership’ exhibited at the Manager and Supervisor levels, along with leaders at the staff level. Furthermore, two (2) Formal Complaints and Attachments were sent in January 2023 to the following agencies due to evidence of unfair treatment and inequality, as well as a hostile, punitive, and retaliatory work environment encountered while seeking professional growth and career advancement opportunities at CareOregon between 2016 and the present: 1) Oregon Bureau of Labor and Industries; 2) The Oregon Health Authority Program Integrity Audit Unit; 3) Oregon Department of Justice; 4) The United States Department of Health and Human Services (HHS) Office of Civil Rights; and 5) The Department of Health and Human Services (HHS) Office of Inspector General. I did this after CareOregon failed to respond to my two (2) Formal Complaints submitted to the “leader” in the Equity, Diversity, and Inclusion activity. CareOregon has a history of acting hypocritically, acting contrary to their professed principles of being responsible with public funds. Furthermore, employees in a commercial or for-profit health insurance plan would not be allowed to engage in these activities since they would be held responsible for their acts (or inactions). Since CareOregon is a nonprofit organization that receives all of its funding from the government, it ought to be held to even higher standards of financial responsibility. I saw an organization that did not hold senior management responsible for carrying out the responsibilities for which they were hired, therefore it does not seem that this is the best course of action. Furthermore, if the problems are related to the "Culture of CareOregon" and "Tone from the Top," the internal audit function has very little power to address inadequacies that are found. The Oregon Health Authority ought to mandate the imposition of a Corporate Integrity Agreement (CIA) in light of CareOregon's operations, deficiency of internal controls, and senior management staff's lack of qualifications. A corporation that is required to be under a CIA commits to a number of responsibilities, and in return, the OIG promises not to pursue the company's exclusion from federal health care programs, such as Medicare and Medicaid.