June 11, 2015

Another behavioral health provider cleared of fraud

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The Attorney General’s office has cleared the Service Organization for Youth in Raton from Medicaid fraud allegations, though it did find that there was some overbilling.

Health MoneyThe news came on Wednesday, as Balderas sought bids from forensic accounting firms to look into the remaining 12 providers under investigation. In all, three firms have been cleared from charges of Medicaid fraud after allegations of fraud from the state following a 2013 audit that the Human Services Department showed “credible allegations of fraud.”

A former therapist with the Service Organization for Youth was charged with Medicaid fraud six weeks ago.

According to the office of the attorney general spokesman James Hallinan, this fraud was from an employee who was not in management was it was “not systemic.”

Hallinan told New Mexico Political Report that the investigation found overbilling, which was referred to the state Human Services Department for that department’s processes for dealing iwth overbilling.

New Mexico Political Report reached out to a spokesman for HSD on the next steps but did not receive a response.

The state shut off funding because of these “credible allegations of fraud” as allowed by federal law, and an number of the behavioral health providers had to cease operations and firms from Arizona were contracted to take over; now some Arizona firms are leaving the state.

In all, the state said it found $36 million in overbilling.

The Counseling Center of Alamogordo and Easter Seals El Mirador out of Santa Fe were both previously cleared of Medicaid fraud charges by the office of the Attorney General. The two firms are still figuring out what they would owe the state for overbilling that did not reach the levels of fraud.

The audit itself has been controversial from the beginning, mostly because of the secrecy. The audit was not released publicly and judges ruled that the law enforcement exemption in the state Inspection of Public Records Act meant it did not have to be released.

Earlier this year, Balderas released a redacted version of the audit, the most comprehensive release yet. At the time, Balderas also asked for additional funds to complete the investigations more quickly.

Balderas did receive more funding for the investigations during this year’s legislative session.

Hallinan was not aware of any other investigation by other agencies into the Service Organization for Youth.

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