Company involved in behavioral health shakeup faces suits

The company responsible for oversight of the 15 behavioral health providers that lost funding for alleged Medicaid fraud is now itself facing lawsuits over alleged fraud. OptumHealth faces three lawsuits over alleged malfeasance in its contract with the state to oversee the state’s Medicaid program. Of the 15 companies that the state Human Services Department, […]

Company involved in behavioral health shakeup faces suits

The company responsible for oversight of the 15 behavioral health providers that lost funding for alleged Medicaid fraud is now itself facing lawsuits over alleged fraud.

OptumHealth faces three lawsuits over alleged malfeasance in its contract with the state to oversee the state’s Medicaid program.

Of the 15 companies that the state Human Services Department, citing an audit by Public Consulting Group, said had “credible allegations of fraud” already 13 have been exonerated by the state Attorney General after investigations.

It was Optum’s efforts to root out alleged fraud and waste that led to the shakeup. The shakeup included the state bringing in Arizona companies to take over for the New Mexico providers that no longer had funding to continue, some of which have went out of business.

The Santa Fe New Mexican reported on the lawsuits on Tuesday.

One of the lawsuits would be familiar to NM Political Report readers. Earlier this year, NM Political Report reported on a lawsuit by former Optum employee Karen Clark.

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 Optum took home 28 percent of the wrongly reimbursed Medicaid claims.

Clark said that when she brought up the alleged fraud to superiors, she was told to back off.

The New Mexican outlined a lawsuit by Valerie Tafoya. She was once the senior fraud investigator at Optum and says when she found $4 million in possible Medicaid billing errors, she was told to keep quiet.

She did not and says she instead went to the Attorney General’s office; she says she was then fired.

A third lawsuit is from one of the Arizona companies brought in to fill the coverage gap created by the funding freeze for the 15 new Mexico providers.

From the New Mexican:

La Frontera Center Inc. alleges OptumHealth and other UnitedHealth Group subsidiaries had accused providers of fraud to cover up their own inability to pay Medicaid claims to those providers. The companies have asked to halt the lawsuit in favor of arbitration.

Optum told the New Mexican there was no wrongdoing in the Tafoya or Gonzales cases.

We're ad free

That means that we rely on support from readers like you. Help us keep reporting on the most important New Mexico Stories by donating today.

Related

Governor to call special session for public safety legislation this summer

Governor to call special session for public safety legislation this summer

Gov. Michelle Lujan Grisham announced that she will call the Legislature into a special session this summer to address public safety legislation that did…
Emily’s List endorses seven candidates for Legislature

Emily’s List endorses seven candidates for Legislature

Emily’s List, a nonprofit that supports women candidates and reproductive rights, endorsed seven incumbents facing general election opponents in New Mexico legislative elections. All…
Equality New Mexico endorses 15 legislative candidates

Equality New Mexico endorses 15 legislative candidates

A New Mexico-based LGBTQ rights organization endorsed 15 candidates for state House and Senate seats for the 2024 elections.  Marshall Martinez, executive director of…
Sandia researchers look at ways to store hydrogen underground

Sandia researchers look at ways to store hydrogen underground

As the world looks to decarbonize, governments are promoting hydrogen, a somewhat controversial energy source, as an important component of that effort. But that…
American Rivers ranks waters in New Mexico as the most endangered in the country

American Rivers ranks waters in New Mexico as the most endangered in the country

New Mexico rivers are the most endangered in the country, according to the annual report from American Rivers. This is because of two U.S.…
Economic Development Department announces Energy Transition Act funding awards

Economic Development Department announces Energy Transition Act funding awards

Funding to assist with economic development following the closure of the San Juan Generating Station will be distributed to four projects in San Juan,…
Amid new graduation requirements, what do high schoolers want to learn?

Amid new graduation requirements, what do high schoolers want to learn?

By Margaret O’Hara, The Santa Fe New Mexican The main things that bring Brayan Chavez to school every day: Seeing, talking to and engaging with…
Special ed teachers hope lawmakers OK pay raises, admin changes

Special ed teachers hope lawmakers OK pay raises, admin changes

By Margaret O’Hara, The Santa Fe New Mexican Brittany Behenna Griffith has a laundry list of adjectives to describe the ideal special education teacher:…
Lawmakers must find consensus on competing education spending plans

Lawmakers must find consensus on competing education spending plans

By Margaret O’Hara, The Santa Fe New Mexican A challenging task awaits New Mexico lawmakers in the next 30 days: Reconciling three very different…
Health workers fear it’s profits before protection as CDC revisits airborne transmission

Health workers fear it’s profits before protection as CDC revisits airborne transmission

Amy Maxmen, KFF Health News Four years after hospitals in New York City overflowed with covid-19 patients, emergency physician Sonya Stokes remains shaken by…
Lujan Grisham, Biden admin announce $10 million in federal funds for tribes, pueblos

Lujan Grisham, Biden admin announce $10 million in federal funds for tribes, pueblos

Gov. Michelle Lujan Grisham announced Friday $10 million in funding from the federal American Rescue Plan Act was awarded to six tribal nations and…
Proposal to curb executive powers moves to House Judiciary

Proposal to curb executive powers moves to House Judiciary

The House Government, Elections and Indian Affairs Committee discussed a potential constitutional amendment that seeks to limit the governor’s executive powers. The committee approved…
Politics and abortion, how much will it matter?

Politics and abortion, how much will it matter?

At the national level, abortion is still a high-stakes issue with both major presidential candidates talking about it in their campaigns, but it may…
How the AZ Supreme Court decision on abortion impacts New Mexico

How the AZ Supreme Court decision on abortion impacts New Mexico

The Arizona Supreme Court ruled on Tuesday that an 1864 abortion ban is enforceable, throwing another state bordering New Mexico into the situation of…
The status of the lawsuit New Mexico joined to remove FDA restrictions to mifepristone

The status of the lawsuit New Mexico joined to remove FDA restrictions to mifepristone

While the U.S. Supreme Court considers the future of access to the abortion medication, mifepristone, another lawsuit against the FDA that would expand access…
Politics and abortion, how much will it matter?

Politics and abortion, how much will it matter?

At the national level, abortion is still a high-stakes issue with both major presidential candidates talking about it in their campaigns, but it may…
How the AZ Supreme Court decision on abortion impacts New Mexico

How the AZ Supreme Court decision on abortion impacts New Mexico

The Arizona Supreme Court ruled on Tuesday that an 1864 abortion ban is enforceable, throwing another state bordering New Mexico into the situation of…
The status of the lawsuit New Mexico joined to remove FDA restrictions to mifepristone

The status of the lawsuit New Mexico joined to remove FDA restrictions to mifepristone

While the U.S. Supreme Court considers the future of access to the abortion medication, mifepristone, another lawsuit against the FDA that would expand access…
Vasquez calls out Republicans for ‘inaction’ on border policy

Vasquez calls out Republicans for ‘inaction’ on border policy

U.S. Rep. Gabriel “Gabe” Vasquez, a Democrat who represents the state’s 2nd Congressional District along the U.S.-Mexico border, cosponsored a resolution on Monday calling…
Politics and abortion, how much will it matter?

Politics and abortion, how much will it matter?

At the national level, abortion is still a high-stakes issue with both major presidential candidates talking about it in their campaigns, but it may…
Politics Newsletter: Early and absentee voting

Politics Newsletter: Early and absentee voting

Good morning fellow political junkies! Early and absentee voting for the June 4 New Mexico primary begins in about a month. The nonprofit election…
American Rivers ranks waters in New Mexico as the most endangered in the country

American Rivers ranks waters in New Mexico as the most endangered in the country

New Mexico rivers are the most endangered in the country, according to the annual report from American Rivers. This is because of two U.S.…

Can the Albuquerque Police Department ever be reformed?

by Joshua Bowling, Searchlight New Mexico In the past decade, reforming the Albuquerque Police Department has cost nearly $40 million and generated 5,600 pages…
Politics Newsletter: Uncommitted primary voting

Politics Newsletter: Uncommitted primary voting

Hello fellow political junkies! Early and absentee voting in the New Mexico Primary begin on May 7. With many voters readying their choice for…

GET INVOLVED

© 2023 New Mexico Political Report