State Agencies Hindered “Many” Fraud and Elder Abuse Investigations

We are aware of this problem and have been in situations of where State agencies not only hindered but blocked, and threatened to take action should we proceed to press forward with complaints of elder abuse so we are glad that someone found the nerve to blow the whistle on this wide spread and common practice for state agencies to stifle,block, hinder elder abuse investigations often hiding behind a veil of secrecy...

By Bryant Furlow 1/28/10

Investigators were stonewalled by the New Mexico Human Services Department (HSD) and Health Department, according to the Fraud Division’s 2009 annual report to the Inspector General of the U.S. Department of Health and Human Services.

HSD administers the state Medicaid program with help from the Health Department. The agencies hindered “many” fraud and elder abuse investigations during 2008 and 2009, according to the report.

“It appears that the (HSD) inappropriately filters the information they provide to the Fraud Division,” the report states. “[T]his sterilization has inhibited our ability to access and prosecute both fraud and abuse claims.”

According to the report, investigators were unable to obtain pharmaceutical pricing or patient care data. Investigators were also repeatedly unable to secure copies of contracts with the state’s four Medicaid managed care organizations — Lovelace Community Health, Molina, Presbyterian Health Plan and Blue Cross/Blue Shield New Mexico — from either HSD or the managed care organizations themselves, the report states.

The June 2009 report followed a January 2009 audit by the Legislative Finance Committee, which called for an evaluation of how exactly HSD combats Medicaid fraud.

“It appears that both the (HSD) and Department of Health…review and, on occasion, redirect the Division’s data or documents requests, instead of allowing a free flow of information as anticipated by Medicaid regulations and the Memorandum of Understanding between (HSD) and the Division,” the report states.

Fraud Division Director Elizabeth Staley did not respond to emailed questions about the report and could not comment due to a busy schedule related to the legislative session, according to spokesman Phillip Sisneros.

“The Human Services Department was unaware of this report until now and is surprised by the allegations,” HSD spokeswoman Betina Gonzales McCracken told The Independent. “The HSD Medical Assistance Division meets with the (Fraud Division) monthly. During these meetings, the issues described in the report have never been mentioned.”

Secretary of Health Alfredo Vigil said in a single-sentence e-mail to The Independent:“We believe we have been cooperative in providing any documents that the Attorney General’s Office has requested.”

The Independent’s public records requests to the Fraud Division and state and federal agencies have not yet been fulfilled.

“This just goes to show the importance of the free flow of information,” New Mexico Foundation for Open Government Executive Director Sarah Welsh said.

“It’s not just reporters who are harmed when agencies withhold information, or try to spin it – it’s citizen activists, candidates for public office, business owners, legislators and in this case, even the state’s top law-enforcement agency. …What happens to the victims and perpetrators of (elder) abuse while we fight over documents? In a democracy we’re all responsible for government oversight, and our system of checks and balances simply doesn’t work without access to unfiltered information. I hope that bringing this to HSD’s attention will resolve this issue and head off any future ones.”

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