Kevin Techau and Dean Lerner on Medicaid Fraud Task Force

News Talk 1540 KXCL, where Iowa comes to talk on a Friday morning, at least on this Friday morning, the last Friday in August.

It's time to connect with the Iowa Gallivant, JJ Goodvin, who writes about traveling the state at theiowagallivant.com and shares insights with us here on News Talk 1540 KXCL every couple of weeks.

JJ, good morning.

Good morning, and I don't know if we can get any more Central Iowa than Franklin County, but we'll let our listeners tell us.

Maybe it's in somewhere in Wright County, but this is Central Iowa.

I do have to put in a word for a state center, but that's neither here nor there.

But we are talking about Franklin County with JJ as the county we randomly selected.

The last time he was on the program a couple of weeks ago, we flipped a coin over the Iowa map.

That's where it landed.

And so off to Franklin County and Hampton and everything else that's in Franklin County.

Off we go.

Yeah, you know, last.

summer in the summer of 25.

I had the great pleasure of being at the State Fair with my friend Tate.

He's a kid that raised a steer.

The steer's name was Pablo.

and he did a great job showing that.

So that was my first time I've ever shown any kind of livestock of any of any sort and it happened to be right there at the governor's charity steer show right there at the state fair.

So that was pretty cool.

So and Pablo was pretty docile every time I went to go see him at the Franklin County Fair and then and then of course when he gets into the big arena, that's when he really wanted to strut his stuff.

So it was a little hard, but it was well worth it.

So yeah,

you got to be ready for this kind of thing when you're a celebrity.

I know, yeah, exactly.

Which of course, you know, maybe I should have done a little bit more practice.

Well, let's talk about things that are in Franklin County.

And I know that you left us with a little bit of a nugget that you wanted to begin with, JJ.

So let's pick up there.

So yeah, one of the things that I found most interesting when I was going through Franklin County the last time I was there is the RAC building there.

It's historic.

electrical plant in the middle of rural Franklin County.

It's got a Hampton address, but no, it is not in Hampton proper whatsoever.

And it's very historic in the sense that obviously it powered the rural areas of that county and was very much needed, as you can possibly imagine, you know, with the technology of farming and the 30s expanding into the mid 20th century.

But it's also, you know, it's one of the few that could actually, if you gave it the old one,

too could actually be revved up again.

It's a very rare piece of history here in Iowa and not just in Iowa but throughout the country and they just got it on the National Register of Historic Places and it is one of the sites for silos and smokestacks national heritage areas.

So

it's got a lot of history in that building and it's one of those places that you didn't realize just how important it was until you dive into that thing and boy if you can imagine just how

Wow those sort of things must have been

we're talking with JJ Goodvin.

He is the Iowa gallivant and we're talking with him about Franklin County and some of the things that he has seen there some of the things that you can see not far of course from the Cedar Valley even from the corridor It's a pretty reasonable drive up into north central Iowa and you mentioned that the

REC, the Rural Electric Cooperative, that was started there for folks in the rural areas of Franklin County back in the 1930s.

It has a Hampton address but not really Hampton proper.

Tell us about what you'd want to have folks know about what they can find in Hampton itself.

If you love just good traditional small town food, Willys, there in Hampton, that's a great place.

Of course, go there for breakfast is what I really recommend.

Get one of the omelets.

I got a huge omelet.

You'll have to get the big one, but they're kind of known for that, the coffee shop.

right directly across the street is also a very good place, not only just for coffee, but just, you know, just a great place to relax.

I go there every time I'm in Hampton, and I actually go to Hampton quite regularly.

I haven't been there in a while, but for three or four years in a row, I got used to going to the Franklin County Fair.

It's too bad we didn't have the show a few weeks ago, and it is truly one of the best county fairs out there.

It's pretty big.

It's not, obviously, it's not.

as big as Clay County.

No one will be ever as big as Clay County

when it

comes to fares.

But yeah, the Franklin County Fair is definitely one of Iowa's finest when it comes to local fares.

Now, I'm going to try to outgallivant the gallivant here.

I happened to be driving through Franklin County several years ago.

I think it was not too long after the

COVID lockdown happened and I was just out driving around trying to get out and about and stopped and just was looking around the Grand Army of the Republic Hall, which is across the street from the Franklin County Courthouse.

There happened to be someone there with the keys to the building.

They let me in along with my family.

We got the chance to take a lap around the Grand Army of the Republic Hall, which is a really unique space.

And I've got to ask JJ, have you been there?

They

have not

yet been there.

So tell us about it.

Well, it was very cool.

It has a lot of artifacts.

It goes back to the post-Civil War era.

That's the reference to the Grand Army of the Republic.

We're talking about the Union Army from that time.

And this was kind of the equivalent of what the American Legion would become in the years after World War I. It was an opportunity for all these former soldiers to stay together to try to maintain their connections with each other.

And there were these Grand Army of the Republic.

groups all over the northern states and they built this grand army of the republic hall in franklin county it's rare at this point there are not a tremendous number of them out there that are still standing but a lot of old artifacts from that era and from subsequent generations of american soldiers in that space

i've seen some of those in other cities and i never really put the connection together like that being part of the same

I guess, family of networks that you just explained, because I've seen that throughout the country, actually.

So it wasn't just an Iowa thing.

It must have been all over the country.

Because recently, I was in upstate New York, and I saw something like that.

So there you go.

And I think they tend to be a little bit more common out east, but I don't think that there are a tremendous number of them anywhere.

Oh, wow.

That's interesting.

Now we've got to go on a hunt.

Now we've really got to.

but a homework assignment right there.

So, and what we, another

homework assignment we've got to do is go to JJ's and Bradford.

I know I'm JJ, so I might be a little partial to the name, but yeah, JJ's and Bradford before the restaurant was renamed with new ownership and everything like that.

It was very well known in Bradford, but it does have a new owner and they're pumping out some pretty good food too.

I haven't been able to do a video there yet, but yes, the food is pretty good there and I need to go back and do a video.

So it's, I really recommend it.

You know when it comes to history in Franklin County, Hampton and really a lot of the county right on the Jefferson Highway route that ran from New Orleans up towards Winnipeg and do you see some of that heritage still JJ as you're out looking around for different points of interest.

Yeah, yeah, especially when you get to the Ackley area.

Because a little bit of Franklin County touches into Ackley.

Actually, Ackley's in four different counties, to be honest with you.

And over there in Ackley, they've got a great little camping area and a rec area that's technically in Franklin County.

And it's one of those places where, yeah, that's Highway 20 country right there.

But like when you get into the Jefferson Highway and also the Lincoln Highway, it's kind of interesting.

You feel different when you're traveling north and south.

It just has a different feel to it.

You know, because like when you go east to west, especially cross country, and I think one of the reasons why is the geography tends to change more often when you're going east to west or west to east.

Then when you go north to south because you can drive from Fargo to Dollhart, Texas and basically it'll not change You know, so it's a um, it's basically the same thing so and when you get on the Jefferson you do go I feel like you do go through more towns than the Lincoln on a per capita square mile.

I have no data

to back that up but for some reason I feel like the Jefferson goes through more towns and maybe I can look that up and maybe our your listeners could look that up too because it just feels like uh it just feels like just goes through more towns like you go little town of Leon and places like that in southern Iowa but yeah getting back to Franklin County Prairie Bridges Park right there uh just just uh um over by uh Ackley that's a great little

place to the camp, kind of a rec area, if you will, and you know, it's right off of old 20.

And Franklin County actually has the record for historic highway 20, which goes from Newport, Oregon to Boston, Massachusetts, technically, America's longest highway, but the shortest stretch of it in the country for one county is in Franklin County.

So it's very, it's not, it's like,

About a mile almost I think maybe two miles.

So it's it's so they have that going for him

We're talking with JJ Goodvin.

He is the Iowa gallivant and talking about Franklin County in north central Iowa not hard to get to from This part of the state really not too hard to get to from just about anywhere in the state because it is so centralized and What have we missed so far JJ?

Yeah, it is a very, you know, it's a very rural county, obviously.

You're not too far from Des Moines.

You're not too far from the Cedar Valley.

And, you know, we touched on how big their county fair is, which goes to show you just how rural it is too.

A lot of times.

in those smaller populated counties, the bigger the county fair could be.

But yeah, so in getting back to Hampton too, it's one of those perfectly sized towns for me.

It's just like, it's still small, but it's got everything you need.

I think their courthouse is one of the neatest looking courthouses in the entire state.

And it's right by that civil war.

Paul, you were talking about too.

And so a lot of people I know actually have done the thing where they've been to all 99 counties and get a picture of all the courthouses.

And a lot of them do actually say that Franklin County is pretty is pretty interesting when it comes to the architecture of it.

Well, any last hidden gems, JJ, that we haven't talked about in Franklin County.

I know we haven't gotten to all the communities in Franklin County yet.

Is there one of those that you direct us toward?

So, well, yeah, I mean, there's, you know, of course, there's like a Pope Joy over there.

There's it's a lot smaller off the beaten track.

communities.

When it comes to Franklin County, you know, obviously Hamptons, the big draw there and everything, but yes, the little towns are off the beaten track.

And we talked about Bradford a little bit, but, you know, WKW Conservation Park, that's, you know, that's a nice little place to get off and just stretch your legs, get to know the area a little bit more.

It is one of those flatter counties too.

So, you know, we do have some of those counties out there that are pretty flat, and this would be one of them.

That doesn't mean it doesn't have its own kind of beauty and things like that.

And when it comes to like getting off that beaten track, you're going to go through like little towns of Coulter.

They're in Franklin County.

And you know, it's one of those it's one of those counties where I mainly have stuck to Hampton and just kind of just taken my lackadaisical time throughout the rest of the county when I've been through there.

You know, I've been to Latimer, but we really haven't done anything in Latimer.

We just kind of

absorb the small town nature.

Sheffield's got a good little restaurant there.

So yeah, so there is some things to see and then, you know, you could say you've been to Geneva and not even didn't even have to go to Switzerland.

That's right.

It's one of a number of Geneva's out there, but the easiest one to get to for most Iowans.

Well the time has come for us to pick the next county that JJ will tell us about when he rejoins us in a couple of weeks.

It'll be on the other side of Labor Day.

We'll be out of the official summer travel season, but certainly plenty to talk about when it comes to getting towards fall.

And the procedure, as many of you know, is to flip a coin over the Iowa map and see where it lands.

We've got a 1995 traditional quarter that we're going to toss up into the air and see how it lands on the Iowa map.

to tell us where we're gonna go next as JJ guides us through all 99 counties every couple of weeks.

We get one of those 99 added to the list.

So here we go with this quarter that we'll put in the air.

Almost straight south from Franklin County and about as far as south as you can go and still be in Iowa, it looks like we're headed to Wayne County in a couple of weeks, JJ.

Okay, listen, this is gonna be fun.

We're gonna go to a restaurant where you can eat one of the best smoked brisket sandwiches I've ever had in the Midwest and quite possibly the best baked beans I've had anywhere.

And you can eat it in Missouri and Iowa at the same time, right there in Wayne County.

Something to look forward to when JJ Goodman rejoins us.

He is the Iowa Gallivant and writes about traveling around the state at theiowagallivant.com.

JJ, thanks so much for your time this morning.

This is the station where Iowa comes to talk.

News Talk 1540 KXEL.

News Talk 1540, KXEL, where Iowa comes to talk.

Hello, I'm Jeff Stein.

Start of a new school year, lots of education going on.

How about educating students, young people generally about financial literacy?

We are joined via Zoom by a returned guest to the program.

She is Heather Kreiner.

Ms.

Kreiner is Financial Literacy Director for the Iowa Department of Insurance and Financial Services.

Thanks so much for coming back on the program.

Yes, thank you for having me.

For many young people when they go off to college, it's the first time they've been out on their own, maybe the first time that they have to manage money without mom or dad always being there to help.

What are some things that adults, parents, grandparents can do to try to make sure that that young person doesn't make some of the more common mistakes?

So I think one of the important conversations to have just first of all as a parent with a student who's going off to college

is the kind of sticky conversation of who's going to pay for what.

I think having those conversations up front and really setting crystal clear boundaries about this is what.

I as a parent am going to be responsible for versus this is what you as the student are going to be responsible for and just setting really crystal clear boundaries about what that's going to look like can avoid a lot of conflict and confusion really for the student further down the line.

So we're really encouraging parents to start to have those conversations early is a big part of this.

And early really includes, I would suggest, the high school years as they're preparing to go to college.

As I recall, it's been many years ago, as I recall, going off to college has its own set of stressors.

You don't need to then add another layer.

Hopefully that kind of conversation has been had previously.

Yes, definitely.

And that's the hope.

And I know a lot of families maybe aren't so comfortable having financial conversations, especially if they feel like this is actually an area that I've really struggled in throughout my life.

And so to now try to have that conversation with the next generation, so to speak, can be really difficult.

And so our office does actually have some free online financial literacy classes and resources that are available.

We have a program called Smart Her Money.

There is a website that people

visit it's smarther.iowa.gov that has some of those resources available that can really help families navigate through these transitions as students are going off to college for the first time.

Something that I certainly didn't think of when I went off to college.

I went to a public university and the dorm room and back then they were very small and back then we didn't have an awful lot of electronics and so you didn't really have to worry about ensuring your belongings.

But a couple of years later, time to get an apartment, all of a sudden the insurance agent says this might be worth $100 a year.

So insurance plays a role not just with regard to belongings but vehicles, health insurance, etc.

Yeah, there's a couple of specific insurance considerations that we want families to be thinking about as students go off to college.

One of them, as you mentioned, is does this child need renters insurance?

And that really kind of depends on where they're living.

So if your student is on campus living in a dorm,

Typically, your homeowner's coverage will actually extend to cover their belongings in that dorm room, but that will be up to a certain percentage.

And so you're going to want to talk to your insurance agent to figure out what your specific policy terms are.

But typically around 10% of your total limit is the coverage that will extend to your student who's living in a dorm.

Now, if they are living off campus, you are going to want to check out renters insurance to cover their belongings, but also

some of those liability concerns that you have once a student is living in their own apartment just in case you know someone were to get hurt or if they accidentally cause damage to the building that they're living in.

And renters insurance is typically very affordable.

Policies you can still find at typically $15 to $30 per month and you know when you start to add up all the different like you mentioned all these different electronics that students have now it certainly can be worth ensuring.

The other

consideration that we want families to kind of have in the front of their mind is auto insurance.

Oftentimes...

students may not take their car to college, you know, especially if they're a freshman and some universities have limited parking available for underclassmen.

If they leave their car parked at home while they head off to school, you may qualify for a student away at school discount, which can significantly lower your bill for your auto insurance.

And so that's something, again, that you'd want to check with your insurance agent about.

Also, particularly if your student is taking a car and they are

going to school out of state.

you're going to want to check with your insurer to make sure that you are meeting the coverage requirements of that state and that your coverage is appropriate.

And then once you are kind of in the school year, you can always ask also about a good student discount.

So if your student is maintaining a B average or better, many companies will kind of slice off a chunk of your premium for a good student discount.

So those are all things to kind of be considering when it comes to insurance.

And again, if you

have the student off at college designation, when the student comes home and wants to go out and have a good time with their friends, they're still covered.

It's just that it's a different kind of coverage because it's not the daily use, the daily mileage, or having it in a different location as you would if you took it to school.

Exactly.

And I seem to recall, and again, it's been so long ago, but I grew up in a fairly small town.

And then I went to college in Iowa City and by changing the zip code on my residence, that changed things.

And so you have to let the agent know where the person's living, where the car will be operated, because that can make a difference.

And I suppose it cuts both ways depending on where the student is.

Yeah, and I think that's a great reminder too to just always be checking in with your insurance agent on an annual basis anyway to make sure that coverages you have are appropriate, not just for an auto, but for your home, you know, your homeowners insurance.

We've seen what's happened to prices of everything in the last few years.

And if your coverage doesn't match what it would take to actually replace your home at this point in time, that's something that needs to be looked at on a regular basis as well.

We're speaking with Heather Kreener.

She is financial literacy director for the Iowa Department of Insurance and Financial Services.

She joins us via Zoom on News Talk 1540KXEL.

Let's stick with parents a little bit more.

Let's say that you are a parent and you've already sent the kid off to college, but you've got others at home never too soon to start.

So what does the conversation look like?

That first conversation

where I trust if teenagers are like they used to be, they start rolling their eyes when mom and dad say, we want to talk to you about something.

How do you start and how do you help bolster the confidence of the young person who will at some point be leaving home?

I think one way to really build their confidence is to give them some practice.

And so whether that means a teenager's going to have an actual job that they go to, or if that means that you're giving them some type of allowance at home, or they're getting paid for chores around the house occasionally, I think that that's kind of maybe a little controversial to pay your child for those kinds of things.

But they have to get practice somehow.

And if they don't have access to money where they can start to, for one, be motivated.

by that, where they have this thing that they want to save up for.

they want to work towards that goal, they have to have a way to do that.

And so, you know, whether that is working outside of the home or working inside of the home, I think that that can be a great first way to give them a little bit of a taste of like, oh, if I want that thing, I can get that thing.

I just have to work towards that thing.

And then actually teaching them, okay, this is how much you have coming in.

So realistically, how much of that money needs to go towards this category and how much needs to go towards

this category and how long will it take to get to that goal?

I think those are all really good first lessons to learn that you can do while the child's still in that safety net of living in your home.

We have had a guest on the program in the past who advocated if you are an individual with a small business, that you should put the kids on the payroll because you're paying for some of their things anyway, whether it's school trips or clothing, etc., so you put them on the payroll, you get tax benefits.

They also then

to your point, get to learn how to budget and spend money, etc.

So every parent's situation is different, but if you've got the added opportunity of a small business where you might be able to put the kid on the payroll, that serves a number of great purposes.

And if you have a child who has earned income they can also open up an ira so then they can start to learn that lesson of okay if i put you know and they've got such the benefit of time as a teenager if you start investing in those teenage years i mean man that money really has time to work for you and so if they can start to see.

what that means to invest and, you know, the payoff of that over time.

That's a great lesson to learn as well.

You know, that's something that I do with my children, even with I save five to nine college savings plans is, Hey, guess what?

I've been putting a very minimal amount of money in this since you were born.

But because I do it every month, you know, you can see this is how much I've put in your 10 years old now.

This is how much it's worth.

And that's because of the magic of compounding earnings.

and things like that.

And so it's, I think, a really good teaching tool for kids as well.

I recall back as I was growing up, my father would put a quarter on the counter.

One for me, one for my brother every Monday.

with the rule that that has to go into your college fund.

Now you can do the math and even back then a quarter a week wasn't going to do it, but it was the principle of it and the suggestion of stick to it.

It's the same thing that you're mentioning with a five to nine and putting this amount in every month.

Look how it grows.

It just gets a young person into good lifelong patterns.

Yes, exactly.

I agree.

I mean, we

I talk to people all the time because I do financial literacy education who are in their late 50s, early 60s, and really coming to terms with the fact that they are either not going to be able to retire when they had always envisioned for themselves or that retirement's going to look nothing like what they had hoped.

And I think that building some of those habits early, we're talking about teenagers potentially putting in an IRA.

I mean, that could be the solution to that problem if they had just

been able to get an earlier start, not had to put so much of their own money in because they had time working in their favor instead of against them.

So that's the kind of messaging that we're trying to get out.

Now we've been focusing on parents and their educational role in all of this, but students need to take some responsibility on their own and they know their own comfort levels.

What can a young person who might come across this conversation, what are some things they can

do to start building the knowledge, the mindset, the skill set that will be helpful for their success.

Yeah, I think education is key.

Like I said, we have some of those free online financial literacy courses.

Those are good because they're not just for parents.

Those could be for the child as well where they don't have to get this messaging from mom and dad.

If they would rather go out and pursue that information and, you know, make their own decisions about how they want to handle their finances, that is going to really empower and enable them to be able to do that because they can get some of that.

non-biased financial education information without having to rely on mom and dad to give it to them if maybe it's not handled.

You know, sometimes it's not as well received, unfortunately.

When we as parents try to talk to our children, sometimes they would rather receive it through a different avenue, it seems.

So this gives them an option to be able to do that.

I don't have children but I used to teach college students and so I think I understand the whole point to each student in their own time and with the right messenger.

I also would really encourage students to find something that interests them to deal with personal finance and just

go on a deep dive, you know, go down the rabbit hole, try to learn as much as you can about that one thing.

Because I found for me that that oftentimes will spiderweb into many different interests and then all of a sudden you're like, well, what about that though?

But how does that work?

And you kind of all, you know, so much of this is interconnected.

It's very interesting to a lot of people.

I know it's not to everyone, but to just kind of dive in and start doing some research.

You mentioned the Smart Her program and website.

I'll ask you if you would please to repeat that in any other websites tied to the department that would be very helpful for folks.

That website is smartherher.iowa.gov and then we do have another program called Save for Later and that website is save the number for Later Iowa.

Heather

Kreener, Financial Literacy Director, Iowa Department of Insurance and Financial Services.

Great advice and insight on an important topic.

I appreciate the time today and we'll talk again soon.

Great, thank you so much.

This is where Iowa comes to talk.

News Talk 1540, KXEL.

And as KXEL Live and Local continues on this Friday morning, I'm joined via Zoom by two individuals to talk about Medicaid fraud and the best way to ferret out fraud and enforce the rules that are in place.

I'm joined by Kevin Tachau.

Mr. Tachau is a former U.S.

attorney for the Northern District of Iowa.

In addition, director of the Iowa Department of Inspections and Appeals for a period of time, as well as commissioner of the Iowa Department of Public Safety.

Mr. Tachau, good to talk to you again, sir.

Nice to talk with you.

And Dean Lerner is a former Iowa assistant attorney general, deputy director and director of the Iowa Department of Inspections and Appeals, and that included the state Medicaid fraud control unit.

Also worked within the US attorney's office.

Mr. Lerner, good to meet you.

Nice to meet you, Jeff.

Folks may have followed in the news the creation of a Medicaid fraud task force.

And I believe this was established by the governor who appointed the attorney general to chair it.

I believe they've had one meeting.

Mr. Tech, I'll help us first.

Let's just really roll it back for people.

They hear a lot of terms.

When we're talking about Medicaid, what is that and how does that fit within the state government system?

Well, Medicaid is a federal program that works with the state to provide primarily medical benefits to people that qualify financially.

And so it's got a pretty broad reach.

It touches a lot of people throughout the state.

And it's a very important program, and we want to make sure it's operating correctly, and we want to make sure that the dollars are used wisely, and we want to eliminate as much fraud as we can in the administration of the program.

Mr. Lerner, based on the bios that I just read, and they were very sketchy bios based upon each of your very long and illustrious careers,

We've been watching fraud with Medicaid for a period of time, right?

This is not something brand new, correct?

We've been watching fraud forever.

I was in office.

I don't even want to say how long ago.

I followed director tech out as the director of the Department of Inspections and Appeals.

And within it, of course, is the Medicaid fraud control unit.

And Kevin and I have long

had an interest in combating Medicaid fraud.

And in fact, when I worked for Kevin in the U.S.

Attorney's Office in the Northern District, we brought Medicaid fraud cases against

in particular a nursing home that I might like to speak about later on that was taking millions of dollars in Medicaid money to provide what was ultimately determined in a settlement woefully inadequate care and we sued to get some of that money back that the state and the federal government had spent on Medicaid in getting a very unsatisfactory product.

So, Mr. Tekau, we've got infrastructure for this, proven infrastructure.

Is there a need in your view for this separate task force?

Is this a level of oversight that is redundant, needed, or performative?

Well, what caught my attention and Dean's attention when we talked it over is there's no secret in where Iowa could do better in Medicaid fraud units.

felt that the calendar was ticking, you know, the campaign's coming up and it was more of a political tool at this point than really drilling down and doing what's necessary because it's no secret to what can happen and what should happen to improve the Medicaid fraud investigations in Iowa.

And let me say this, I mean, there's no criticism here for the frontline investigators and the prosecutors.

We have some very good, talented people.

And we have really good people in the partnerships in both the northern and southern district of Iowa that will take those cases.

And so if I can, I mean, I would just mention that what really got me interested in digging down deeper is every couple of years, the federal government, HHS, does an audit of each programs.

In the last two audits, 22 and 24, if you read that report, show that Iowa is understaffed.

And that when you compare, then you compare the number of staff in the Medicaid fraud unit compared to comparable states, Arkansas, Nebraska, Kansas that have a similar population and a similar Medicaid budget, we don't have as many people working on the issue.

And so that, and they reply back from the Reynolds administration was, don't worry about it, we got it, we're doing as much as we can.

And so when they,

create this task force it makes me wonder well why why are you ignoring the the bargain because three fourths of the dollars 75 cents at every dollar for those extra staff come from federal dollars and only 25 cents would come from the state and time has proven throughout Iowa across the country for every dollar spent on medicaid fraud some somewhere between four and five dollars comes back and so that was kind of a head scratcher and then when we listen to the first

press conference about the task force, it led us to believe it was more of a political sham than really interested in really drilling down and doing better.

There's a number of tools that can be used to more target Medicaid fraud.

When I ran the unit, had responsibility for oversight of the unit and Dean did, it was more of needle in the haystack.

One thing I learned at the U.S.

Attorney's Office, and we converted the position,

from a paralegal into an analytic advisor is because there's so many claims you can't go through them one-on-one but if you drill through the numbers you can look at patterns and you can detect things that may be fraud, red flags I'll call them and that really helps the investigator drill down and investigate and find where the where the fraud is and so when you look at those two things plus we wanted to look at the false claim act which was enacted in 2010

How is the Attorney General using that very strong prosecutorial tool?

And we found that that act actually requires the AG to file a report at the end of each fiscal year.

And the first report was filed.

It showed no action in false claims acts, and the other two were missing.

And what we've learned since we raised this issue, and a reporter Clark Hoffman dug in a little bit, those reports were only filed at the end of July after we raised this issue, and they showed no work on false claim acts.

So the task force is really only to stir up some attention and not really

any directed at really improving false claim investigation and recovering those dollars in Iowa in our estimation.

So we just wanted to call attention to it and ask the Attorney General and the Reynolds administration to explain why they haven't used these tools in the past and are kind of spinning their wheels on this task force.

Mr. Lerner, you folks held a news conference at the end of July raising these issues and asking the questions that Mr. Techow just pointed out.

Has there been any response from either those in the Reynolds administration directly in the capital or from the Attorney General's office in the Hoover building any response at all?

Well, I think I heard you say that there's only been one task force meeting.

Actually, they had a second task force meeting very recently.

The next one isn't scheduled till the end of September, we found out.

And from our

reading of the reporting on the first and the second task force meeting.

We haven't heard a single new thing.

that we didn't suggest in our opinion piece that we had published.

And so I think it is a political theater to get some attention to the issue, which I think Vice President J.D.

Vance is kind of heading up a national fraud effort.

But Iowa's efforts have been

with available tools disregarded, essentially.

I suggested a big focus on the Iowa False Claims Act, which for you, Jeff, if you want to take a peek at it, it's found at Iowa Code Chapter 685.

And if you look at Section 685.3, when you get a chance, it says, and I'll quote,

The Attorney General shall, and the word is shall, not should, or we advise, shall diligently investigate a violation under Section 685.2 if the Attorney General finds that a person is violated or is violating Section 685.2.

The Attorney General may bring a civil action under this section against the person.

And to my way of thinking,

thinking and I study nursing home issues every day of my life.

I'm still very active nationally in nursing home reform.

There are around 400 mostly for profit nursing homes in the state of Iowa and the profit taking from those facilities has been astronomical.

The staffing levels have been reported as grossly insufficient.

And when you combine a nursing home giving millions of dollars in funding from Medicaid taxpayer dollars with woefully inadequate care, that is a wide opening to an Iowa false.

Claims Act action.

And if you look at those reports that Kevin was referring to, you'll find that there has been little to none of that action where the Attorney General

is charged under law with pursuing it.

That's a wide open opportunity for a collection of a lot of Medicaid fraud dollars.

And you might ask, well, what's our suspicion as to why that nursing home litigation may have not been...

initiated and you might read reports about campaign contributions from the nursing home industry flowing to the governor's office and other

mostly leadership in the Republican Party.

So I'll leave it there and let you ask some more very penetrating questions, Jeff.

Well, you did, in fact, hear me say that the board had met once because that's the only one I was aware of, so I stand corrected.

There have been two meetings.

But to the point that you're making, and obviously, any time there is an industry, that is, shall we say,

under-regulated in terms of enforcement.

My antenna goes up in terms of, let's look at the financial contributions.

I mean, it has been this way across the board, unfortunately.

I mean, we see this an awful lot.

I want to make sure that I understand, and for the audience's benefit, Mr. Lerner, the Iowa False Claims Act, this sounds to me like exactly the sort of tool that a prosecutor would want.

because it allows you to go in for civil enforcement.

Very different standard of proof than a criminal prosecution, and especially when you're talking about businesses, the civil fraud is the way that you can hold them accountable, and it's not just limited to Medicaid, correct?

I mean, this is a broad act.

Am I missing what a wonderful bullet this would be in the chamber, if you will?

Well, I think you nailed it pretty well Other than the the nomenclature that you use was prosecuted I think of prosecution in terms of criminal but you did note that this was civil litigation and it is

specifically for the recovery of Medicaid dollars that were wasted, if you will.

And these for-profit nursing homes take a lot of money.

The staffing levels, as I noted, are inadequate.

And might I add, as sort of a tangential remark, our Attorney General Byrd was the leader.

of 18 or 19 other Republican attorneys general filing a lawsuit in the Northern District of Iowa that attacked the government's minimum staffing standards rule that would have, after it's been needed for decades, that would have imposed minimum staffing standards on nursing homes.

She wanted that gone and she and

the Republican Congress and president did away with the minimum staffing standards rule.

And Iowa is notable in a negative way to have low staffing levels in our nursing homes.

Mr. Tachau, based on past history, and if I recall the conversation, the Iowa False Claims Act is

about 15 years old, something like that.

Was it used by the prior attorney general to a much different level than what you have discussed here?

Unfortunately, I don't think it really was.

But we did use it quite extensively at the U.S.

Attorney's Office.

And so there's a similar false claim act at the federal level.

And so

Iowa has good partnerships.

I mean, one thing I've learned from my positions is, you know, law enforcement works well in Iowa, and that includes fraud investigators for civil enforcement as well.

And so we worked with the Mofuku, the Medicaid fraud unit, and got some really good cases from the state level that were prosecuted then at the federal level, and they do the same thing in the Southern District.

But if I could just sum up kind of what

Um, Dean has said, I mean, so, you know, Medicaid fraud isn't just about the money.

Um, you know, when taxpayers, um, pay for care and then the standards aren't upheld, um, that's another kind of fraud.

And so there can be two victims, you know, the taxpayer that's paying for the, for the service and then

uh the vulnerable island who doesn't get the care and so one of the odd other odd things about the fraud uh task force is that the Medicaid I mean Iowa private governor Branstad privatized uh the over the the administration of the program so you have these private Medicaid organization Medicare organizations um that that run the program provide the paperwork and they're included on the task force but our state auditor who's um actually audited the program was excluded so that

to me is another kind of flashing light about the sincerity of really digging down and finding ways to really improve the fraud investigations by the Mifuku and elsewhere in the state of Iowa.

We're speaking with Kevin Tachau and Dean Lerner, each of the gentlemen with great experience at state and federal level.

And the topic is the Medicaid task force that was established by the governor earlier this year.

They're kind enough to join us via Zoom on News Talk 1540, KXEL.

So Mr. Tekau, if the task force was not in existence, what should the state, quote unquote, and I've just made a very broad the state, be doing to adequately improve upon

holding the bad guys accountable, if you will, for this.

And I'm glad you both mentioned this is much more than just financial.

Yes, financial, we can document.

But when you start denying care to a loved one,

That absolutely adversely affects quality of life or life itself that that is an abhorrent level that you can't put a dollar amount on So we always tend to look at dollars just because that's scoreboard, but we don't want to lose the personal aspect I'm glad you mentioned that but mr. Tech I would forget the task force.

What should the state be doing?

Well, it's really there in flashing lights from the last two audits They should staff it at the full level

It's a bargain because 75% comes from the federal government only 25% from the state and Experience shows the return is four to five dollars for every dollar spent.

So I would assert, you know, we could go through it But you know, there's hundreds of thousands if not millions of dollars that have been left on the table because they didn't fully staff it and the other thing that I'm not sure of is are they fully using analytics Analytics can show where there's been double billing

Maybe there was just a mistake.

That's a red flag.

Maybe the example I like to use is, you know, you can't pull the same tooth twice.

And so there are cases where those claims come in.

Maybe it was fraud.

Maybe it was just a bad billing practice, but that gives the investigator something to drill down on and really look at.

And, you know, there's only 24 hours in a day.

Sometimes you'll see

claims that really show a medical care that was over 24 hours in one day.

Again, a red flag gives the investigator, it's a quick way to get to the bottom of it.

Maybe it was just a billionaire, but so the analytics has really improved the ability of fraud investigators to where to go fishing.

I mean, that's the analytics really shows them where they can best spend their time rather than having to go through.

you know, the prior way.

And the other thing that's really missing and that we really emphasized back in my time was a hotline that was easy to use.

I went looking for it.

Maybe I missed it, but it's very hard to find.

We partnered even with high V. We put the number on garsi sacks.

We handed out whistles to blow the whistle on fraud.

I mean, just to elevate the

the public's knowledge that, hey, we're interested in this, and if you have a tip for us, let us know.

That is something that's been mentioned in this task force, but it's really absent from my review of how it's being used currently.

Well, and again, in essence, it's reinventing the wheel because it had been done and done successfully previously.

And Mr. Lerner a moment ago in the question, I said, forget about the task force.

That sounded rather dismissive because the

performative nature, perhaps the task force is diverting people's attention.

I was trying to say absent the issue of the task force, what should be done.

Add to what Mr. Techhouse said, if you would, if you were in a position of consultation or authority on this issue, in addition to what he just mentioned, what should be done?

Well, not to reiterate and rehash the subject of utilization of the False Claims Act, but that's such a big ticket item.

You can't hardly go by a day where some terrible story about a horrible treatment in a nursing home has occurred in our state.

And we're over

institutionalized in our nursing homes.

I would have preferred that we divert dollars to home and community-based services instead of institutional care, which is cheaper and is exactly what people who are getting elderly want.

They want to stay in their homes and communities with appropriate supports and services for as long as they are able to, and our leaders

have instead chosen to continue this institutional care in a disproportionate number of nursing homes in our state.

There's one other thing that's been a heartburn of mine forever, and I hope you will look into this and talk about it more.

It ties into waste, fraud, and abuse of Medicaid dollars, and that is that, and this is a little known subject,

but the nursing home associations that represent the interests of nursing homes, they want less staff having to have less staff, they want less oversight, they want more money.

That's the goals of the associations.

Guess who is funding in large measure the

association and I'll specify the Iowa Health Care Association.

Just take a guess who that might be.

I have a feeling it's the same people who benefit from the current system.

It's taxpayer dollars that are funding Medicaid taxpayer dollars that are funding the Iowa Health Care Association and let me give you another Factoid if you look at their form 990 not-for-profit tax return you will see that they're the head their chief officer Is with salary and benefits earning

in excess of $850,000.

The organization itself is receiving about $2.6 million a year in membership dues and the nursing homes put membership dues on their cost reports and they get reimbursed for it by Medicaid dollars.

The government relations person in the most recent form 990 was around half a million dollars in salary and benefits.

And don't you think that that is just a prime example of waste, fraud and abuse of our government resources?

Well, you've got two individuals and the salary alone is close to a million and a half.

And I know what a lot of the people listening to this conversation bring in.

and declare on their taxes.

So they probably are like-minded with your comments.

So my question, I guess, in light of that, Mr. Techow, the privatization, is that where everything, and I'm probably mischaracterizing it, is that where everything went wrong?

Is that where everything went off the rails?

I don't think entirely.

I mean, and I'm not an expert on the privatization.

I know there are problems.

I've heard the complaints.

There was fraud before, and there's fraud now.

And so what we've really zeroed in on for this, and I think it's a fair discussion whether the privatization has really served Iowa's needs well and the tax dollars have been spent.

But within that framework,

there's been fraud before and there's fraud now.

And so what we're talking about, there wasn't a need for a task force.

I mean, fighting fraud is absolutely the right goal.

So we didn't need a task force to come up with the solutions.

We just needed to look at the tools that we had, listen to the audit and fully staff those departments and make better use of analytics, make better use of a hotline, and let's get to work.

This may be unfair, I'll ask anyway.

Mr. Teco, is this more an issue of let's make it look like we're doing something until we get past the election and then we'll worry about it?

In other words, it seems to be trendy to use the phrase waste, fraud and abuse.

As each of you gentlemen have noted and throughout your careers, you have worked on ferreting that out, but it's now a brand name, right?

Everybody talks about waste, fraud and abuse.

Is this just the latest example?

not political, I'm not limiting it to one political side or another, but another example of, well, here we go, governments wave in its arms saying it's going to do something and we'll just kind of let it die in the vine until we get past the next election.

Well, I think you're right.

It's a buzzword that catches people's attention.

I mean, no one wants fraud in government.

Unfortunately, there's been some bad examples around the country that's really magnified some of the problems.

I don't believe those problems are in Iowa, but with any program, there's going to be some fraud.

So time will tell how sincere they are in fighting this issue on another day.

Our concern was,

it seemed more theater at this point and you know trying to jump up and down and say we're going to do something about it when really the the the methodology the tools were there right in front of us and they've been ignored for quite a while in the state of Iowa when when the state stiffed armed the federal government to say hey we'd like to

I have you staff up a little bit and we're going to pay 75% of that and they said, no, we've got this.

And so I think that's a big inconsistency in the Reynolds administration's posture on this.

I don't criticize the frontline workers.

I know they would appreciate the additional help because they work hard.

I don't really know why the Reynolds administration stiff armed it, but they did.

And I think the Attorney General has just kind of carried on that attitude and we need to.

I'm trying to light on it and have a fair discussion.

I'd like to have her answer these questions fairly.

Maybe we've missed something that was going on that we just didn't know about.

And if I might add, they kind of stiffed arm to there and then they kind of ignored opportunities where perhaps their interests.

with the nursing home industry are more aligned, forgot about getting those dollars back that were wasted on terrible, horrible care, much less the victims of that neglect.

The Attorney General does join us on this program once a month, and I have made a note to bring this up in the September conversation.

Dean Lerner, Kevin Tecow, thank you so much for the extended conversation and shining a light on the issue.

To be continued, gentlemen, I appreciate it.

Yeah, thank you very much.

Appreciate the opportunity to speak with you, Jeff.

Thank you, Jeff.

Appreciate

it.

Nice

to meet you.

Good to meet you, sir.

And again, the gentleman joined us via Zoom on News Talk 1540 KXEL, where Iowa comes to talk.

And as KXEL Live and Local continues in this 8 o'clock hour on a Friday, time for our monthly conversation with the auditor of the state of Iowa, the Honorable Rob Sand.

He is kind enough to join us on a monthly basis, as do many of the state office holders.

Auditor Sand, thanks so much for taking the time, sir.

You bet.

Happy to be here, Jeff.

Again, Mr. Sand is joining us as the auditor.

We have other opportunities to speak with him in his role as a candidate for governor.

Today we're sticking with the day job.

I'd like to make that clear to the audience.

Your office issues a number of audits and reports and I recall a couple of years ago we spoke about a report the auditor's office released on nursing home inspections and staffing and it was not terribly

Promising there were some problems.

My understanding is things have improved in a few years.

That's right Jeff.

We go off of the most recently released federal data for this and back in 2024 we were not meeting the federal mandate for nursing home inspections.

They weren't happening frequently enough.

Oftentimes there was much too much space in between the same home getting inspected twice.

But they have improved that, so that is good news.

They're now doing inspections on average every 12 months.

Back in 2024, those federal figures were showing it was every 17 months.

That's a good improvement.

It's worth noting that we're still about 3%, a little under 3% of them did not meet the expectation for individual nursing home inspections for how often those inspections are repeated.

That's a really big improvement from where it had been.

What might this be attributed to?

Is it to some degree sunshine being a good disinfectant or what do you think based upon the information

you

have?

Sunshine always is a good disinfectant, but they also actually added people to doing this work.

I'm sure you'll be shocked to hear, Jeff, that when you have more people

available to do nursing home inspections, they happen more often.

So that's a place where making the investment makes a difference.

They increase staff available to do this work and so these inspections are having much more in line with what the expectation is.

Was there a reason why staffing was lower than perhaps was optimal?

Was it budget?

Was it inability to find qualified people or what?

I can't answer that question specifically for nursing home expectors.

I certainly can say that I do think that there's been struggle.

Obviously, there's a workforce crisis in Iowa in general.

Many jobs need people.

We need to have more folks in Iowa to do the work that needs to get done here.

But I think it's important to keep in mind too, you know, we want to have people working for the taxpayers in the state of Iowa when there's important work to be done.

And so a mindset of always cutting government, no matter what, well, at a certain point, you cut so much that you're not getting inspections done and that's when problems begin to pile up because you do need those inspections and you do need that expectation that someone's going to be looking to help all of us follow the rules we know we're supposed to follow anyway.

How does Iowa, and this may be beyond the scope of the report, so forgive me if it's an unfair question, how does Iowa rank then versus similarly situated states with these sorts of results, with the CMS expectations, et cetera?

So we're certainly, again, we're meeting the expectation for investigations, inspections, excuse me.

Part of the trouble that we have still is the amount of nursing staff that we have per residence in nursing home.

We are 47th nationally.

So we could certainly use more licensed nursing staff per nursing home resident.

That makes a difference.

You want to have a little bit more time per day, just one-on-one.

But again, we're struggling to have enough people here in the state of Iowa.

So we would be better off if we had a few more.

So in that situation, and this is, I'm going to lump it in with the rural health care issues.

It is hard to get qualified people to work in the broadly written health care system or industry because of a variety of factors, namely the bodies just aren't in the state.

Correct.

That's certainly a piece of it.

Rob Sand is the state auditor.

He joins us on a monthly basis here on news talk 1540 kxl Well speaking of staffing shortages again something that we have discussed before CPAs Auditors folks who are competent and qualified to do this kind of work They're hard to find especially for those in rural areas that actually led your office to be involved with the city of Moville to help them get caught up and

to help them through no fault of their own to help them be accountable.

That's right.

So this has been a national issue for years.

Plenty of news articles to read if you search for accountant shortage.

It's an issue all across America.

So Movil asked us to complete a couple of their audits because the CPA firm that they had originally hired to do it, failed to do it.

So they had waited quite some time.

It was quite overdue.

Went back to fiscal year 2022.

And they just said, hey, the CPA firm hasn't done this work.

We are hoping you guys can get it done.

So as we do, we are doing public service work here, stepped in, got that taken care of as well as the fiscal year 2023.

as well as the fiscal year 24 and 25.

Just want to make sure that we get that work done.

So if the private sector is failing, we don't like it, but we certainly can step in to try to fill the gap where needed.

Because realistically, the city is to hire someone privately to do it.

And then, in essence, your office is there as necessary if something doesn't look right.

on that audit or if the local people have concerns, correct?

I mean, the first resort is not the auditor's office, in other words.

That's right.

I mean, if they hire us, then we're the first resort, but if they don't, then we aren't.

But, you know, data shows there's about 20,000 fewer licensed accountants in 2025 compared to just 2024 nationally.

And the number of people completing an accounting degree also has gone down 30% in the last decade.

So this is something we've been working on.

We tried to address this back in 2022.

And we did it to some degree by expanding eligibility for jobs as auditors with our office.

We decided to start accepting people who had an associate's degree, a two-year degree in accounting rather than just forcing them to have that four-year degree.

And that helps a little bit.

We'd also love to see some tax incentives so that CPA firms can pay a lower tax rate or audits they do of government entities as opposed to the private sector entities, and that would help more of them be willing to do that work.

It seems like, and I have not studied the data too closely, but I often hear about job opportunities for those in the skilled trades,

as being places where young people might decide to get training and have a good career.

I don't often hear about it with regard to accountants and auditors, but it sure seems, based on the numbers, that this is an opportunity, not necessarily that it itself is a growth industry, but so many are leaving through retirement, etc.

There could be jobs for people who are so inclined.

Absolutely.

Look if you want to have a

study job for a very long time if you get into accounting right now.

Certainly AI is going to be changing things in every sector, but for a very long time I think that it's going to be a co-pilot for people who are already there and there's certainly work to be done.

Rob Sand is the auditor of the state of Iowa.

He joins us on a monthly basis here on News Talk 1540 KXEL.

More online about the taxpayers watchdog at auditor.iowa.gov that's auditor.iowa.gov and you can read the audits reports etc that are released right there and I noticed over the course of the summer your office had as part of its normal practice released reports or recommendations

on a variety of things, including the Regents institutions and because those are high-profile entities that are held by governments, supported by taxpayers, what are some of the headlines from the audits or the reports on our three educational institutions, four-year educational institutions within the Board of Regents?

Sure.

We released this just a couple days ago.

We are reported recommendations for the three things looked pretty good.

No findings that we needed to bring to anyone's attention in the report and recommendations.

And so while we audited all three of those entities found no issues that we needed to have the state address this time around.

That's obviously encouraging for someone listening who cares about how their tax dollars are spent or cares about good government or good governance.

I'm wondering if this has been the situation consistently during your terms of office.

In other words, have there been things you've flagged in the past that then they've corrected or have these been institutions that have pretty generally gotten no pun intended good report cards from you?

One of the real struggles for smaller towns is having enough people around and enough professionals around in auditing to get everything done and to get it done the right way.

Our regents institutions are big enough to do that.

They've got those specialties and so typically speaking they're doing a pretty good job.

We've had issues in the past.

Obviously, there was an individual who worked in the machine shop at the University of Iowa.

We stole hundreds of thousands of dollars there.

You can go back to my first term.

They deal to sell the utilities plant at the University of Iowa.

It was a fight that we took all the way to the Iowa Supreme Court where we won.

And so we've had a lot of situations where we've had work to do, but this time around, clean bill of health.

Remind people who may not be aware or have not remembered our past conversations.

You do audits as part of your regular course of business.

You do audits when requested and there are also some agreed upon recommendation reports.

Differentiate what those are so that when people see the headline or they see the news release, they can put it in proper context, please.

Sure.

You know, special investigation means that

There was some particular need that we needed to come in and do a special.

That means typically that there's something going wrong and somebody asked us to look into it.

Our annual audits are okay, we come in every year.

We got to take a look and so we don't necessarily have anything specifically that we want to be looking at.

We're just doing our annual audit where you check different places to see what's going on.

And then for smaller cities

We oftentimes also have the periodic exams.

Those are for smaller cities.

They don't do an annual audit when they're small enough.

Instead, they get an exam, not a full blown on it, but an exam every few years.

This question is going to sound political and I don't mean it to.

But you have held this office now for two terms.

You are leaving it to pursue another elective office.

What advice would you have for whoever holds the position in the future in terms of office operation, in terms of function, regulations, et cetera?

If this were like the presidency and you wrote a little note and left it in the desk in the Oval Office for your successor, what are a few things that might be on that?

Here's one to lead with.

I'm a big believer that when people who think differently from each other,

think together that we tend to get better outcomes than when everybody thinks the same way.

So I appointed an independent and a Republican who had made campaign contributions to my opponent for the most senior positions in the office in 2019.

I think that's the way you're supposed to do it.

And when you're willing to look at things from different angles and being willing to be challenged, you're in a much better place in terms of your ability to make good decisions.

Sound advice to start with.

Bring people together and have a good conversation.

Rob Sand is the auditor of the state of Iowa and again the website for the office is auditor.iowa.gov and if you're interested in his other political efforts, robsand.com that also includes where his town hall meetings will be held.

You have done 100 town hall meetings as auditor every year as I recall.

And

he

shifted the focus this year and said so that nobody thinks I'm trying to campaign on the public dime.

We're just going to have the same town meetings, but we're going to have the campaign run it so nobody can can suggest that there's anything nefarious going on.

So if they have questions about your current office or what you want to do in the future, I trust the town hall is the place to air those.

You bet.

All right.

Auditor Rob Sand, thanks for the time.

We'll talk again next month, if not before.

Thanks Jeff.

Appreciate you having me.

Auditor Rob San joins us on a monthly basis on News Talk 1540 KXEL, where Iowa comes to talk.