Episode 710 - Behavioral health audits latest

>> THE CONTROVERSY OVER AN AUDIT OF 15 BEHAVIORAL HEALTH PROVIDERS HAS ONLY INTENSIFIED AS STORIES HAVE EMERGED OF SOME ROCKY TRANSITIONS TO THOSE NEW OWNERS FROM ARIZONA, AND MANAGERS BROUGHT IN BY THE HUMAN SERVICE DEPARTMENT. NOW, HSD CLAIMS THESE STEPS WERE NECESSARY TO ATTACK WHAT THEY SAY IS RAMPANT FRAUD. PROVIDERS SAY THEY'VE BEEN UNABLE TO DEFEND THEMSELVES AGAINST THESE CHARGES, AND NEWS ORGANIZATIONS SAY THEY'RE BEING BLOCKED FROM GETTING INFORMATION. SO JOINING US TO TALK ABOUT THIS, ONE OF OUR LINE REGULARS IS BACK, SOPHIE MARTIN, FORMER EDITOR OF THE NEW MEXICO LAW REVIEW. ON TO BIGGER AND BETTER THINGS, AS THEY SAY. AND WITH US ONCE AGAIN IS FORMER STATE SENATOR, NOW EXECUTIVE DIRECTOR OF THE ALBUQUERQUE MEDICAL ASSOCIATION, H. DIANE SNYDER. ALWAYS GOOD TO HAVE HER. FROM THE CENTER FOR CIVIC POLICY, OUR FRIEND JAVIER BENAVIDEZ RETURNS. AND TO THE LINE TABLE ONCE AGAIN FOR THE CAPITAL BUREAU OF THE TEXAS/NEW MEXICO NEWSPAPER PARTNERSHIP, JOURNALIST MILAN SIMONICH IS HERE AS WELL. NOW, DIANE, A NUMBER OF THESE LEGISLATORS, AND YOU'RE AN EX-LEGISLATOR, ARE PRETTY UPSET. THEY HAD A MEETING ON TUESDAY, SOME HOT THINGS WERE KIND OF THROWN ABOUT IN THIS HSD MEETING. BUT WE'VE GOT A LOT OF ISSUES GOING HERE, AND I WANT TO KIND OF BUZZ THROUGH A BUNCH OF THEM AS WE'RE TALKING HERE. WE'VE GOT A SITUATION WHERE IT HAS BEEN REVEALED THAT THERE WAS A TRIP TO ARIZONA BEFORE THE AUDIT CAME OUT. I WANT TO GET EVERYONE'S GUT REACTION TO THAT REVELATION RIGHT OFF THE BAT. HOW DID THAT HIT YOU WHEN YOU FIRST READ THAT? >> WHEN I FIRST READ IT, IT WAS, UH-OH, WHY? I'M ONE OF THOSE PEOPLE THAT IF YOU HAVE LEGITIMATE REASONS, YOU DOCUMENT THEM, AND THEN I'M WILLING TO BELIEVE YOU. THE THING THAT I FIND MOST INTERESTING ABOUT ALL THIS PROCESS, AS BEST I CAN TELL, ASIDE FROM THE FACT OF THE DISRUPTION OF SERVICES THAT HAS APPARENTLY OCCURRED, IS THAT THE SECRETARY ACTUALLY HAS FOLLOWED EVERY STEP OF THE LAW, AND I SAY THAT -- THE REASON I SUPPORT THAT IS, I BELIEVE THAT THE U.S. ATTORNEY AND OUR STATE ATTORNEY GENERAL, WHO ARE BOTH DEMOCRATS, ONE OF WHOM IS RUNNING FOR GOVERNOR, IF THERE WAS ANYTHING IN THAT AUDIT OR ANY SUSPICION OF MISMANAGEMENT ON THE PART OF THE SECRETARY, THAT WOULD BE POLITICALLY PUT IN THE PROCESS. THE SECOND PIECE IS THE FACT THAT I KNOW FROM MY TIME IN THE LEGISLATURE THAT THE HUMAN SERVICES DEPARTMENT WAS THE DEPARTMENT I RECEIVED THE MOST CALLS AND COMPLAINTS ABOUT, AND I WAS THERE FROM 2001 TO 2008, SIX YEARS UNDER A DEMOCRAT AND TWO UNDER A REPUBLICAN. AND ONE OF THEM WAS A PATIENT WHOSE MOTHER CALLED ME WHOSE CHILD COULD NOT GET APPROVED BY THE DEPARTMENT FOR THEIR MEDICATIONS. THEY ALREADY HAD PROCESSED IT, THE DOCTOR HAD IT, WALGREEN'S HAD IT, AND I SAID, WELL, LET ME SEE WHAT I CAN DO, HOW LONG HAS YOUR SON BEEN OFF THE MEDS? AND SHE SAID, SIX WEEKS. I SAID, SIX WEEKS! AND SHE SAID, YES. AND I SAID, THAT'S RIDICULOUS. SO I KNOW THIS IS NOT JUST A RECENT ISSUE, AND I BELIEVE THAT THERE ARE A NUMBER OF PEOPLE THAT WE THINK WE KNOW, AND I'VE HEARD STORIES, I THINK THERE PROBABLY ARE GROUNDS. AND I'M NOT SAYING THAT EVERYBODY'S GUILTY, BUT I THINK THAT AN AUDIT SHOULD HAVE BEEN DONE, AND PROBABLY SHOULD HAVE BEEN DONE FIVE OR SIX YEARS AGO. >> I DON'T THINK IT WOULD BE A SURPRISE TO ANYONE AT THIS TABLE, OR ANYWHERE ELSE, IF SOMETHING TURNS UP. THERE'S NO QUESTION. BUT JAVIER BENAVIDEZ, AS IT STANDS NOW WE'VE GOT ANOTHER ISSUE I WANT TO GET TO BEYOND YOUR GUT REACTION TO THAT BIT, IS THE IDEA OF DRIBBING AND DRABBING THROUGH THEIR PIO AT HSD ACCUSATIONS OF THIS AND THAT AND THE OTHER THING WHERE NOBODY IN THE PRESS CAN CONFIRM ANYTHING AT THAT POINT. THIS IS WHERE WE'VE COME. SO ON THE ISSUE OF GOING TO ARIZONA, AM I MAKING THIS OUT MORE THAN IT SHOULD BE AT THIS POINT? BECAUSE SOMETHING JUST SEEMS KIND OF ODD HERE. >> I THINK IT'S A BOMBSHELL. I THINK IT HAS THE APPEARANCE OF THIS ALL BEING GREASED, THAT A MEMBER OF THE ADMINISTRATION AND A MEMBER OF PCG FLEW TO ARIZONA FEBRUARY/MARCH, MONTHS BEFORE THE AUDIT EVEN BEGAN, AND I THINK YOU'RE RIGHT, I MEAN, THE DAMAGE IS IN THE FALLOUT FROM THESE COMPANIES BEING ACCUSED OF FRAUD. AND LET'S BE CLEAR, NOBODY IS IN FAVOR OF FRAUD, BUT THERE SHOULD BE A DUE PROCESS. AND THEY'VE LOST THEIR BUSINESSES NOW, AND IT'S THE TAXPAYERS OF NEW MEXICO THAT ARE GOING TO BE ON THE HOOK FOR THE DAMAGES IF THEY FILE LAWSUITS. SO IT'S VERY CONCERNING, AND I THINK LEGISLATORS WERE ASKING THE RIGHT QUESTIONS ON TUESDAY. WE DON'T HAVE ACCESS TO ANY OF THE INFORMATION ABOUT THE AUDIT, BUT WE DO KNOW PCG'S RECORD FROM NORTH CAROLINA, FROM OTHER STATES WHERE THEY'VE ACCUSED COMPANIES OF, IN ONE EXAMPLE, $700,000 WORTH OF ERRORS THAT ENDED UP BEING $300. AND THESE COMPANIES, YOU KNOW, THEY'VE HAD TO LAY PEOPLE OFF, AND THERE HAS BEEN DISCONTINUITY IN CARE. >> SOPHIE MARTIN, GOOD TO SEE YOU AGAIN. WELCOME BACK, IT'S BEEN A WHILE. I KNOW IT'S A BUSY TIME IN YOUR LIFE RIGHT NOW. >> I HAD TO TAKE THE BAR EXAM >> YEAH, A SMALL THING. AM I HEARING OUR AUDITOR CORRECTLY WHEN HE SAYS TO OUR EX-COLLEAGUE MATT GRUBS IN A PIECE ON CHANNEL 13 THE OTHER NIGHT THAT HE SAW NO CREDIBLE EVIDENCE OF FRAUD? WHAT DID YOU MAKE OF THAT? DID YOU HEAR HIM SAY ABOUT THE ENTIRETY OF THE WHOLE THING, OR HOW DID YOU PARSE THAT IN YOUR OWN MIND? >> JUST TO CLARIFY THAT, WE'RE TALKING ABOUT HECTOR BALDERAS, STATE AUDITOR. MY UNDERSTANDING OF HIS STATEMENT WAS THAT HE HAD READ THE AUDIT REPORT FROM THE OUT-OF-STATE AUDITOR, AND WHAT HAPPENS IS THAT THE AUDIT IS PRODUCED AND THEN HFC EVALUATES THAT AUDIT AND MAKES DECISIONS BASED ON THAT, AND WHAT THEY SEE FROM THE PROVIDERS ABOUT THE COURSE OF ACTION THEY'RE TAKING, AND WE HAVE SEEN MUCH LESS THAN AUDITOR BALDERAS HAS SEEN. ONE THING THAT WE HAVE SEEN IS A SET OF RECOMMENDATIONS FROM THE OUT-OF-STATE AUDITOR, NONE OF WHICH SUGGESTS YANKING THE CONTRACTS FROM THE 15 PROVIDERS. IN FACT, IT SAYS LET'S PUT SOME NEW MANAGEMENT PRACTICES IN PLACE, MAYBE SOME OVERSIGHT. BUT THAT REPORT FROM THE OUT-OF-STATE AUDITOR SAYS THE STATE OF NEW MEXICO IS GOING TO MAKE A DECISION ABOUT WHETHER THERE'S ANYTHING MORE SERIOUS. SO THERE'S THIS LITTLE GAP HERE. WE GO OVER TO HFC, AND HFC MAKES THE DECISION, WE'RE GOING TO DO THIS MUCH MORE SERIOUS SET OF ACTIONS, AND THAT'S THE GAP I THINK WE'RE LOOKING AT. SOMEWHERE BETWEEN WHAT HECTOR BALDERAS HAS SEEN AND THE ACTION TAKEN BY HFC, SOMETHING DRASTIC SEEMS TO HAVE OCCURRED. >> WE'VE ALSO, TO GET MILAN IN HERE -- SORRY TO CUT YOU OFF A LITTLE BIT; WE'RE A LITTLE TIGHT ON TIME ON THIS ONE. WE'VE ALSO GOT A SITUATION, MILAN, WHERE WE HAVE PRESS ORGANIZATIONS NOW IN A SUIT TO GET INFORMATION. YOUR SENSE OF THAT, AND WHY IT HAS HAD TO GO THIS FAR TO GET SOME INFORMATION. WHAT'S YOUR SENSE OF WHERE THIS COULD POSSIBLY GO FROM THE PRESS SIDE? >> WELL, WHO KNOWS WHERE A LAWSUIT CAN GO, BUT I THINK THIS SYMBOL OF FILING IT IS IMPORTANT BECAUSE THIS THING HAS BEEN CLOAKED IN SECRECY. AT THE U.S. DISTRICT COURT HEARING FOR AN INJUNCTION THAT THE 8 OF THESE 15 PROVIDERS TRIED TO GET THEIR MONEY BACK AND THEY LOST THAT CASE, THEY MADE THE POINT THAT ONLY A HANDFUL OF CASES FROM EACH PROVIDER WERE ACTUALLY EXAMINED; 150. AND SO YOU'RE LOOKING -- >> THAT'S A KEY THING, IT SEEMS TO ME. >> YEAH, THEY SAY IT'S A RELEVANT SAMPLE, MUCH LIKE WE TALK ABOUT A POLL. BUT NEVERTHELESS, THERE ARE TENS OF THOUSANDS OF CASES, AND THEY LOOKED AT A RELATIVELY SMALL SAMPLE AND CAME UP WITH THIS $36 MILLION IN POTENTIAL FRAUD. SO, SUING TO GET TO THE BOTTOM OF THIS IS AT LEAST SYMBOLICALLY IMPORTANT. >> SURE. WE'VE ALSO GOT SOME LEGISLATORS OUT THERE TALKING ABOUT AN EXTRAORDINARY SESSION TO GET TO THE BOTTOM OF THIS. YOU'VE WRITTEN A PIECE ABOUT THIS VERY SUBJECT. TALK ABOUT WHAT THE PLAN IS ON THAT AND WHY THAT MAY OR MAY NOT WORK. >> WELL, I CALLED MY PIECE EXTRAORDINARY NONSENSE, BECAUSE IT'S NOT GOING TO HAPPEN. THEY'VE BEEN TALKING ABOUT THIS FOR THREE MONTHS. I SEE SENATOR BILL O'NEILL FROM ALBUQUERQUE FREQUENTLY IN SANTA FE, SAW SENATOR MICHAEL SANCHEZ LAST WEEK, AND THEY'RE BOTH TALKING ABOUT IT. WHERE ARE THE VOTES? THEY NEED ONE REPUBLICAN TO COME ALONG WITH ALL THE DEMOCRATS IN THE SENATE. DIFFICULT, BUT NOT IMPOSSIBLE. BUT THEY NEED FIVE REPUBLICANS TO GO WITH ALL THE DEMOCRATS IN THE HOUSE, AND THEY'LL NEVER GET IT. >> AND BEYOND THAT, DIANE, THERE'S ANOTHER STEP THAT INVOLVES THE GOVERNOR. LET'S ASSUME THIS DOES HAPPEN AND SOMETHING GETS PASSED. >> THE GOVERNOR VETOES IT, AND THERE IS NO PROVISION IN LEGISLATIVE RULES OR REGULATIONS OR STATUTES TO PROVIDE FOR A VETO OVERRIDE SESSION, SO THEY'RE LITERALLY FORCED TO WAIT UNTIL JANUARY ANYWAY. ONE OF THE THINGS THAT I THINK, PIECES, THAT EVERYBODY KEEPS MISSING IS, WHAT IF THE SECRETARY HAD NOT HAD THE AUDIT DONE AT ALL, AND THEN WE COME TWO OR THREE YEARS AGAIN DOWN THE ROAD AND WE FIND OUT THAT NOT ONLY IS THERE MASS FRAUD AND CORRUPTION, BUT WE END UP LOSING ALL OF OUR MEDICAID FUNDING NOT JUST IN BEHAVIORAL HEALTH, BUT EVERYTHING ELSE. I WOULD NEVER SAY, BECAUSE I HAVEN'T SEEN IT -- I DO BELIEVE THAT SHE FOLLOWED THE LAW AND GAVE IT TO THE ATTORNEY GENERAL. EVEN THE ATTORNEY GENERAL ONLY GAVE A HEAVILY REDACTED COPY. SO IT'S LIKE, OKAY, SHE IS DAMNED WHETHER SHE DOES OR DOESN'T. AND WHAT LITTLE I KNOW ABOUT THIS PERSON -- FIRST OF ALL, THIS IS THE MOST DIFFICULT CABINET JOB IN SANTA FE. I DON'T KNOW WHY ANYBODY WOULD WANT IT. YOU HAVE TO REALLY CARE ABOUT THE PEOPLE THAT YOU'RE SERVING, AND I BELIEVE THAT OF HER, AND I'M JUST GOING, THERE'S NO PERFECT WAY TO HAVE MADE THIS NOT HAPPEN, UNFORTUNATELY >> SURE, THE DISRUPTIONS AND ALL THAT KIND OF STUFF. NOW, IN A MOMENT WE'RE BACK TO TALK ABOUT ATTITUDES AND PERCEPTIONS OF NEW MEXICANS ON EVERYTHING FROM MEDIA TO BIG CHAIN RETAIL STORES.