ORDINARY TERROR: COMING OF AGE IN MEXICO NARCO

mexico-violence

____EXCLUSIVE  BY CLAIRE O’BRIEN___________________

First published on Latina Lista by Claire O’Brien at  

  At my school, the students created a gigantic number 43, each candle symbolizing a missing student, so that anybody from the sky — the UFOs, the airplanes, God, perhaps? —  could see and understand the sorrow that the Mexican students are dwelling with. Maybe now the people  will understand why it rains: even the sky is crying .”

Valerie Rodarte,  Mexican university student

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A street of small adobe houses runs through a middle class neighborhood on the outskirts of a Mexican city. It looks peaceful enough at first glance.

But those who live there know better.

To residents who have gazed at the street over time, the signs of a neighborhood transformed by seven years of horrific violence are clear. A big iron gate blocks off the entrance, and curtains are drawn across every locked window. People walk directly from their front doors to their cars or to the bus stop. They don’t go out for strolls. They stand aside for certain of their neighbors and avert their eyes.

And there are no children in sight.

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Inside one of the smallest houses, a girl who grew up playing tag on the street sits at a computer typing an email to an American journalist. Valerie Rodarte has just finished up another week of  a heavy college course load, but she won’t be joining her  classmates  for a night on the town – or a even a study group in the library.Neither will many other students at her university, especially girls.

In fact, until recently, Rodarte hadn’t been outdoors at night in six years
“Parents don’t let kids play outside anymore,” wrote Rodarte, “We were just about the last of those children,or maybe second to last. And even though I’m no longer a child, in general I try to follow my mother’s wishes as best I  can.She tends to get sick or unwell if we’re not all in a place she trusts, and that’s only home.”

Rodarte added that her mother has good reason for her fears:

“It’s dangerous,”she said.

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At 22, Rodarte tends to view life before drug cartel violence as if through a telescope, from a great distance. There were no gates blocking the street ” back then “.  Until 2008, when former President Juan Calderon’s war on Mexico’s powerful drug cartels reached Valerie’s city, her street reflected her universe of childhood, family, and school.

Rodarte’s archaic description of childhood play as “merry” strikes an American ear as melancholy, as she recalls long games of hide and seek, tag, and just kicking a soccer ball around.

“It was safe and fun to play outside in those days.We played a tag variation called Police and Thieves, where we had our “prison” and sent all the bad guys in there,” Rodarte recalled. “If that seems ironic, I’ve heard that children today play that they are drug traffickers.”

She added that the neighborhood children had also been free to walk to the nearby little shops for treats,

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Pollo-Asado

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“Almost everywhere in my street area there is a little shop or food stand run by families who need more income, as jobs are scarce nowadays in Mexico,” Rodarte said,” I remember how much we loved to buy candy, but potato chips were actually the most popular thing. They came with prizes and toys and that’s what made potato chips incredibly loved by children.”

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V A L E R I E   W R I T E S:   A B O UT   8   Y E A R S  O L D

I can’t recall my exact age but I was still a child. It was Christmas. I  received new N64 games—Hey You, Pikachu!, is a vital mention—and I felt cozy at my home, surrounded by good smells, speaking English for the first time of my life, feeling protected, as in a cave in where pleasures abound and where I can finally feel fully protected. My mother’s not in this memory scene I am describing right now, but I know she’s near—that everybody’s near. I know that my family is near, that no one’s far, that I just need to raise my voice to be heard and stop being alone.

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A G E   T W E N T Y – T W O

Violence made me see the worst part of humanity and turned me into a rather distrustful and insecure person; I no longer trust  people much, and I feel bad about a future where I can get shot if I raise my voice higher than I’m supposed to.

I still wonder if the world even cares about us. I mean, Mexico’s not a white country, and we’re not a First World country, so obviously our problems won’t be treated with media coverage like the Charlie Hebdo tragedy. And because our tragedies aren’t  good excuses for war (yet), we won’t be heard as much as we need to be. Thus, our politicians will keep mistreating us from the shadows – because of this impunity.

Most Mexicans think real life lies outside and what we produce is purely crap. People still gush and get excited when they discover that somebody else had a trip to somewhere outside Mexico or to the U.S. For me, it is sadder when Mexicans leave to any American city and forget their own culture.

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When a Nightmare Moves In 

 The city knew what to expect when it became a battleground.

People were terrified before the terror began.

For two years a wave of brutal executions had swept the nation, as Mexico’s powerful drug cartels fought both one another and the corrupt government with which many had long-term relationships.The United States had helpfully trained the bloodiest of these as Special Forces, armed them to the teeth, and returned them to Mexico, where they promptly deserted.

After re-emerging as the notorious Zetas, the cartel cut a swath of blinding terror across the country, skinning people alive, beheading them with chainsaws, and hanging their headless bodies from overpasses.

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” The violence didn’t hit us until 2008, but when it did, it hit hard and quickly.First came massacres of our police force,” reported Rodarte,”and next the doctors fled the city after narcos made public threats against them.”
With relatives escaped to America, and her father gone since childhood, Rodarte’s already small family became even smaller.They hunkered down together – Valerie, her mother and older sister – in the little house the two girls had always known.

Valerie was fifteen years old.

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Rodarte described schools that shut themselves in and “turned their walls into literal prison walls, with the spiky wires on their tops to protect children from any unwanted intruder.”

“I saw my first dead body not long after that.It was lying in the front of the gate in my schoolyard. Since then, I’ve seen so much.” she reported. “My mother no longer wanted us outside, unless it was for an important thing. And if we ever want to hang out with friends, we must be back at a certain hour. So you could say we build a routine that feels like a kind of prison”.

 Shootout Drill

The violence slammed into Rodarte’s family with the first robbery of the bank that employs her mother:

“She tends to be the target of most robbers who assault her bank.  Trust me, it’s terrible when your mother returns, all soaked in tears after surviving yet another robbery – and to know that this will repeat sometime again later. So I tend to live the worst of the city through my mother.”

Rodarte believes that her life has shown her the dark side of human nature:

“All this violence made me discover who were drug traffickers, who weren’t and who were actual people of trust. So you could say I met the dark side of people,” she relected.” I saw how low and cruel can somebody can become, and it made me realize how sometimes civilization tends to be an erroneous concept. I wasted what was supposed to be the prime of my youth because of this imprisoning routine I became used to.”

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Over the past year and a half, Valerie has slowly been adding carefully planned activities to her life – nighttime as well as daily. She doesn’t remain out after dark often, nor stay out late, and she’s intensely aware of friends’ reports of being robbed on the street.

But Valerie wants to live.

“In the end, I don’t think you can keep kids away from each other,”she writes in a tone that sounds almost, well, merry.

Rodarte also had to expand her sphere of daytime activities in order to accomodate the academic requirements of her degree program. She’s breathing bigger these days. Not big. Bigger.

The danger is no less for Valerie and her generation than it was before.

They are just standing into the wind.

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They know that most of Mexico’s people don’t live in adobe houses – however small – with running water and heat, food, clothing, and school.

They live in houses like this one.

But Valerie Rodarte hasn’t forgotten her people. She comes from a generation that can’t forget

EN CALMA TRANSCURRE MARCHA PARA PEDIR EL REGRESO DE DESAPARECIDOS EN GUERRERO

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V A L E R I E   W R I T E S

I turned on the laptop, the name Ferguson — FERGUSON, in caps — popped onto the screen. And this time I knew the world was burning, slowly and painfully. This time I saw that the world is truly flying away, burning, losing itself into the universe, prepared to crash itself into a bigger wall of nightmares. I read the news. I read the anger. I read the poison that was boiling so much for the people of the north. And even though the fabulous world of the Internet offered me a video to understand the judicial side of the Ferguson incident, I declined. I didn’t want to know the hypocritical side, for I knew the social side, which is, frankly, far more important and powerful than the former.

Only then I felt so much smaller, as I used to blame the United States for all of our problems, and then I realized that we’re all just victims from the same monster. Then I saw that we’re not small, but rather little water drops, as those hidden inside of popcorn, slowly heating ourselves in order to explode and, finally, occupy the space we deserved from the beginning and without the lies from the Big Ones.

 I realized that a new culture came, and it was the pop culture, not to be confused with the “popular culture” term, but rather with the new mindset that the world’s getting now that we’re finally meeting the real cause of our problems. A culture that has said “Enough!” and it’s ready to burst and destroy all the injustices of which we’re all victims with just one loud “Pop!” explosion…

I just now wonder how much heat we need so we can finally go “POP!”

When will the pop come…

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NOTE: None of the photos used in this article are specifically associated with Valerie Rodarte. They do not  identify her location in any way, but have been approved by her as representative of her experience. The photos all come from Google Images and are unrestricted.

When the people stole back the books

Don’t get sick or disabled in New Mexico

Cover-MAIN

Anson Stevens-Bollen

Access Peak

How United Healthcare bought access to the governor, won lucrative contracts with New Mexico and avoided scrutiny in the behavioral health care shakeup

March 18, 2015, 12:00 am

During the heat of her first gubernatorial campaign, Susana Martinez used what would turn out to be, in many ways, a prophetic phrase. She wrote in a Sept. 15, 2010, column that the state had lost its prestige due to the “waste, fraud and abuse” of her predecessor’s administration.

A day before NMPolitics.net published the column, Martinez attended a meeting at United Healthcare Group’s Pennsylvania Avenue office in Washington DC, according to campaign records and a source close to the corporation.

And afterward, the company cut a $25,000 check that would eventually land in the coffers of the state Republican Party’s Political Committee, its reports to New Mexico campaign finance regulators show.

The check came, the source says, with a personal thank you note from a United Healthcare vice president named Stephen Heyman to Martinez.

“We enjoyed meeting with you,” read the note from the head of the corporation’s state government lobbying divison, “and look forward to seeing you again soon in Santa Fe.”

“LIKE ANY COMPANY, WE REGULARLY MEET WITH OUR CUSTOMERS TO DISCUSS THE STATUS OF OUR WORK AND WAYS WE CAN EVOLVE OUR PARTNERSHIP TO BEST MEET THE NEEDS OF THE PEOPLE THEY SERVE.”

With swipes of a pen, an insurance company executive in the nation’s capital had given to a state party in New Mexico more money than an adult eligible for Medicaid—the federal program that covers health care costs for low-income individuals—makes in an entire year.

And United Healthcare, thanks to decisions made after Martinez became governor, would be awarded state contracts to oversee taxpayer money that funds mental health services.

“We need a new direction in state government,” Martinez proclaimed in the column, “one that has zero tolerance for pay-to-play deals for affluent special interests.”

An SFR investigation of the relationship between the Minnesota-based insurance giant and Martinez sheds fresh light on her administration’s harsh interpretation of new language issued with the implementation of Obamacare that gave states more leeway to freeze Medicaid payments to health care providers if the state believed “credible allegations of fraud” existed.

On June 24, 2013, in what’s become known as the behavioral health care shakeup, the Martinez administration made a stunning accusation: that “credible allegations” existed to show that 15 nonprofits pro-viding mental health services to Medicaid enrollees defrauded the federal program out of $36 million in a three-year period.

State officials refused to show those providers, and the public, the $3 million audit by Public Consulting Group, a Boston firm, used to justify the allegations. New Mexico contracted with five Arizona behavioral health agencies in no-bid deals for almost $18 million to take over the New Mexico services, pending the results of criminal investigations by the attorney general.

Almost two years after that decision, which affected up to 85 percent of the state’s behavioral health spending and 30,000 patients being treated for those services, none of those providers have been criminally charged with fraud. Two of them have been cleared of criminal wrongdoing after the attorney general said overpayments of Medicaid cash to providers had been a fraction of what the audit alleged. The review raised questions about some practices but found no criminal fraud. Providers have sued the administration for due process violations in cases that are pending in the First Judicial District Court.

Patients from Santa Fe to Las Cruces directly suffered disruptions in care as a result of the shakeup.

Records show OptumHealth—the United Healthcare subsidiary that’s been driving the insurer’s profits—led state officials toward the fraud allegations just as it was pitching to sell its new fraud detection products.

Following Martinez’ historic election, United Healthcare lobbyists and executives would greet administration officials at some of the finest lodges and restaurants in the nation.

Susana Martinez speaks at 2013 fundraiser in Arizona attended by the typical crowd that included insurance  
industry and local business leaders / Courtesy sonoranalliance.com

United Healthcare lobbyists and the head of Martinez’ Human Services Department had been scheduled for a retreat at Utah’s premier ski resort hosted by a political group—and financed in part by United Healthcare’s money. A United Healthcare lobbyist dined with Martinez’ chief of staff at a steakhouse in Las Vegas, Nev. And the law firm of the man who is now one of the company’s New Mexico lobbyists, Mickey Barrnett, also represented Martinez’ advisor Jay McCleskey in child-custody hearings as recently as the summer of 2013.

United Healthcare’s money seemed ubiquitous. The day after the state accused the 15 providers of fraud, United Healthcare announced that it had invested $22 million in three affordable housing communities across the state, including Stage Coach Apartments in Santa Fe. “These new housing developments are models of how business and community partners are working together with government agencies to help improve the lives of New Mexico families,” Martinez said in a United Healthcare press release.

HSD spokesman Matt Kennicott, in response to a detailed list of questions, broadly defended the state’s revamp of its Medicaid program, called Centennial Care and administered in part by United Healthcare, by saying that 185,000 new adults have been enrolled in the joint federal-state program.

Medicaid enrollees, he says, “receive care coordination, meaning that each of their individual needs is assessed and met.” Since the implementation of Centennial Care, he says, “New Mexico has seen an 84 percent increase in the number of behavioral health care consumers being served.”

State officials bristle at the notion that the insurance industry had more sway than New Mexicans in the redesign.

“HSD held seven meetings statewide with more than 674 people in attendance, two tribal consultations with over 229 tribal representatives in attendance, eleven meetings with individual Native American groups or individuals throughout the state, a legislative meeting and hearing, four workgroups that met over 16 hours each with 66 people participating [including advocates],” reads Kennicott’s written statement, “and a dedicated phone hotline, email, and snail mail where more than 94 comments were received, including 7 tribal position papers and positions papers from advocate groups.”

McCleskey would not comment for this story. A spokesman for the United Healthcare subsidiary OptumHealth only emailed a brief statement after a series of phone conversations and written questions. He said he was also speaking on behalf of United Healthcare.

“Like any company, we regularly meet with our customers to discuss the status of our work and ways we can evolve our partnership to best meet the needs of the people they serve,” Optum spokesman Brad Lotterman writes in a statement, after SFR provided the details of the political meetings. “We also work with a wide variety of parties to discuss ways to improve the quality and delivery of health care and to inform policy development.”

Both United Healthcare and Martinez’ political machine benefited financially as that partnership continued to evolve.

A DECADE OF SHAKEUPS

Martinez’ redesign of New Mexico’s Medicaid program harks back to Gov. Gary Johnson’s Medicaid redesign that required federal intervention.

Under Johnson, who served on the Fourth Floor from 1995 to 2003, New Mexico contracted with three insurers to serve as managed care organizations to administer Medicaid cash. The managed care arrangement works like this: The state gives a set monthly payment of Medicaid cash to each insurer so it can cover all its members. A provider treating a Medicaid enrollee bills that insurer for a reimbursement and, ideally, gets paid. The insurers are stewards of the Medicaid money who are tasked to pay for treatments specifically covered by the state-federal program—and only those treatments.

Through the Johnson arrangement, the insurers began denying and delaying coverage to one of the most expensive patient populations in their networks: those receiving behavioral health care treatment.

“The MCOs are in business to make money,” even today, says Dan Ranieri, CEO of La Frontera, an Arizona behavioral health care agency that the state shipped into New Mexico as a replacement agency for the accused New Mexico providers. Ranieri claims the original reimbursement rate it negotiated with the four managed care organizations now handling Medicaid had been too low. “Obviously they’re going to try to buy those services at the lowest rates possible.”

United Healthcare VP Stephen Heyman

When Richardson took office, New Mexico made unique changes to the delivery of behavioral health services- attracting attention across the nation. In 2005, state officials established what ethnographic researchers who conducted an extensive study on the effort would later call a community—based participatory approach to treat behavioral health care patients.

“People with mental illness felt empowered for the first time to have some say in what is often a system that makes choices for them,” says Dede Feldman, a former Democratic state senator who sat on key health committees during her legislative tenure, “not with them.”

The state established local behavioral health groups across the state to advise the New Mexico Behavioral Health Purchasing Collaborative—composed of 15 state agencies that provided mental health treatments in various capacities. Officials encouraged patients and others to participate in the local groups, which would advise the decision-making state collaborative about the unique health care needs of each region. Those in a rural area of the state, for instance, might need transportation services to get to far-flung providers.

“It was a great idea,” says Cathleen Willging, a senior research scientist at the Pacific Institute for Research and Evaluation, who helped author the ethnographic study about the collaborative system, “a promising model.”

Yet research found politics made its way into the local groups. State officials didn’t always listen to the recommendations or provide enough financial support for the various administrative tasks they required. Eventually, participation dropped off.

While the statewide collaborative shaped policies and procedures, it contracted with one company under a managed care arrangement to administer Medicaid dollars to behavioral health providers.

The approach kept behavioral health Medicaid services “carved out” from physical health services so the managed care organization would cover only mental health treatments. Ini- tially, from 2005 to 2009, New Mexico entrusted Value Options with the task of administering the money.

State officials, following concerns about Value Option’s performance, selected Optum for the roughly $370 million annual contract in an agreement that ran from July l, 2009, through June 30, 2013—days after the state accused the 15 providers of Medicaid fraud.

OPTUM SCRUTINIZED

United Healthcare, one of the largest publicly traded insurance companies in the US, is a leader of the so-called Medicaid managed care market. United Healthcare companies have also faced more sanctions than other Medicaid managed care companies, logging at least $2.4 million for 11 fines imposed in seven states in a three-year period, according to the Kaiser Foundation.

Compare those fines to United Healthcare Group’s 2014 profits of $5.6 billion, and it’s easy to see that state government-issued sanctions haven’t always fundamentally threatened the Fortune 500 company’s bottom line.

Kaiser’s data doesn’t include sanctions New Mexico imposed against Optum. Just six months after Optum scored the behavioral health Medicaid contract, the state fined it $1 million. Behavioral health providers alleged it hadn’t been processing their claims in time—sometimes taking months to reimburse them for services.

Problems with Optum didn’t stop there.

On Dec. 29, 2010, Optum sent an alert to providers that it would be “enhancing” its electronic billing claims system through which the providers requested Medicaid reimbursements. The alert was vague.

But just weeks later, providers discovered its implications: Optum began cutting payments to them for outpatient services for the mentally ill meant to help them with life-coping skills. Optum’s imposition of “clinical triggers”—demanding that providers justify the services before being paid for them—had been unilateral.

Officials went as far as saying Optum misled them about the change that resulted in denial of more than $200,000 in claims. Optum initially fought a state-imposed sanction to stop the action. But it eventually agreed to pay up.

“Under OptumHealth, people had tremendous difficulties getting paid, particularly when they first got on the scene,” says Willging, referring to behavioral health care providers.

Providers also say Optum wasn’t always the most diligent auditor.

“OptumHealth came to see us to conduct an audit, once, twice,” during the years that it administered the state’s cash, says Patsy Romero, chief operating officer of Santa Fe’s Easter Seals El Mirador.

“The monitoring shall include regular provider reviews,” reads the Optum contract, as well as “on-site audits to determine provider compliance with clinical and non-clinical requirements.”

Optum spokesman Lotterman wouldn’t address that charge but defends the company using a familiar phrase: “We consistently fulfilled our contractual responsibilities, including helping people get the most appropriate care and reporting potential instances of fraud, waste and abuse to the state for further investigation.”

OPTUM TURNS THE TABLES

Martinez’ campaign, in the spirit of transparency, would release a list of the private donors to a committee that financed the governor’s inaugural celebrations. The usual benefactors, like energy companies, contributed. Yet one donor that had never appeared on her campaign reports made a hefty contribution: United Healthcare, donating the committee’s self-imposed $25,000 limit.

A month later, The Centers for Medicare & Medicaid Services announced a new regulation to give states more leeway in accusing providers of committing “credible allegations of fraud.” In Washington DC, the insurance industry continued its lobbying efforts to support legislation that would strengthen anti-fraud efforts for both private insurance plans and public ones like Medicaid.

The administration began to gear up to fundamentally revamp its Medicaid program. In New Mexico, as a group of patients, providers and advocates convened a Behavioral Health Expert panel that would make recommendations on those changes, state officials solicited advice from the more powerful corridors of the healthcare industry.

In August 2011, emails show, the head of the Human Services Department, Sidonie Squier, planned on attending the Republican Governors Association’s Health Care Policy Summit in Washington DC with 80 “professional peers” from the health care world. They would stay at the Ritz Carlton and discuss topics like “the overarching burdensome regulatory environment” during sessions that mixed state human service department officials with industry representatives like health insurers.

The RGA raises and spends unlimited amounts of cash from its corporate and individual benefactors, like United Healthcare, to help elect GOP governors. Contributing members get a return on investment from that support in the form of access to the politicians.

Hurricane Irene caused the RGA to reschedule the summit, but its policy committee still organized a survey for state officials to assist in the association’s “networking efforts” with RGA members.

On Aug. 24, Dan Derksen, the director of the New Mexico Office for Health Care Reform,sent New Mexico’s responses to an RGA official. He copied Squier and Martinez chief of staff Keith Gardner on the email. One discussion topic listed on the sheet?

“Fraud, waste and abuse.”

The results of the RGA’s questionnaire to state officials would be a Republican Governors Association Public Policy Committee task force paper on Medicaid. States should be given more responsibility in rooting out Medicaid fraud, according to the paper, instead of relying on federal contractors that simply engage in “pay and chase”—trying to find fraud after Medicaid reimbursements have already been paid to providers.

A report to the Legislature about the Public Consulting Group audit that triggered the fraud allegations against the providers would later say that in “early 2012 OptumHealth implemented an enhanced software system designed to more efficiently detect potential fraud, waste, and abuse to assist in monitoring providers within its network.”

But Romero says that “never did we get denials” of any of the billing codes they’d entered into the new software. She says Optum was “setting up a false sense of security.”

In March, around when Optum reportedly began running audits of behavioral healthcare agencies, Squier and Gardner began preparing for a trip to the upscale Deer Valley Resort in Park City, Utah, situated near mountain slopes that local boosters say are host to the “greatest snow on Earth.”

More than 50 corporate representatives whose companies contributed $250,000 (the “statesmen level”) or $100,000 (the “cabinet level”) were invited to listen to speeches from a handful of public officials in Republican gubernatorial administrations during the closed-to-the-press, “very casual and informal” retreat, whose focus, according to the group’s records, was “relationship building.”

For Sunday evening, the first day of the trip, officials scheduled cocktails followed by a buffet-style dinner at the Empire Canyon Lodge, which offers intimate meals cooked in stone fireplaces. Horse-drawn sleigh rides were available, “before and after the speaking presentation” by then-chairman of the RGA, Virginia Gov. Bob McDonnell.

Reese Edwards, then United Healthcare’s Colorado-New Mexico lobbyist, is listed in records as one of the firm’s two “statesmen” for the event, meaning the company paid half a million dollars to send two representatives to it.

Patsy Romero says Easter Seals is only still in business after New Mexico accused the nonprofit of fraud because it provides services paid through a variety of funding sources.

Justin Horwath

In an interview in December, after she left her post, Squier said she didn’t recall the specifics of the retreat. Cell phone records confirm she was in Park City. It’s unclear whether Edwards went.

But Squier made at least one relevant connection. On March 26, 2012, Lee Cowen, a DC lobbyist for Dutko Grayling, emailed Squier, saying it was “great to see you in Utah.”

Cowen wanted to know if Squier would be willing to meet with Cowen and David Javdanof a firm called Alvarez & Marsal on April 16 in Santa Fe. Cowen also suggested that Alicia Smith, a consultant on contract with HSD to help it redesign Medicaid, join them “to see if there’s some way that A&M might be useful to her efforts to help you with Medicaid reform.” (Prior to the Martinez administration, the state had contracted with Smith to monitor Optum after the initial sanctions against the company.)

Alvarez & Marsal is a professional services firm famous for charging Goldman Sachs almost half a billion dollars for managing its bankruptcy after the financial collapse. In 2014, the state of North Carolina awarded the firm a $3.25 million no-bid contract to reorganize its Medicaid program.

When Cowen opened Cowen Consulting in 2012 he listed United Healthcare as a client, yet he writes SFR that United wasn’t his client when he asked for the meeting. A year later, he began helping out with Martinez’ re-election campaign on the Beltway, hosting$5,200-plate fundraisers.

Monday morning at 11 “works best,” Cowen said, replying to Squier. “By the way,” he wrote, “on a totally separate matter, does [New Mexico] procure managed care for Medicaid dental separate from Medicaid medical? Or are they lumped together? I forgot to ask you in UT.”

Just ten days later, the state submitted its Centennial Care plan to the feds, stressing that it sought to deliver Medicaid money through a “single, comprehensive” system of care with incentives for patients “to take a great sense of personal responsibility for their own health and for accessing the system more effectively” as well as administrative flexibility and simplicity in managing the Medicaid system to drive down its bloating costs without cutting services.

Like Gov. Johnson’s plan, this one requested permission for “carved in” behavioral health care with physical health care to better integrate the delivery of services, while calling for transparency in the spending of those funds.

In the coming moths, Squier’s HSD unveiled Centennial Care, and on June 5, Susana PAC, a Martinez political action committee, reported that it’d received $10,000 in contributions from United Healthcare. HSD released a request for proposals that called for four insurance companies to manage the $4 billion program in August of 2012.

By October, Optum alerted HSD officials that it had flagged suspicious billing activity of behavioral health providers. In an already widely publicized email to an HSD official, Optum CEO Elizabeth Martin laid out options of how to handle the allegedly unscrupulous behavioral health providers.

“For example,” she wrote, “OHNM has in its Arizona network outstanding behavioral health providers with over $200,000 in revenue who could assume wholesale management.”

The publication of Martin’s email by media outlets in October 2014 caused an uproar because it indicated that state officials had vetted the Arizona agencies before the Boston-based Public Consulting Group even started its audit.

But there’s a less-quoted line at the end of the email. It’s Martin making a pitch to the HSD official that “in the long term,” Optum, whose contract with the state was set to expire, “has the capability” to ensure program integrity for billings.

“Optum’s state-of-the-art fraud, waste and abuse detection and prevention capability is a leader in the nation,” Martin wrote, “and has been specifically tailored to the NM system.”

In December, Optum announced that it had partnered with a North Carolina firm, SAS Institute, to “further enhance its comprehensive health care antifraud, waste and abuse services.”

The Tar Heel State had previously hired SAS to audit its own Medicaid providers. After those audits, as in New Mexico, Public Consulting Group followed up with an enterprise audit that the state used to justify freezing payments to accused providers. There, as in New Mexico, PCG’s methods of extrapolation faced criticism.

“THIS WAS A RESULT SOMEBODY ALREADY WANTED TO COME TO.”

“This was a result somebody already wanted to come to,” Bryan Davis, an attorney representing the providers in the lawsuits against HSD, says of New Mexico’s allegations against his clients.

Five days before responses to that Centennial Care bid were due, Edwards and Gardner met at an upscale Sin City steakhouse called Botero. Edwards reported on lobbying disclosure forms spending $75 at the steakhouse in “a meeting regarding Medicaid expansion.”

In January of 2013, HSD awarded the four Centennial Care contracts to cover Medicaid enrollees. The state announced that United Healthcare would be one of four companies to administer that $4 billion pot of cash. Albuquerque Business First later reported that three insurers who lost filed a protest to the bid saying the state didn’t properly score the proposals—even alleging that the HSD scoring sheets that evaluated them had been destroyed.

In May of 2014, the New Mexico attorney general’s office secured a ten-count criminal indictment against Optum executive Deborah Gonzales for falsifying Medicaid documents between October 2010 and April 2011. Investigators alleged that she ordered the destruction and alteration of records that documented appeals and grievances from Medicaid clients who had been denied services by Optum—at the same time the state had been scrutinizing its performance, the Albuquerque Journal reported. Gonzales pleaded not guilty on all the fourth-degree felony charges. The case is pending.

Deer Valley Resort in Park City, Utah, was the scene of one junket for coporate lobbyists and New Mexico cabinet officials through the Republican Governors Association.Courtesy Creative Commons

HSD officials, meanwhile, had to figure out which contractor would administer non-Medicaid behavioral health money—which had also been Optum’s responsibility. In December, seven months after that indictment, state officials extended Optum’s nonMedicaid contract.

The 18-month agreement gives Optum the responsibility of handling $29 million in funds to oversee money that goes to programs like outpatient behavioral health care services for New Mexico Correction Department offenders on probation or parole. Optum did not bid on a June 11, 2014,request for proposal issued by HSD for the contract, writes the agency’s spokesman, and the two companies that did respond “were disqualified from the bid because they did not meet mandatory requirements” laid out in the request. “To maintain services, Optum received another contract extension because of this,” HSD’s Kennicott writes, “and HSD is exploring other options.”

The 15 New Mexico providers, none of which have been criminally charged as a result of the audit, weren’t so lucky. Many are still out of business. A month after the fraud allegations, Martin had a “chance meeting” at a Dallas airport with Lorraine Freedle of Santa Fe-based Teambuilders. Freedle and Martin had a history, both previously attending the governor’s inaugural ball using United Healthcare’s allocation of tickets.

The shakeup strained that relationship. Martin wrote a July 12 email to HSD officials to recount the airport conversation. She labeled the email as “confidential.” Freedle, she said, congratulated Martin on her recent marriage. “I said ‘thank you’ and began to walk away,” Martin wrote. But Freedle touched her arm and asked, “What are you all doing?”

“We have always worked [with you] on claims and getting necessary documentation,” Freedle reportedly said. “Why is this different?

“Now you drop in a whole new snoop and sniff system and 15 [providers] are crooks?” Freedle said. “Bullshit. You got it wrong.’’

Editor’s Note: SFR previously reported that the Behavioral Health Expert Panel “recommended against” HSD carving in the delivery of behavioral health care services with physical healthcare services in its revamp of New Mexico’s Medicaid program. While the panel reported “minimal support” to the carve in, it ultimately said in its White Paperthat no “consensus” emerged as to whether behavioral healthcare services should be carved into physical healthcare services. HSD’s submission to the federal government for the redesign called for more transparency in the funding streams for behavioral healthcare services, as the panel requested, and carved the delivery of those services into physical healthcare. Additionally, PCG did not start auditing work in the state in 2012, as SFR previously reported.
 
Email the author at justin@sfreporter.com 

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Mayan Girls Empowered

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LatinaLista — In the small town of Concepción Chiquirichapa in the highlands of Guatemala, two young Mayan girls did an extraordinary thing that gained them international attention. Bucking cultural tradition, Elba and Emelin spoke up for the girls in their community by going directly to the town’s leading politician for help. The girls convinced their local mayor to help support girls in getting an education, finishing school, not having teen pregnancies and preventing violence towards girls.

Elba and Emelin drafted a policy for the mayor. He and other government officials were so impressed that because of the girls’ hard work, a special department was created in the town to help women and girls. The new department was awarded a budget of over $200,000.

Elba and Emelin’s story was made into a 16-minute documentary (already garnering film festival awards) and aptly titled “Poder.” Directed by Emmy-winning filmmaker, Lisa Russell and Elba and Emelin playing themselves, Poder takes viewers alongside the journey of how two indigenous girls from Guatemala not only found their voice to speak up but made themselves heard and accomplished their goal.

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New threats challenge Mexico’s Teotihuacán

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LatinaLista — Mexico’s pyramid Teotihuacán is not just a popular tourist destination and iconic symbol of Mexico’s significance in the annals of ancient history but it’s also an archeological treasure living on borrowed time.

Located 25 miles northeast of Mexico City, Teotihuacán is a pre-Columbian Mesoamerican city renown for its long-standing structures and well-preserverd murals. However, restorers from the country’s National Institute of Anthropology and History (INAH) reveal a sad reality: “Forty percent of the murals have disappeared or have been damaged in the past decade.”

Speaking to the Mexican newspaper Excelsior, the restorers attribute the loss of the murals to three things: the use of inadequate techniques in the past, budget constraints and urbanization. ”

As an example of the decline, the restorers cite an area in Teotihuacán known as Atetelco, “where a decade ago there were at least 100 murals, of which 78 have already been lost.” On top of that, anonymous sources tell the newspaper that of the 80 murals removed from the site in the 1960s and placed at the Teotihuacán mural museum, the majority of them are not in a perfect state of conservation.

Though existing murals are disappearing, the good news is that new ones are being discovered. A new mural was found last November in the southwestern corner of the Palace of Quetzalpapálotl, painted between 250 and 300 AD. The new mural is exciting researchers because it shows a procession of several warriors with unique characteristics, namely a distinct bundle carried on the bodies of the warriors and which archeologists have found in the Mayan area.

However, though the discovery of new murals may be able to replace the disappearance of others, there’s nothing that can replace the pyramids of Teotihuacán when they disappear. In March, New Scientist reported reported that Mexican scientists found that the largest of the complex’s pyramids, the Pyramid of the Sun, was in danger of collapsing like a “sand castle.”

The pyramid is covered with three million tons of volcanic rock built around an interior of nothing more than a “mound of earth.” On a quest to find interior chambers, the scientists didn’t find any in the Pyramid of the Sun but did discover that “the density of the earth in the pyramid is at least 20 percent lower on one side than the other.”

The consequence is that unless something is done the pyramid is in danger of collapsing in the future — and taking with it a window into humankind’s history

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