With possible overbilling and so-called “credible allegations of fraud” in hand, the state’s Human Services Department (HSD) said Obamacare required freezing the 15 organizations’ funding during criminal investigations.
Their claim was little comfort to the tens of thousands of people who had medical services disrupted and, in some cases, eliminated. HSD’s claim was also false.
When government acts destructively, journalists have a duty to question, to dig, to find truth and speak it. Some of us did. Federal regulations “give the state discretion in deciding whether to suspend payments and risk disrupting patient care, according to experts, federal regulations and documents,” the news organization New Mexico In Depth reported on July 11, 2013.
In other words, HSD “could have chosen not to abruptly suspend all Medicaid payments” while still initiating investigations, NMID reported.
At the time I was an editor at NMID and assisted on that story, which should have been a game-changer in the public’s understanding of what was happening.
Then came the Albuquerque Journal’s editorial board.
Those “protesting” the Medicaid freeze “are targeting the wrong people,” the editorial board stated on Aug. 1, 2013. “The requirement to suspend payments where fraud is suspected is part of President Obama’s Affordable Care Act.”
The editorial correctly stated that Obamacare changed a “may” to a “must” in federal regulations – as in, “The State Medicaid agency must suspend all Medicaid payments to a provider after the agency determines there is a credible allegation of fraud for which an investigation is pending…”
The editorial even quoted the most relevant part of the regulation to this discussion – “…unless the agency has good cause to not suspend payments or to suspend payment only in part.” Good causes included preserving access to medical services.
But the editorial ignored the “unless.” HSD “is required to suspend all payments,” it stated.
That support for HSD’s fake narrative gave the Martinez administration cover. “See, the state’s real journalists know there was no choice,” became a common social media narrative.
Instead of restoring funding, HSD killed many health organizations and destabilized the statewide system, which has yet to recover.
Four years later, the justification for HSD’s decision has fallen apart. The state attorney general found no fraud. HSD is seeking far less in overbilling reimbursements than it alleged. One Las Cruces organization originally accused of overbilling $2.8 million has to repay just $484.87 – for one claim that lacked documentation.
Armed with hindsight, the Journal’s editorial board flip-flopped last weekend.
“For its part, the state has said it had to take such drastic action to comply with the Affordable Care Act, which requires funding be halted when there are ‘credible allegations of fraud,’” the board’s new editorial states. “OK, except the language also gives the state the option of not doing so if officials believe there is ‘good cause’ for several reasons, including jeopardizing access to services.”
Such a basic statement of fact might have made a difference four years ago. Now it’s too late. A news organization that is called to be prophetic instead aided and abetted a tragedy.
I wrote last year that Martinez owes New Mexicans an apology for devastating our Medicaid-funded behavioral health system. The Journal owes an apology for enabling her to do it.