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Government pays millions for neglected native health care
Anchorage Daily News


December 19, 2007
Wednesday AM

ANCHORAGE, Alaska -- For 13 years, villages in the Yukon-Kuskokwim Delta didn't get the money they were due from the federal government to cover health care costs.

Now the U.S. Indian Health Service is paying the bill: $25 million, plus interest, which could amount to a total of more than $48 million.

It's believed to be the largest judgment ever against the Indian Health Service, according to Lloyd Miller, an Anchorage attorney who has filed claims on behalf of tribal organizations against IHS.

Efforts to speak to IHS officials about the settlement were unsuccessful Monday. The Alaska area office referred questions to headquarters in Rockville, Md., where officials weren't able to respond late in the day.

The huge funding shortfall for health care has hurt the Y-K Delta region, where people suffer high rates of cancer, heart disease, diabetes, suicide and unintentional injury, often related to drinking, said Dan Winkelman, Yukon-Kuskokwim Health Corp. vice president and general counsel.

YKHC runs a hospital in Bethel, 45 village-based clinics and four bigger clinics. It serves an area stretching across 75,000 square miles of tundra that is home to 30,000 people. Providing health care in the region is very expensive, Miller said.

Lawyers for YKHC said they couldn't discuss the specifics of the mediation. The corporation had filed claims for millions more, but the decision clearly went their way.

"That's why we are so happy," Winkelman said.

YKHC hasn't yet decided how to spend the money. Its board meets Wednesday and will consider the corporation's finances and pressing health needs as it develops a plan, he said.

The Indian Health Service for decades has paid Indian tribes and Alaska Native groups to provide health services on behalf of the federal government.

According to Miller, IHS has shortchanged the contracts since the 1990s. Congress didn't appropriate enough money, but the agency's responsibility to honor contracts didn't go away, Miller said.

The battle wasn't over money for doctors and nurses, but rather about how much the government owes tribal health agencies for heating bills, personnel costs and administrative overhead. Ultimately, the health care is affected, Miller said.

With relatively flat revenue streams and rising health care costs, YKHC has repeatedly had to lay off or cut back its staff, including two "reductions in force" just this year, Winkelman said.

In 1996, YKHC filed the first of five claims, demanding to be paid in full under various contracts, funding agreements and compacts. IHS didn't pay the claims. In August 2006, YKHC filed its appeal.

The settlement was approved last week by the U.S. Civilian Board of Contract Appeals. Interest on the amount is calculated from May 23, 1996, as agreed to by both sides.

Miller said the real solution to the problem is for Congress to put more money into the Indian Health Service.

The issue has the attention of U.S. Sen. Lisa Murkowski, R-Alaska. She's the ranking Republican on the Senate Indian Affairs Committee, which is considering oversight hearings on the matter.

"Sen. Murkowski has long believed the IHS budget has insufficient funds for contract support costs," said her press secretary, Kevin Sweeney.

About two dozen other cases are pending against the Indian Health Service, most of them before the appeals board and some in federal court. Hundreds of other claims haven't yet reached the point of a formal appeal, according to Miller.

Many of the cases come from Alaska, where Native organizations have been providing health care for years.

Lisa Demer can be reached online at










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