Thursday, October 9, 2014

Martinez GOP-ALEC Regime "Picks Winners" - Too Bad, New Mexico Health Care
New Mexico's "prosecutera maxima," ex-Democrat Martinez  [image REAL CLEAR POLITICS]

 Governor Martinez' Republican Dilemma
How do you continually loot the poorest state in the nation?

Given the difficulty of the task of "locating" convenient areas in the New Mexico state budget for "cash re-allocation," Susana, predictably, begun with all the things which perturbed her adjacent state "industrial buddies." 

At every "first opportunity" to maniacally pursue one of ALEC New Mexico's ideological "silver chalice" ideological "purification" projects, she grabs her purse and the state's check book and heads to Texas or Arizona where "capitalism is still flourishing." You know, near by states where the local billionaires still like her.

She's eviscerated the state's environmental over sight agency, battled against minimum wage hikes, fought against even asking what New Mexicans thought about penalty reductions for smoking pot and gutted everything that used to be even marginally effective in the state's admittedly out of date public education structure [She probably doesn't actually hate education per se. She just hates teachers' unions that campaign against her.]

It's not surprising that Miss Governor latched onto to behavioral health care. In her eyes the state budget allocation appeared as a literal "pot of gold," waiting to be "liberated" and handed over to the "free market." It turns out that her "expert" health care management friends in Arizona were exactly the right folks to "empty that pot."

Of course, there's simply no telling where the money went.

Targeting Presbyterian Health Care
Who cares what the facts are. Get the rope.
 We can pay off even more bribes for "economic development!"
And, hee hee, "job training!"

The following article is presented here in its entirety. It represents some excellent reporting. Frankly missing a responsible local newspaper while living in MeanMesa's "host" city of Albuquerque -- with only the tatters of a 1930's local newspaper that still publishes editorials on its front page as it they were news -- makes this appreciation even greater. 

Congratulations, and thanks.

 health and science

Presbyterian says it was forced to pay state $4M

 By Patrick Malone
Posted: Wednesday, October 8, 2014 9:00 pm
[Visit the Santa Fe New Mexican site for the original article here.]

ALBUQUERQUE — Executives for a behavioral health company that reached a multimillion-dollar settlement with the state last year over allegations of Medicaid fraud told lawmakers Wednesday that Gov. Susana Martinez’s administration exerted extreme pressure on the company to settle, even though the company believed it was innocent. 

The company, Presbyterian Medical Services, was one of 15 behavioral health providers the state Human Services Department accused last year of overbilling Medicaid by $36 million as part of a shake-up that rocked the state’s mental health system.
Presbyterian spent $4 million to settle the case and remained in business. One other company also settled, but the rest were replaced by companies that the Martinez administration brought in from Arizona.

Presbyterian officials told the New Mexico Legislature’s Behavioral Health Subcommittee on Wednesday that heavy-handed tactics by the state Human Services Department backed the company against a wall, leaving it little choice but to pay millions of dollars that the company says it didn’t owe, or face being shut down.

The company reviewed and disputed an audit that found millions of dollars in overbilling of Medicaid for treatment of indigent patients with mental health and substance abuse problems. The contract auditor, Public Consulting Group, agreed to reconsider its findings, but the New Mexico Human Services Department blocked the auditors from considering Presbyterian’s explanations, according to Don Daniel, the company’s general counsel.

As a result, Presbyterian faced limited options: Pay the state $4 million in restitution to keep its doors open, accept a takeover by one of the five Arizona companies hired to replace the New Mexico providers, or walk away shamed by the specter of fraud allegations and stop providing behavioral health services — which generate nearly half the company’s 300,000 annual patient visits.

After three months of negotiations, with its funding stream frozen from late June through the start of November, Presbyterian paid the state in order to keep offering services and prevent its complete collapse.

“We had expended the vast majority of our resources at that time,” said Steven Hansen, Presbyterian’s chief executive officer. “We couldn’t have continued much longer — a few weeks, maybe a month beyond when we settled.”

Rep. Liz Thomson, D-Albuquerque, who chairs the Behavioral Health Subcommittee, bluntly summed up the Presbyterian executives’ description of the circumstances that led to their settlement with the state.

“I have visions in my head of a gun to the head: ‘Either you give us this money or we kill the patients,’ ” she said.

Human Services Department spokesman Matt Kennicott described what transpired between the department and Presbyterian in less dramatic terms.

“They did not have to agree to a settlement in paying back taxpayers for services that were overbilled,” he said. “They were informed of their options and chose to settle.”

Wednesday’s revelations by Presbyterian executives marked the first time that either of the New Mexico behavioral health providers who survived last year’s shake-up had spoken up publicly about their struggles to remain open and the ultimatums presented by the Human Services Department. Youth Development Inc. also continued providing services after reaching a settlement agreement to repay the state about $250,000.

In June 2013, the Human Services Department announced it was freezing Medicaid funding to all 15 New Mexico-based behavioral health firms. As the basis for the action, the governor’s administration cited findings in the PCG audit that accused the providers of fraud by overbilling Medicaid by millions of dollars.

Records obtained by The New Mexican showed that the state paid at least one of the replacement companies from Arizona for work it did to prepare for the takeover before the PCG audit had even begun. That discovery prompted leaders of a New Mexico provider that maintains its innocence, Easter Seals El Mirador, to conclude that the Martinez administration had made up its mind well in advance of the audit that it would yield findings of fraud and that the in-state behavioral health providers would be replaced.

The PCG audit also has come under scrutiny because the New Mexico Attorney General’s Office, which is reviewing all 15 New Mexico companies for potential acts of criminal fraud, has issued reports exonerating two of them so far, although one case has been reopened. The investigation turned up questionable billing by Easter Seals El Mirador and The Counseling Center of Alamogordo that were a fraction of the amount identified in the PCG audit, and the Attorney General’s Office found no credible evidence that either company had committed fraud.

Six or seven years could pass before the investigation is complete, according to Attorney General Gary King, who has been criticized by lawmakers and the affected behavioral health providers for the pace of the probe. On Wednesday, Presbyterian executives told lawmakers that to date, the Attorney General’s Office has not contacted the company to ask questions or seek records that would advance the investigation.

Because of the attorney general’s ongoing investigation, the original PCG audits of 13 companies remain under wraps, including Presbyterian’s audit. The Human Services Department granted the company a chance to review it, but didn’t allow Presbyterian to keep a copy, according to Daniel.

But the company’s executives noted important parts of it, including PCG’s determination that there was no credible evidence of fraud and that billing discrepancies discovered in the audit likely could have been reconciled through training on proper procedures.

When Presbyterian conducted its own audit and challenged some of the overbilling identified by PCG — which calculated its estimate of the company’s excess billing by reviewing 150 cases and extrapolating them thousands of times over — the contract auditor was agreeable to considering the company’s response, but the Human Services Department wouldn’t allow it, according to Daniel.

The Human Services Department informed Presbyterian that the department, and not PCG, was the ultimate authority on whether fraud had been found.

Daniel said Presbyterian’s review resolved all but a few hundred thousand dollars in questionable receipts — about 1 percent of the more than $40 million in Medicaid billing that Presbyterian had submitted during the span of more than three years covered by the audit. He said neither PCG nor Presbyterian found evidence of safety lapses or that the company had billed Medicaid for nonexistent clients. Those mistakes had been suspected by the state’s contract managed-care overseer, OptumHealth, which triggered the audit.

When Presbyterian agreed to settle with the state to keep operating, the pact ended any chance of any monetary civil claims against the state. It also included a one-year gag order prohibiting the company from discussing the settlement. Daniel said the Human Services Department insisted on that provision, although it’s irregular.

“That is not standard operating procedure,” Daniel said, “and pretty much the whole process has not been standard from our experience and our knowledge of other states.”

Sen. Mary Kay Papen, D-Las Cruces, who serves on the Behavioral Health Subcommittee, said she is in the process of crafting legislation for consideration next year that would require the state to take the intermediate step of correcting problems such as those the audit identified with the behavioral health providers, rather than immediately terminating ties.

The Presbyterian executives said their support for legislation that would give businesses suspected of wrongdoing a chance to answer allegations before being removed had motivated them to speak up.

“How do we really have a system or a process in place that will eliminate the purgatory, if you will, between that allegation and the finality to it?” said Doug Smith, the company’s executive vice president. “If an organization is proven to be doing those kind of activities, they shouldn’t be allowed to continue. If they haven’t, they should.”
Contact Patrick Malone at 986-3017 or Follow him on Twitter @pmalonenm.

Yes, November

If any New Mexican hasn't had enough of this governor's cheesy "bite and snatch" tactics yet, there will be an opportunity to go to the polls and re-elect her on November 4. See you there.

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