It will be a month next week since I wrote about my new home
state, New Mexico’s so-called mental health service scandal.
I say, “so-called” scandal, because the state’s Human
Services Division, while proclaiming a $36 million in fraudulent billings, made
by first 15, now 12 mental health service providers, continues to provide no
useful information about who done what wrong to whom and how.
In fact, I’d have been content to give the HSD more time to
sort things out had today’s NY Times not “taken national” a story about what
reporter Don Frosch called “a sweeping criminal
investigation.” Me, I’d call it a
“reeking” investigation which has been, so far at least, “swept under the rug.”
There are 2 reported investigations;
one led by NM Attorney General Gary King, who has refused to answer questions
about his probe from the accused providers, their clients or journalists. He’s even “protected” his work by refusing to
share data with the State Auditor. He
has, however, whined that he may not have enough resources to carry out the
massive criminal probe, which his office says may not be completed for
months. Meanwhile the accused providers
have been cut off from public funding, many are closed and many of their
vulnerable, mentally ill or disabled clients have been left hanging while their
successors from Arizona slowly set up shop.
There is also a purported
Federal investigation of the case, but so far, the Centers for Medicare and
Medicaid Services haven’t visibly proceeded beyond a conference call with a few
abandoned clients of the shuttered service providers.
So much for the prosecutorial
future. He are a few things we know
about the investigation’s past and present.
The State Human Services
Division has contracted with Arizona service providers to replace the fired New
Mexicans at far higher rates of pay, especially at the executive/managerial
level, than the allegedly scandalous providers charged.
At least one of these well-paid
providers, it has been reported, has ties to one of Governor Susana Martinez’
biggest campaign fund bundlers.
HSD
has claimed that Federal rules gave them no discretion when it came to cutting off
the accused providers. But, a close
reading of the applicable rulebook shows that to be untrue. In fact, according to Linda Rosenberg, the
CEO of the National Council for
Behavioral Health, "I've never seen a state behave like this."
The Executive Summary of the
actual audit done by the Boston-based Public Consulting Group (PCG) made no
recommendation that any of the providers be closed, and said none of them were
bad enough to mandate closure. Of the 15
providers audited, only 7 were rated bad enough for “potential closure” even to
be considered. As for the other 5 locked
out providers, all PCG recommended was that the state provide some additional
training and “potentially embed clinical
management to improve processes.”
Then, there’s this about
PCG. It conducted an audit of health
service providers for the State of North Carolina in 2012, and alleged, the
Santa Fe New Mexican reported, “$38.5 million in
Medicaid overpayments, [for which it] was paid $3.2 million.”
But, according to North Carolina State Auditor
Beth Wood’s report, the New Mexican reported, a review of “one of the
companies, which PCG said had overpayments totaling $1.34 million, submitted “additional
documentation and re-reviews, [and] the recoupment amount was revised downward
to only $22,093.”
Overall, “Wood found that of the $38.5 million
overpayments cited, the Health and Human Services Department had only been able
to collect $3.7 million — less than 10 percent.”
In other words, the bounty hunter’s claim for
payment was only about half a million less than the total amount the State of
North Carolina took in.
Not to worry, says the NM HSD, their contract with PCG has no such
bounty clause, just a flat payment of, the investigative website New Mexico In
Depth says it was told, “$2 million.”
But wait, PCG was hired on the recommendation of
OptumHealth which had originally been overseeing New Mexico’s health service
providers. OptumHealth’s contract with
the state says, it gets from 25 to 40% of any fraudulent claims against HSD
that it recovers. Does this mean they
get the bounty-hunter’s pelf for PCG’s accusations? This is another thing the Health Service
Division refuses to talk about, to the public, the media or even the State
Legislature.
Part
of Optum Health’s claim to be paid for helping to unearth the alleged frauds is
that they “installed new
program-integrity software in late 2011.”
Asked what was new about their software, which HSD
has said was “not off-the-shelf,” but custom-made, Optum has stayed mum, but at
least one report says, HSD still uses FICO software which is straight off the
shelf.
Oh, and who is Optum Health?
It is one of the innumerable subsidiaries of the
country’s biggest health service company United Health Group, whose subsidiary
Optum Insight was the re-named Ingenix, a database supplier run out of New York
State in 2008, when investigators for then NY Attorney General Andrew Cuomo
found it was supplying United Health with phony estimates of medical billing
costs that allowed the giant UH medical insurer to underpay doctors and
patients, who then overpaid “their share” of their medical costs.
How big a scam was that? United Health settled with the AMA and
patients by paying back $350 million in ill-gotten gains.
But, wait, that scandal was chicken-feed
compared to the one 2 years earlier in which United Health’s CEO Dr. Bill McGuire
was forced to resign and disgorge himself of $468 million and pay a “whopping”
$7 million fine for manipulating his stock option opportunities and covering it
up from the company’s shareholders. Even
after that punishment (repeat after me –“TOO BIG TO JAIL?”), the Wall Street
Journal estimated that McGuire was allowed to keep about $800 million.
Oh, but that was years ago, you say. Yeah, but today’s CEO of United Health Group,
the Grand Poobah of fragments like Optum Health, McGuire’s “hand-picked successor,” is Stephen
Hemsley, who was then president and chief operating officer, and a member of
the board of directors.
“Sweeping” investigation, as the Times says, or
“reeking?” What do you think?
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