Women and men of the news media, apparently it is our job to explain a complicated issue, even if we have few of the facts.
Gov. Susana Martinez said so, according to a recent column by Walt Rubel, the managing editor of the Las Cruces Sun-News.
Rubel wrote of a recent sit-down with the governor and recounted suggesting “the state has taken a 'trust us' approach to the complicated issues surrounding its decision to freeze funds to mental health clinics accused of fraud.”
"Yeah, it's your job to make it clear," she shot back, according to Rubel's account.
I don’t know about you, but I’m choosing to interpret the governor’s comment as an olive branch to the media rather than a sarcastic – even condescending – quip.
What I hear you saying, Madame Governor, is that you want to help us clear things up for the public.
So I have a few suggestions on how you can help.
First, tell officials in your administration to start answering the media’s questions. Tell them to turn over requested public documents and not to deflect tough questions with non-responsive talking points.
There’s no quicker way to make a reporter angry than to give him or her a statement that doesn’t even pretend to answer his or her questions.
No question, your administration has a compelling narrative: the Martinez administration is going after Medicaid fraud.
To protect taxpayer money and to root out scammers wherever they are is a worthy endeavor. More power to you!
As compelling as your anti-fraud narrative is, however, it doesn’t tell the whole story, Madame Governor. What I mean to say is that the public still doesn’t understand how your Human Services Department came to decide to suspend payments against all 15 organizations. Nor does your anti-fraud narrative explain how the state found “credible allegations of fraud” against each of the organizations that were audited.
So far, all the media has heard from your administration is "trust us" about what the audit says and doesn’t say. The 400-page document remains undisclosed.
Between you and me, Madame Governor, journalists don’t do “trust us” really well, especially when it comes from people in power, whether they are Democrats or Republicans, conservatives or liberals.
Dispensing with the niceties
I thought you’d like to know this, seeing as how I am a long-time reporter and am intimately familiar with our species who, for the most part, I admit are a pesky, irritating bunch of inquisitors.
When documents aren’t turned over and agency spokespeople stop answering questions, any reporter worth his or her salt begins to suspect that there is a reason nothing is being said, and it’s because either officials are incomprehensibly incompetent or they are hiding something.
If you truly want to help the media clear things up, and in so doing give New Mexicans a clearer picture of what’s going on, help us shake loose a few facts from state agencies that work for you.
Ah, I know what you’re going to say. Attorney General Gary King’s office is investigating "credible allegations of fraud" against the 15 organizations that were audited. Let’s dispense with the niceties, shall we, Madame Governor? It’s hard to argue the sanctity of the investigative process when in all likelihood someone who works for you already has shown a willingness to part with details, albeit in carefully controlled circumstances.
For example, someone with access to the undisclosed audit leaked portions to the Albuquerque Journal that suggested activity by one of the 15 organizations bears closer scrutiny. (Before you protest innocence, I know folks at the Attorney General’s Office, Office of the State Auditor, the auditing firm – Public Consulting Group Inc. (PCG) – and OptumHealth also possess the document. But a leak from your administration makes the most sense politically. The story advances your anti-fraud narrative.)
Anyway, it was a good story. Wish we’d gotten the details here at New Mexico In Depth.
But where is the same information for the other 14 organizations also accused of “credible allegations of fraud?”
For nearly two weeks, I’ve asked your Human Services Department (HSD) that question, in a nice way. (I thought you’d like to know.) And I’ve gotten zilch, zero, nada.
I think it’s a reasonable question. What I don’t understand is your administration’s silence on the issue.
Acting appropriately or 'juking the stats?'
Learning how the state made the determination that there were “credible allegations of fraud” against each of the 15 organizations would go a long way to help us in the media more accurately report what’s actually going on in a very complicated situation.
From reading federal regulations you know that “credible allegations of fraud” is not the equivalent of actually discovering Medicaid fraud.
“Credible allegation of fraud” is a new threshold the 2010 health care law created. It gives states more authority to pursue Medicaid fraud by lowering the threshold from “reliable evidence of fraud.”
To quote from the Feb. 2, 2011 edition of the Federal Register:
“In this case we believe that there is a substantive difference between the threshold level of certainty or proof necessary to identify a ‘credible allegation’ versus the heightened requirement of ‘‘reliable evidence’’ in the current regulation.” (page 5,932)
Not to go all Bartlett’s Quotations on you, but here’s another passage from the Federal Register:
“In many cases, what constitutes a ‘credible allegation’ must be determined on a case-by-case basis with the State agency looking at all the factors, circumstances, and issues at hand.” (page 5,932)
And yet another:
“We will neither seek to limit what States may determine qualifies as a ‘credible allegation of fraud’ nor will we require States to consult with HHS in making such a determination.” (page 5,935)
So my take from reading these passages is that a state has some flexibility in how it chooses to define “credible allegation of fraud.”
But if I hadn’t come to that conclusion after reading federal regulations, I certainly would have after reading the executive summary of the otherwise undisclosed 400-page audit – a small portion that actually was released by the Attorney General’s office.
According to the summary, PCG, the firm your HSD commissioned to audit the 15 organizations, acknowledged it could not determine a “credible allegation of fraud” from what its audit had found. Only the state has that authority.
Think about it, Madame Governor.
Releasing a detailed explanation of how the state reached that conclusion in the case of each of the 15 organizations could go a long way toward neutering your critics’ complaints if your administration did things appropriately. On the other hand, it could throw fuel onto the fire of protest if the explanation reveals that your administration did the state-government equivalent of “juking the stats” to reach certain conclusions.
I don’t care either way. Trust me, Madame Governor, when I say I care much more about how vulnerable New Mexicans are affected by these decisions than how you or your critics come out looking if all the information is released. The political discourse around this issue, as with many political elections and most public debates, is shallow, short on facts and tilted toward scaremongering.
Answering a question I didn't ask
I’d like to pose another question while I have your ear, Madame Governor, because, well, your administration hasn’t really been in a sharing mood lately, at least with NMID.
Why did the state seek "credible allegations of fraud" against all 15 organizations despite audit findings that ranked some of those entities as less of a financial risk than others?
According to the executive summary released by the Attorney General’s office, the auditing firm PCG, with help from your Human Services Department, developed scorecards for each of the 15 audited organizations.
Using those scorecards, PCG then grouped the organizations into risk tiers, with 1 representing the least risk and 4 representing the most.
PCG grouped eight of the 15 providers in Tier Two, a category for which the firm recommended the state provide training and clinical assistance as needed and, potentially, embedded clinical management to improve processes, according to the summary.
The other seven organizations were grouped into Tier Three, a sign that PCG had found more serious problems. The firm recommended for these organizations training and clinical assistance as needed; the potential for embedding clinical management to improve processes; and a possible change in management, according to the summary.
(You can click here to read the 18-page summary. The Risk Tier categories, and the grouping of organizations, in on page 6. As you will see, the summary doesn’t identify any of the providers when rating their risk threat.)
I explain all of this to you, Madame Governor, because I have repeatedly asked your Human Services Department in writing to explain this. To date, HSD has not answered my questions.
HSD spokesman Matt Kennicott did send me a statement four days after I sent an email asking for an explanation. Here's what it said:
“We’re not going to turn a blind eye to fraud, waste, and abuse in the Medicaid system. There has been broad agreement that we are following the law in response to the serious findings that approximately $36 million in funding to help those in need was misspent and not used to properly provide behavioral health services. Our top priority throughout this process is to ensure that we are protecting consumers, and that entails requiring that Medicaid dollars are used to support them and nothing else.”
The statement made me laugh, if you must know, Madame Governor. As I said above, kudos. You’re cracking down on Medicaid fraud. But my question didn’t ask if going after fraud was a good use of the state’s time. I asked for an explanation of how the state went about making important decisions.
I responded to HSD’s statement by repeating my questions. That was a week ago, Madame Governor. I haven’t heard back.
Do people in your administration think I’ll go away because they don’t answer my questions? I once made Gov. Bill Richardson’s press people so angry that one spokesman yelled at me in the governor’s office. Seems I had driven the press office crazy because I had followed Richardson to as many public events as I could over several weeks to ask the same question over and over again, which his press office eventually answered. True story.
Those things you aren't saying
In closing, Madame Governor, if you are indeed serious about helping us in the media clear some things up, tell the HSD and other state agencies not to respond to our questions with statements that make all of us wonder if your administration is waging a political campaign rather than engaging in an important policy discussion.
And remember this: Those of us in the media who are old enough to have covered our share of complicated stories and juicy scandals notice the silence in all those words that add up to so few answers.
Call it some over-developed sense of inquisitiveness, but, suddenly, those things you aren’t saying become as significant, sometimes more so, as what you are saying.
Thanks for letting me bend your ear, Madame Governor. Hope you’re doing well. We in the media are counting on your help.