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.
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 curious case of Senate bill 531 is heating up. The bill–which would force state agencies to share financial data, including Medicaid spending, with the Legislative Finance Committee–is on today’s agenda of the House Judiciary Committee, but it wasn’t…
In a series of three formal Medicaid program improvement recommendation letters sent to the state Human Services Department (HSD) in 2009, the Attorney General’s Medicaid Fraud & Elder Abuse Division laid out how better HSD compliance with Medicaid rules and regulations could have saved taxpayers up to $31 million.
It is unclear how much of the $31 million would represent a one-time savings, and how much represents potential repeating, annual gains. The Attorney General’s office did not respond to repeated emails requesting comment about the letters and HSD’s responses.
The state Senate voted last week to override Governor Bill Richardson’s veto last year of SB 531, which would have required state agencies to share confidential data from Medicaid and other state programs with the Legislative Finance Committee.
Rep. Paul Bandy, R – Aztec, yesterday charged Speaker Ben Lujan with attempting to block a similar override vote in the House.
“It’s important that we connect our issues with Medicaid fraud, and the associated tens of millions of dollars in fraud, and our current budget challenges,” Sen. Tim Keller, D-Albuquerque, said of the override effort. “The challenge here is how to handle confidential information between different parts of government. This has long been a sticking point when it comes to program evaluation. We’ve seen similar impasses with prison contracts, Salud and public schools in the past.”
The Medicaid Fraud Division’s 2009 letters to HSD and HSD’s response letters were disclosed to The Independent in response to public records requests.
Out of State Medicaid Recipients: $16.2 million lost
According to state law, Medicaid is for “eligible New Mexico residents who otherwise would not have the financial resources” to obtain medical care.
But, according to a Sept. 30, 2009 letter from the Medicaid Fraud Division to HSD, a Tulsa, Oklahoma lawyer earning $231,000 a year secured $135,000 in New Mexico Medicaid assistance — $9 ,000 a month — to place his 9-year-old daughter in a residential behavioral health center in Los Lunas by listing her as a New Mexico resident and a “head of household” with no income.
Up to $16.2 million could be saved by denying New Mexico Medicaid benefits to non-residents, the letter claims.
The HSD does require New Mexico residency for Medicaid eligibility, HSD Medical Assistance Division Director Carolyn Ingram said in an October 29, 2009 response to the Fraud Division’s letter. Ingram’s letter was disclosed to The Independent Feb. 8 in response to a public records request.
In the letter, Ingram discounted any widespread problem with Medicaid benefits going to non-residents.
“In certain rare instances, a child can be placed in a New Mexico substitute living arrangement pending the transfer of guardianship or adoption by a New Mexico resident,” Ingram wrote. “(Regulations) allow a child to be considered a household of one, after the first month of placement in a substitute living arrangement. After the first month in a private facility, a parent or legal guardian who meets the residency requirement, may apply for Medicaid based on the child’s income alone. It appears that an attempt to get around the residency requirement by both the parents and the facility was successful in this situation. The worker failed to look at the legal standing of the Power of Attorney in this case. …Our examination of current policy does not inidcate a revision is needed; we believe the policy is clear on residency.”
Not Disclosing Medicaid Contracts to Investigators: $13.7 million lost
HSD’s failures to disclose Medicaid providers’ contracts to the Medicaid Fraud Division cost taxpayers up to $13.7 million, according to a June 29, 2009 letter from the Fraud Division to HSD.
The Medicaid Fraud Division frequently sues health care providers for over-billing Medicaid using breach-of-contract law, arguing the Provider has not complied with the terms of its Medicaid Provider Agreement with the state. But because HSD has failed to disclose these agreements “many” times, investigators have been unable to seek recoveries for fraudulent over-billing, the letter states.
“Additionally, criminal prosecutions may be adversely impacted if the state is unable to present proof a defendant is a contracted Medicaid Provider subject to the terms of the agreement,” the letter states.
Responding to the letter, Ingram pointed out that other agencies held provider agreements and said HSD was working with those agencies to revise internal policies and procedures to maintain entire contract documents.
“Currently, the (Health) Department maintains all pages with provider specific data including signature pages,” Ingram wrote in the July 15, 2009 letter. “However, we do not retain standard text pages.”
But the Health Department also failed to disclose requested records to the Medicaid Fraud Division, according to the Fraud Division’s June 30, 2009 annual report to the Inspector General of the U.S. Department of Health and Human Services. Both the HSD and Health Department “review and, on occasion, redirect the (Fraud) Division’s data or document requests,” the Fraud Division’s annual report stated. “The Division repeatedly has requested copies of the contracts between the Medicaid agency and the Medicaid managed care organizations to no avail.”
HSD posted signed Medicaid managed care organization contracts on its Salud website earlier this year.
Informal Review Conferences: $1.5 million lost
HSD grants providers gratuitous informal administrative hearings when no right to a hearing exists, costing Medicaid up to $1.5 million, according to a Dec. 23, 2009 Medicaid Fraud Division letter to the HSD.
For example, Cuidando Las Familias in Rio Rancho failed to properly screen 75 care providers, in violation of the state’s Caregivers Criminal History Screening Act, the letter states.
Because the facility charged Medicaid $3.69 million for services provided by unscreened caregivers, the Medicaid Fraud Division recommended that HSD implement a check hold for overpayment, citing federal Medicaid regulations. But the facility requested and was granted an administrative hearing to challenge the check hold.
The Fraud Division letter does not contest the legitimacy of the bills for the care provided to patients, however — just the eligibility of the caregivers in question to receive Medicaid funds.
The Fraud Division letter attributes HSD’s granting of the “gratuitous” and “unjustified” hearings to ambiguities in the state’s Medicaid regulations and recommended that “administrative review” be more clearly defined.
In a January 21, 2010 response letter, Ingram disagreed that the recommended clarification would yield savings for the Medicaid program.
Indeed, the additional responsibility would likely cost HSD time and money, Ingram suggested.
“(T)his recommendation would have significant fiscal implications to the (HSD) since it would essentially require HSD to implement a completely new process for the remaining (Fee For Service provider) population,” Ingram wrote.
The federal Medicaid Integrity Group plans to investigate allegations reported in The Independent that the HSD stonewalled Medicaid Fraud Division investigators during 2008 and 2009.
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.
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.
