First vaccine rolls out in New Mexico Monday

The first  batch of COVID-19 vaccines have already arrived in New Mexico. Christus St. Vincent Regional Medical Center in Santa Fe received its first shipment of the first COVID-19 vaccine Monday. Christus St. Vincent was one of 145 hospitals in the country to receive the vaccine Monday, according to the hospital’s Facebook page.

Hospitals expected to begin rationing care before end of the month, say officials

New Mexico has a record-breaking 1,007 individuals in the hospital, according to New Mexico Human Services Secretary Dr. David Scrase. Scrase provided that number during a webinar Tuesday to discuss more in-depth the crisis standard of care. The state experienced technical difficulties, which meant that the event was not aired live over social platforms and that the state could not provide its daily update on additional COVID-19 cases and deaths. Scrase said the state will officially go into the crisis standard of care at hospitals before the end of the month. “In terms of timing, we’re here today because it could be very soon.

COVID-19 hospitalizations grow, hospitals utilizing surge plans

Leaders from Albuquerque hospitals provided an update on the COVID-19 pandemic in their facilities, saying resources are stretched but not yet broken, and said the systems are working together to help patients. Lovelace Chief Medical Officer Dr. Vesta Sandoval said hospitals around the state are seeing an increased number of COVID-19 patients. 

As of Monday, the state of New Mexico reported that over 738 people are being treated for COVID-19 in hospitals statewide. “Everyone’s surge plans are activated,” Sandoval said. “Everybody is evaluating multiple times a day, our status, our bed status, our availability, communicating with everyone within our system, as well as the other facilities within the city and state, trying to have access for the patients that are coming in.”

Dr. Denise Gonzales, the medical director at Presbyterian, said she believed that the two-week shelter-in-place order that began Monday would have a positive impact on the number of hospitalizations. She said Presbyterian facilities are “filled well beyond what is our typical capacity.”

The three healthcare leaders also spoke about the toll the pandemic has taken on healthcare workers as they work to take care of the skyrocketing numbers of COVID-19 patients.” 

All hospitals have already taken measures to expand capacity as part of their surge plans.

The slow-motion unraveling of New Mexico’s Medicaid crackdown

There’s no getting around it. Four years after Gov. Susana Martinez’s administration charged 15 behavioral health organizations with potentially defrauding the state’s Medicaid program, its case has experienced a slow-motion unraveling. No Medicaid fraud was ever found. And those eye-popping estimates that added up to $36 million the organizations had overbilled Medicaid? In the summer of 2017, the Human Services Department (HSD) is seeking drastically lower reimbursements for overbilling the public health insurance program for low-income residents, a review of public records and state court documents has found.

New Mexico tax reform bill faces test in Senate

Those who work on tax policy probably know the saying by the late U.S. Sen. Russell B. Long of Louisiana: “Don’t Tax You. Don’t Tax Me. Tax That Fellow Behind the Tree.” That is the challenge facing Rep. Jason Harper, R- Rio Rancho, as his bill to revamp New Mexico’s gross receipts tax heads to its first Senate hearing on Saturday before the Corporations and Transportation Committee. Harper’s House Bill 412, co-sponsored by Sen. John Arthur Smith, D-Deming, is a years-long effort to calculate what it would cost to eliminate tax deductions, credits and exemptions on some 125 separate economic transactions in dozens of industries.

AG clears ten behavioral health providers of fraud allegations

The Attorney General’s office cleared ten more behavioral health providers of allegations of fraud years after a shakeup of the state behavioral health system based on “credible allegations of fraud.”

A letter from Attorney General Hector Balderas to legislators delivered Monday morning announced that his office’s investigation found no “pattern of fraud for any of the ten completed investigations.”

This brings the total amount of firms cleared to 13. Balderas’ letter said that his office did find “some regulatory violations” but nothing that rose to the level of what the Attorney General’s office could prove as fraud. “We came to different conclusions on many of the alleged violations cited in the [Public Consulting Group] report, and ultimately did not find that the violations that we were able to substantiate reflected a deliberate or intentional pattern of fraud,” the letter says. The letter goes on to say the results will be referred to the state Human Services Department for administrative action on that department’s behalf. A statement from the HSD public information officer vowed to continue to fight fraud.

Lawsuit: $14 million in new Medicaid fraud ignored in botched behavioral health audits

A former investigator for one of the country’s biggest health managed care providers is accusing that company of profiting from turning a blind eye to fraud against the state. Karen Clark, who worked as a senior investigator for a branch of UnitedHealth Group from October 2011 through April 2012, filed a lawsuit accusing Optum Behavioral Health Solutions of giving Medicaid payments to reimburse nearly $14 million in false claims by nine health providers. Clark also alleges that OptumHealth took home 28 percent of the wrongly reimbursed Medicaid claims.

OptumHealth is the subsidiary of UnitedHealth that manages New Mexico’s Medicaid dollars. Clark faults OptumHealth of never having a proper system in place to perform her chief task—catching Medicaid fraud. “Optum was not set up to detect the fraud claims submitted by providers,” Clark’s attorney, Maureen Sanders, told NM Political Report.