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’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.
