The email message is short but to the point.
“This matter is still ongoing. I’ll reach out to you if we need additional information necessary to advance this case,” Special Agent Ike Abanobi, from the Office of Inspector General with the U.S Department of Health and Human Services, wrote back to James Fleming in mid-December. Abanobi is part of an operation overseeing the HHS’s portfolio of programs.
The matter in question here is Fleming accusing his former employer, the Community Health Alliance, a Federally Qualified Health Center catering to lower income populations in northern Nevada, of not adequately spending $455,059 of recent grant money earmarked for COVID testing.
The Health Resources and Services Administration grant for the March 2020 to March 2021 period came with stipulations to “purchase, administer, and expand capacity for testing to monitor and suppress COVID-19.”
But documents on CHA spending that grant money obtained by Fleming through the Freedom of Information Act (including below) have no checks in the testing category. There are marks for staff and patient safety, including the purchase of dental suction systems and blood pressure cuffs, maintaining health center capacity and staffing, including upgrades to its telephone system and replacing flooring in a mobile medical unit, and expanding Telehealth capabilities, but in the delineated testing category, there are no indications of any activity.
Fleming says CHA staff could have put efforts into reaching out to the unsheltered and lower income immunosuppressed in the community, and find a way to actually protect them with testing.
Fleming says he’s looking forward to what the investigation comes up with. “They're experts and they have a very large budget and I'm looking into other fraud cases, you know, around the country that they've looked into because they publish what they've done and what they've caught people doing. And that gives me a lot of confidence,” he told Our Town Reno during a recent interview at the downtown library.
Misspending the grant money is just one accusation he makes, as he also alleges other manipulations, including increasing the number of unhoused and agricultural migrant workers the CHA serves to get access to more funding, using Telehealth as a means to make more money, being way overstaffed with over a dozen employees for the results he saw accomplished for the CHA’s WIC outreach program and losing his job for reporting internally on activities he believes were wrong. WIC is the government program which offers free nutritious foods, health and social services referrals, breastfeeding support and nutrition education for women, infants and children.
Fleming says one recent goal seems to have been to repurpose money that doesn’t actually help the community, but helps the CHA itself. “Imagine like water going into a giant pool,” Fleming said as a way of explaining this. “Like if you had water in a pitcher that was just meant to water the garden, but instead you just poured it into the pool. You can't really see where the flower watering money went.”
He also describes 2020 as a perfect storm of fewer services and more federal money. “We were closing facilities for many months the dental program, the homeless facility shut down. So a lot less services, but more money coming in because you not only do the regular yearly grants and contracts keep coming in, but the Cares Act emergency funding and the paycheck protection plan money is coming in at the same time.”
Fleming says more staff were hired, such as a chief legal officer. Fleming has been trying to organize a meeting with Casey Gillham, listed on the CHA website as the Chief Administrative Officer, and while that seemed like a possibility at first, his recent Medium posts, where he accuses CHA of fraud, seem to have put that type of meeting off the table.
Fleming recently pointed Our Town Reno to documents (including above) indicating salaries have gone up recently, such as for CHA’s CEO Oscar Delgado, who was listed as making $180,000 in the position in 2019, raised to $199,166 in 2020. The previous CEO Charles Duarte was listed as making $146,264 in 2018. Fleming sees this as a disturbing overall trend of money not being used to help those most in need.
Fleming also posts his stories on Facebook, often tagging city council members including Delgado. He’s also sent versions to the Reno Gazette-Journal as letters to the editor.
While he used to be able to tag Delgado, that option was removed in late 2021. “I think it tells me that he's at least noticed a little bit or somebody has told him, ‘hey, some guy's airing out dirty laundry.’”
Our Town Reno reached out to several employees at CHA including Delgado for a response before the Christmas holiday season. Megan Duggan, the Director of Community Relations for CHA, emailed a detailed response this week with Gillham cced.
In terms of the grant for testing and Fleming’s allegations of misuse, Duggan wrote: “This belies a misunderstanding of the HRSA grant process. First, CHA had to apply for the grant. As part of that process, CHA is required to inform HRSA what it expects to spend the funding on. HRSA reviews the application and makes a determination as to whether to award the funds. Second, CHA has to provide quarterly updates and documentation to HRSA on what the funding has been spent on. At any time, if HRSA does not believe the purchases are within the scope of the award, it can prohibit the Health Center from drawing down additional funds. CHA was awarded the funding and never received any indication from HRSA that CHA somehow used this funding inappropriately.”
She also addressed his allegations of how people are categorized when being helped. “Mr. Fleming has also alleged that CHA has inflated the number of homeless people it serves in exchange for some financial benefit,” she wrote. “This is simply not true… In 2018, CHA reported serving 2,250 homeless patients. In 2019, CHA reported serving 2,257 patients, which is seven more patients than 2018. In 2020, CHA reported seeing 881 homeless patients. First, CHA does not receive some type of “yearly bonus” based on the specific number of homeless individuals that we serve. To that point, there is no incentive to inflate that number. Second, if CHA’s intention was to inflate the number of homeless people it served, why would we have reported a nearly 150 percent decrease in 2020?”
In terms of WIC she noted in part: “The National WIC Association reported that since 2017, WIC clinics across the country have reported a heightened level of fear among immigrant and mixed-status families participating in WIC services, prompting eligible families to refuse access to vital nutrition and breastfeeding support. Due to this fear, families have sought to withdraw from WIC services over the years. Hence, the decline in our numbers, though, we continue to be optimistic and ensure the protection of patient information, including one’s immigration or citizenship status. To emphasize, WIC funds are used for WIC services only. In August 2020, the State of Nevada performed an audit to ensure that expenses charged to the WIC program were in accordance with established cost principles in 7 CFR 246 and 7 CFR 3016. The audit stated that ‘[n]o findings were noted.’”
Also included in the email was explaining in person outreach and assistance for unhoused communities: “With regard to the homeless healthcare services CHA provides, we continue to provide free health services (primary care, dental, behavioral health and pharmacy) to the homeless population at our six other health centers in Reno and Sparks,” Duggan wrote. “Additionally, CHA provides medical services on-site through our Mobile Medical Center at OUR Place weekly. Our dental team also regularly visits OUR Place to provide dental screenings and fluoride treatments to pediatric patients. If restorative care is needed, our team follows up to ensure they have access to transportation and can receive the necessary care at our Wells Ave. Health Center. Up until approximately three weeks ago, CHA had an employee serving as a homeless outreach specialist, who would routinely visit homeless camps in attempt to arrange for individuals to receive services. The individual who was serving in that role resigned to take a position with the County.”
There was an article published by This is Reno in November which had back and forth as well between Fleming and Duggan over how the unhoused are counted. Fleming says he was happy with that article as ultimately he says he wants more discussion, openness and transparency in how the CHA operates and funds different programs.
Fleming says he worked for CHA from October 2017 through February 2021 as a “statistician.” We weren’t able to confirm the exact dates of his employment, but he says he started doing data extractions related to dental services CHA provides, and then he says when he did his job well he became “the data guy for everything.”
“I’d be reporting to the federal program that fund CHA and also for internal internal requests, like where are our patients? Where do they live? Where's a good place to build a new clinic? Do we have people coming from Sun Valley enough that it's worth it to open up a clinic there, those kind of metrics,” he explained. “And, also like is the dental department charging out enough services and receiving enough from Medicaid to justify having a dental department, you know, internal questions like that.”
In February 2021, though, he says that after complaining to high level staff that CHA was “turning in false data,” publicly available data he says which did not reflect his own work, and then later that he was filing his complaints to federal authorities, he says he was let go from his job.
He admits part of his current pursuit is “vindictiveness” but that he also wants to do good for the community and CHA in the long run. He says he was complimented for how he was doing his job initially and feels he was then doing what he was supposed to do. “Like if you see something, say something,” he said. He says he loves the idea behind the Community Health Alliance and just wants to make sure it uses the money it gets wisely to help the people who need it the most.
CHA’s Duggan concluded her email saying: “CHA prides itself on serving the most vulnerable in our community. It is unfortunate that Mr. Fleming has resorted to wild, outlandish, and false allegations.”
Our Town Reno Reporting, January 2022