NM probe of Medicaid services could take months

July 17, 2013 • State News

ALBUQUERQUE, N.M. (AP) — State Attorney General Gary King said Wednesday it could take several months for his office to complete an investigation of overpayments and possible fraud by behavioral health providers in New Mexico’s Medicaid program.

King told the Legislative Finance Committee his office hasn’t made a determination about the allegations forwarded to his office by the Human Services Department. There are 17 investigators assigned to the case.

The department froze payments last month to 15 nonprofits that provide mental health and substance abuse services after an audit found what the agency said was a high rate of billing problems and possible mismanagement.

King said his investigation of the allegations would determine whether there’s evidence of fraud justifying criminal prosecutions or possible civil actions [auth] against the behavioral health providers.

“I think it would be an abrogation of my responsibility not to investigate those,” King said.

Human Services Secretary Sidonie Squier defended her agency’s action in testimony to the committee and assured lawmakers that steps were being taken to prevent an interruption of services to patients. Contracts have been signed with five providers from Arizona to step in and provide assistance.

Squier said the department has restored full or partial funding to three of the New Mexico behavioral health providers after they asked for exceptions to the Medicaid payment freeze. Similar requests from other providers were denied.

Senate President Mary Kay Papen, D-Las Cruces, said she worried the department’s freeze would cause nonprofit providers to go out of business.

“I don’t believe that all 15 of these agencies are egregious and have abused the system to the point of calling it total Medicaid fraud,” said Papen.

Lorraine Freedle, co-founder and chief clinical officer of TeamBuilders Counseling Services, criticized the department for not working cooperatively with the providers before suspending their Medicaid payments. She said TeamBuilders had done nothing wrong.

“It is the end of the line for TeamBuilders. As of next week we’re going to need to turn our life’s work over to an Arizona company,” said Freedle.

Freedle said the department’s transition plan with the Arizona firms was seriously flawed and the companies weren’t ready to provide necessary services.

Eight of the nonprofit providers have asked a federal court to lift the state’s suspension of Medicaid patients. U.S. District Court Judge Christina Armijo heard arguments in the case on Wednesday but didn’t immediately make a decision.

Also Wednesday, State Auditor Hector Balderas said he obtained a subpoena from a state district court in Santa Fe to force the department to provide his office with the audit that raised questions about the behavioral health providers. The department had refused to release the audit, saying that could jeopardize the investigation by King’s office. The audit was done by a private firm for the department, which administers Medicaid.

Balderas said, “I am disappointed that I have been forced to take legal action to prevent the obstruction of a thorough audit of these taxpayer dollars.”

Related Posts

Leave a Reply

« »