Reports possible soon on some mental health fraud

October 24, 2013 • State News

SANTA FE, N.M. (AP) — Attorney General Gary King said Thursday his office may soon finish investigations into fraud allegations against some behavioral health providers shut off from Medicaid payments by Gov. Susana Martinez’s administration.

King told the Legislative Finance Committee that he hoped to issue reports before the end of this year on some of the 14 nonprofit organizations that in late June were suspended from receiving Medicaid reimbursement for mental health and substance abuse services. He cautioned lawmakers that it could take longer, however.

The Human Services Department referred allegations of fraud, mismanagement and overbilling to King’s office for investigation. Details of the allegations have not been publicly released.

“We have some cases where we have [auth] made significant progress but we aren’t ready to report on the outcome of those yet,” King told lawmakers.

Legislators are upset that providers weren’t given a chance to review and respond to the allegations before the state froze their payments. Lawmakers also have expressed worries about a disruption of services for needy New Mexicans even though the department has contracted with Arizona companies to take over for the suspended providers.

King wouldn’t speculate on when investigators would complete their review of allegations against all the providers. He said investigators have collected a mountain of documents that must be examined and are interviewing staff and clients of some providers.

“I don’t know that we can go a lot faster,” King said.

There are a range of possible outcomes from the investigations other than criminal fraud requiring prosecution, he said. There could be overbillings or civil fraud, in which the state could try to recover money from the providers. It’s also possible that no wrongdoing will be uncovered.

In response to a lawmaker’s question, King acknowledged the mental health provider dispute could potentially continue for years if there are lawsuits or prosecutions.

The department has said it concluded there was evidence of fraud — enough to forward to the attorney general for investigation — based on information from a company that manages billings for the state’s behavioral health program. The information came from whistleblowers and an audit done by Boston-based Public Consulting Group.

The agency commissioned the audit by the private firm. However, only heavily redacted portions of it have been released publicly. King said some portions of the audit can’t be disclosed because of the ongoing investigation.

“The audit itself is not likely to be the basis for criminal charges. It is a starting point,” King said.

State Auditor Hector Balderas said his office has independent auditors reviewing the department-commissioned audit to determine whether its statistical analysis is valid. There’s also a review to determine if the department has adequate procedures to identify fraud and safeguard federal money, which accounts for the largest share of Medicaid.

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