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.
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
Just before the stroke of midnight on Wednesday, House Republicans tried to bring a dead veto override to life. Just as the House was getting ready to adjourn and discuss budget issues in committees, Rep. Paul Bandy, R-Aztec tried…
A rare veto override move came to a dead end Wednesday afternoon when the House Judiciary committee voted 7-4 to table a bill that would have forced state agencies to share financial data, including Medicaid spending, with the Legislative Finance…
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.
Sen. Keller
On Tuesday Senator Tim Keller (D-Albuquerque) introduced a motion to revive SB 531, a transparency bill that was unanimously passed by the Legislature last year only to be pocket-vetoed by Governor Bill Richardson.
Keller’s recall motion passed with unanimous consent. It was the first step toward a legislative override of Richardson’s veto.
“This was just the first step in a two-step process – recalling the bill to the Senate floor,” Keller explained. “It’s a totally arcane process. You can’t just move for an override. Vetoed bills go to the Secretary of State’s for a year in case they are recalled to the Senate for an override.”
Another motion will be required for an up-or-down vote by the full senate. A two-thirds majority in both houses is necessary for a veto override.
SB 531, which would have forced state agencies to share Medicaid spending and other financial data with the Legislative Finance Committee, unanimously passed both houses of the Legislature last year.
“We definitely have an issue with investigating Medicaid fraud,” Keller told The Independent, referring to allegations by the Attorney General’s Medicaid Fraud and Elder Abuse Division that the state Human Services Department (HSD) and Health Department have repeatedly “interfered” with investigations by not sharing data with investigators.
“This is not glamorous stuff, but it’s very important,” Keller said. “We cannot address the budget crisis without getting to the bottom of this. This year’s budget has $1 to $2 billion going through these Medicaid providers – 20 percent of our budget.”
SB 531 was intended to address state agencies’ failures to share several types of data with the Legislature, Keller said.
In a March 26, 2009 letter, Attorney General Gary King urged Gov. Richardson to sign the bill, saying it “resolves an ambiguity regarding whether existing law allows the Legislative Finance Committee to keep confidential non-public records it receives from agencies” and that the bill would “facilitate the exchange of information between government agencies and the Legislative Finance Committee.”
“Other (than Medicaid), areas where we have had these problems are in education, prison system and state investment funds,” Keller said.
Keller hopes to avoid a contentious fight, he said.
“We did not do this in a controversial way but the issue has come up again with the AG’s allegations, and we need to deal with it,” he said. “We need to keep things focused on the issue and avoid territorial disputes.”
Keller began meeting with officials from the AG and HSD today, he said, though he refused to discuss details.
“The next step is to talk with the agencies,” Keller said. “Then the full Senate will decide whether to move forward with the override.”
The Governor’s office has not yet responded to requests for comment. HSD Spokeswoman Betina Gonzales McCracken refused to comment on Keller’s efforts Tuesday, saying only, “the Human Services Department will work with the AG’s office to clarify any issues that may exist.”
The override motion is evidence of how frustrated legislators have become with the executive branch, according to New Mexico Foundation for Open Government Executive Director Sarah Welsh.
“It’s amazing that we would have to explicitly legislate checks and balances like this,” Welsh said Tuesday. “Basically, they want information and they feel thwarted. This latest move might seem like inside baseball, but it really points to a larger problem that I run into nearly every day – it’s very difficult to get information out of this administration. And it’s not just reporters who get frustrated. It’s legislators and candidates and activists of all stripes. It’s a baffling phenomenon until you remember: information is power, particularly in this new digital age.”
Feds “Aware” of Allegations
Last week, The Independent revealed, in an exclusive story, that an Attorney General’s report shows the state had hindered Medicaid fraud investigations.
Those allegations were forwarded to the U.S. Center for Medicaid and Medicare Services (CMS), the agency that administers federal Medicaid funding to the state, Inspector General spokesman Mark Wilson told The Independent Monday.
“We alerted CMS to the issue, based on the New Mexico Attorney General’s report,” Wilson said. “Now it’s up to them to contact the state and find out what’s going on there.”
CMS officials did not respond to emails and telephone messages requesting comment. McCracken would not comment on whether CMS had contacted HSD about the allegations.
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.
