I am writing today to announce the closure of the New Mexico Independent. After three and a half years of operation in New Mexico, the board of the American Independent News Network, has decided to shift publication of its news…
While environmental activists played their part yesterday during demonstrations at the capitol building, going so far as to dress up as solar panels and to sing the tune of “You Are My Sunshine,” their counterparts, the anti-cap-and-trade contingency who has…
Roughly one quarter of University of New Mexico students are unimpressed with the state’s flagship public school, according to a survey that questioned college students about their higher education experiences.
Incumbent Gary King appears to have prevailed over Republican challenger and Clovis District Attorney Matt Chandler after a heated race for the New Mexico attorney general’s office.
Secretary of State Mary Herrera’s decision to add a space to November ballots for a write-in candidate for governor was legal, Assistant Attorney General Tania Maestas wrote Thursday in letters to Herrera and state Sen. Howie C. Morales, D-Silver City.…
Blue Cross and Blue Shield of New Mexico attorney Paul Bardacke spent much of his time at last week’s Division of Insurance hearing on his client’s latest health insurance rate hike attacking Allan Schwartz, the Attorney General’s office’s independent expert who testified…
A contentious all-day hearing Wednesday left many Blue Cross and Blue Shield of New Mexico customers saying they see little hope for relief from a controversial 21.3 percent increase in their health insurance premiums. Even though the company’s cash reserves have now reached $7.2 billion, an expert witness for the Attorney General’s office’s, who reiterated earlier testimony that Blue Cross had not sufficiently documented its claimed cost figures, and whose analysis found the insurer’s rate filing had exaggerated company losses, said the 21 percent increase was “reasonable, given the circumstances.”
Along with e-mails supposedly from wealthy but financially inept Nigerian royalty, a leading form of financial scam targeting New Mexican consumers involves mailed counterfeit checks that arrive with instructions to cash the checks and wire proceeds to an out-of-state corporation…
A class-action suit against WellCare Health Plans has been settled for $200 million, Attorney General Gary King’s office announced Monday. The State Investment Council (SIC) and Public Employees Retirement Association of New Mexico (PERA) were plaintiffs…
The Public Regulation Commission (PRC) will refer allegations of perjury and witness intimidation against Picacho Hills Utility Company owner and real estate developer Stephen Blanco to the Attorney General’s office, according to PRC records and commissioners. The findings, which the PRC will vote to refer to the attorney general’s office by Aug. 12, resulted from an agency review of Blanco’s company.
A nuclear waste watchdog group says the state hasn’t done enough to make sure radioactive and toxic waste isn’t leaking from Sandia National Labs’ mixed waste landfill. Rebuffed by regional EPA officials, Citizen Action New Mexico now wants agency brass in Washington, D.C. and New Mexico Attorney General Gary King’s office to review the state Environment Department’s regulation of the site.
Raton flower shops are the latest victims of a Nigerian phone scam, the New Mexico Attorney General’s office announced Tuesday.
Instead of using e-mail to contact their victims, the culprits are using Text Telephone (TTY) lines, a phone system for the hearing-impaired. They placed large orders and request to “over-pay” the shops so money can be wired via Western Union money transfers to the shipper, according to AG spokesman Phil Sisneros. More …
The Attorney General’s office cannot say whether or not it received all of the financial records it demanded from Blue Cross Blue Shield of New Mexico before signing off on a controversial April 26 rate hike settlement, according to spokesman Phillip Sisneros.
The company did not disclose financial records to the PRC Insurance Division supporting figures in its rate hike application, The Independent reported. More …
A veterans charity under investigation by the New Mexico Attorney General’s office for falsified registration forms is at the center of an emerging political scandal in Virginia.
Virginia’s Republican governor and several state lawmakers received campaign contributions from…
The U.S. must do more to help fund law enforcement efforts on both sides of the U.S./Mexico border, New Mexico Attorney General Gary King told the U.S. Senate Judiciary Committee‘s subcommittee on human rights this morning.
King urged…
A Doña Ana County long-term care company and three individuals have been indicted on 26 felony Medicaid fraud charges, Attorney General Gary King’s Medicaid Fraud and Elder Abuse Division (MFEAD) announced Wednesday.
New Mexico’s Tea Parties are planning to present Attorney General Gary King with a petition to join other states’ lawsuits against the federal government to reverse health care reform. But the tide seems to be turning against support for such a move, if letters to the AG website are any indication. After an initial flood of often vitriolic comments demanding New Mexico sue the federal government to halt health reform, mid-April brought a majority of letters opposed to such a suit, The Independent has found.
Roughly 40,000 New Mexicans will watch their health care premiums rise by an average of 21 percent after the state struck a weekend deal with Blue Cross Blue Shield New Mexico.
The agreement may be a done deal after Monday, but how it came about had one member of the state Public Regulation Commission howling mad and at least one state lawmaker calling for legislation to overhaul the state’s rate-setting process.
“This should have been deliberated in public,” PRC member Jason Marks said of the rate hike.
PRC commissioners ordered state Insurance Superintendent Morris Chavez last month to hold Monday’s public hearing on Blue Cross Blue Shield’s request to raise rates 24.6 percent, something that insurance Division staff had approved originally in February.
“Instead, we got a backroom deal,” Marks said. “It could be an appropriate, reasonable deal, but I do know I had a lot of questions that haven’t been answered.”
The settlement was negotiated over the weekend by the Insurance Division, state Attorney General’s office and Blue Cross Blue Shield New Mexico, a Division of Health Care Service Corporation.
The rate hike will affect approximately 40,000 policyholders, and will be retroactive, taking effect April 1. The rate increase will affect several individual market health plans offered by the company. Employer-based health plans will not be affected.
News of the agreement surprised and, in certain cases, infuriated some of the more than 50 people that had packed the Public Regulation Commission hearing room in Santa Fe for what had been billed as a public hearing about the company’s request to raise its health insurance premiums. At least eight armed state police officers were on hand Monday, highlighting the tension.
The surprise agreement also led to predictions that the Legislature would tackle how the State Insurance Office sets rates in next year’s 60-day legislative session.
“I think the result of this will be legislation to change rate setting,” Sen. Dede Feldman, D-Albuquerque, told The Independent on Monday afternoon. “I don’t think anyone was happy with this ruling. And I’m hoping for the cooperation of the insurance commissioner and the AG.”
Several attendees of Monday’s meeting, meanwhile, said they were disappointed to learn that the agreement had been forged prior to Monday’s scheduled hearing, especially after some had taken time off from work.
“I came here thinking we’re going to make a difference,” Dr. Christopher Fletcher, a Santa Fe Blue Cross provider, said. “Instead, this was done behind our backs. I don’t care if it was the front room, the back room, or the bathroom.”
How the agreement was struck
State Insurance Commissioner Morris Chavez appeared to take umbrage at the implication that the state or his staff had done something improper in forging the agreement.
“You’ve made some very serious allegations about a backroom deal,” Chavez said to Marks in a moment particularly fraught with tension. “I don’t think it was a backroom deal. To make a statement that the Attorney General of New Mexico made a backroom deal is mind-blowing.”
Chavez told the PRC that the agreement came out of a fear that Blue Cross Blue Shield might pull out of providing health insurance in rural areas around New Mexico. Blue Cross Blue Shield insures up to 70 percent of rural New Mexicans who buy their own insurance, according to Chavez.
“Of concern was they’d potentially be pulling out of the (rural New Mexico) market,” Chavez told the PRC.
The deal struck over the weekend has Blue Cross Blue Shield NM agreeing to continue to sell insurance in rural New Mexico and to do a better job of informing consumers about changes in their coverage, and to provide 60 days’ advanced notice for future rate hikes, Chavez said.
Chavez also pledged to post proposed rate hikes on the Insurance Division website in the future.
Insurance Superintendent’s responsibilities a concern
Chavez said Monday in explaining this weekend’s agreement that he is required by state law to consider the “solvency” or economic well-being of regulated corporations, and Blue Cross Blue Shield NM reports that it is losing money.
That didn’t sit well with Feldman, the Albuquerque state senator.
“They say they were forced to rule on very narrow grounds,” Feldman said. “We need to make sure the public is protected as well as the insurance companies.”
Also of concern to Marks was the insurer’s “medical loss ratio” — or how much of revenue is spent on medical care — of 66 percent.
“I wonder (about) the loss ratio in the 60 to 66 percent range,” Marks said. “We as a state just passed a law saying the minimum loss ratio should be at least 75 percent. We could ask why 33 percent on overhead and administrative compensation is reasonable, and why they’re sitting on more than $6 billion in reserves. …I would have liked to have heard these questions addressed in a public process.”
Marks was referring to a new law that limits how much an insurance company can spend on administrative costs.
Blue Cross Blue Shield NM owner HCSC is a mutual insurance company, owned by its customers; profits must be reinvested in the business or given to customers. But HCSC’s chief executive officer was paid $10.6 million in salary and bonuses in 2008, according to Consumers Union attorney Sondra Roberto, who had urged Chavez to reverse the rate increase.
“They have a lot of money,” Fletcher, the doctor and Blue Cross Blue Shield provider, told The Independent of Blue Cross Blue Shield NM. “They just lie straight out. Payments for us doctors, Blue Cross is one of the worst.”
The rate hike will hit some hard
The details of Blue Cross Blue Shield’s business structure was lost on Moya Melody, who was concerned with more immediate matters. Melody, who attended Monday’s hearing, said the new rates will represent 30 percent of her household’s income.
“Last year, we had a 20 percent increase and we just couldn’t pay,” Melody said. “So we went from a $500 deductible to a $1,000 deductible. Now, it’s still going up again this year.”
Moya and her husband, carpenter Kim Radsliff, have seen rate increases from Blue Cross Blue Shield NM every year since 2004, when they paid $562 per month, she said. That represented about 16 percent of their household income.
Now, with the increase approved today, they will pay $1,305 per month — 30 percent of their household income, Melody said.
“As far as I’m concerned, they’re a profit-making business,” Melody said. “We’re self-employed and don’t have a choice except to have no insurance at all.”
NMI’s Trip Jennings contributed to this story.
The state Human Services Division (HSD) and Attorney General’s office will sign a new memo of understanding about data sharing and the coordination of Medicaid fraud investigations, officials at both agencies told The Independent Monday.
The AG’s office
New Mexico’s Open Meetings Act is meant to help ensure public involvement and to prevent backroom deals in state and local government, but violations of the law are widespread, an investigation by The Independent has found. School boards, universities, town councils, county and state commissions, and boards across the state have broken the law, casting a shroud of secrecy over government officials’ deliberations and bargaining.
The U.S. Centers for Medicare & Medicaid Services (CMS)’s Medicaid Integrity Group intends to investigate allegations the Human Services Department (HSD) hindered Medicaid fraud and elder abuse investigations by the New Mexico Attorney General’s Medicaid Fraud & Elder Abuse Division, CMS spokeswoman Mary Kahn told The Independent.
“We plan on conducting an inquiry into this situation with the state Medicaid agency,” Kahn said.
HSD and the state Health Department administer New Mexico’s $1 billion Medicaid program.
The Medicaid Fraud Division reported that HSD and the Health Department had withheld, “filtered” and “sanitized” information and documents requested by investigators, hindering numerous investigations. The allegations were made in the Fraud Division’s 2009 annual report to the Inspector General of the U.S. Department of Health and Human Services. But the Inspector General’s office alerted the Medicaid Integrity Group to the 2009 allegations only last week, Kahn said, following inquiries by The Independent.
Similar allegations were also reported in the Fraud Division’s 2008 annual report, The Independent has confirmed.
“We have not heard from the CMS Medicaid Integrity Group, but of course if they contact us we will work with them to address any questions they may have,” HSD Spokeswoman Betina Gonzales McCracken said Monday.
HSD was “surprised by the allegations,” McCracken told The Independent last month.
But the Medicaid Integrity Group was “already aware of similar allegations related to the state’s relationship with its Medicaid Fraud (Division)” in 2008, Kahn said.
Following its May 2008 review of the state’s Medicaid program, the federal Medicaid Integrity Group ordered HSD to prepare a plan to correct violations of several federal regulations, according to a report obtained by The Independent.
“The State is not in compliance with federal regulations related to required disclosure and reporting requirements,” the report states. Among the violations described in the report was HSD’s failure to report fraud to the state Medicaid Fraud Division, “limiting the ability of the (Division) to prosecute fraud cases.”
The report also faulted HSD for failures to screen Medicaid providers for criminal convictions or to verify patients actually received the care for which Medicaid was billed by health care providers.
The HSD is required to track all cases of suspected Medicaid fraud and abuse, but was not doing so at the time of the 2008 review, the report states.
“HSD has implemented the Corrective Action Plan,” McCracken said Monday.
The concerns raised by the Medicaid Integrity Group’s 2008 review were addressed in the Plan and were different from subsequent allegations raised in the Medicaid Fraud Division’s 2009 report, McCracken said.
“We were unaware there were any further issues that needed to be addressed,” she said. “In light of the (Medicaid Fraud Division) report, we will work with the AGs office to address any issues that might still exist.”
On Monday, the state Senate voted to override Governor Bill Richardson’s pocket veto last year of a bill that would require state agencies to share Medicaid and other program data with the Legislative Finance Committee.
The Senate voted Monday to overrideGov. Bill Richardson’s veto of a 2009 bill that would have required state agencies to share confidential data with the Legislative Finance Committee. The tension between the LFC and state agencies over lack of sharing data has simmered for years. But last month, The Independent revealed, in an exclusive story, that an Attorney General’s report shows the state had hindered Medicaid fraud investigations.
The state’s stonewalling of the Attorney General’s Medicaid fraud investigations violates federal regulations, Attorney General’s office spokesman Phillip Sisneros said Friday.
“HSD’s compliance with the federal Program Integrity regulation could be improved,” Sisneros told The Independent. “That regulation requires that (the Fraud Division) has access to any records or information kept by HSD or its contractors and providers.”
Sisneros cited 42 C.F.R. § 455.21, a federal Medicaid regulation requiring states’ cooperation with State Medicaid fraud control units. The regulation requires states to provide fraud investigators with access to any records, information and computerized data kept by the agency or its contractors.
But according to a report by the Attorney General’s Medicaid Fraud & Elder Abuse Division, the state Human Services Department and Health Department have hindered numerous investigations into fraud and elder abuse by refusing to disclose records to investigators.
Human Services Department spokeswoman Betina Gonzales McCracken rejected those allegations earlier this week, claiming investigators had direct access to patient encounter data, describing patient care for which providers charged Medicaid.
“Regarding encounter data, the (Fraud Division) has the same access our Medicaid staff has, and can receive this information directly,” McCracken said.
But Sisneros said McCracken’s claim was “incorrect.”
“(The Fraud Division) does not have direct access to that data,” Sisneros said. “HSD requires the Division’s investigators and attorneys to submit requests for the information to the HSD Medical Assistance Division, which must give authorization…before the data is released. The Division does not have the ability to ascertain whether the data that is received has been filtered in some way.”
Direct access to Medicaid data would be “a significant step forward,” Sisneros said.
Fraud Division Director Elizabeth Staley did not answer emailed questions and was too busy with the legislative session to discuss the allegations, Sisneros said.
McCracken also said earlier this week that the Fraud Division’s allegations had never been raised at monthly inter-agency Medicaid meetings. But minutes from a May 19, 2009 meeting seem to refute that claim, making clear reference to the Fraud Division “having a hard time obtaining some provider agreements (and) files.”
McCracken had initially said there were not any transcripts or meeting minutes for the monthly inter-agency gatherings, but subsequently disclosed summary minutes from six meetings to The Independent — three meetings in 2008 and another three from 2009, the most recent from a meeting held May 19, 2009.
Minutes were not kept from all of the inter-agency meetings, McCracken said of the 18 months for which no meeting minutes were disclosed. Some meetings had been canceled due to holidays and legislative sessions, McCracken added.
