July 27, 2015

HSD fought back against some overbilling accusations

Auditors found over $16 million in alleged overbilling of Medicaid by providers in New Mexico and sought to recoup the funds.

Health MoneyBut the providers of in-home health services didn’t have their funding pulled by the state Human Services Department; instead, the state department went to bat for the providers and they continue to operate.

This is from a report in the Santa Fe New Mexican this weekend, offering a stark contrast between these providers and over a dozen mental health providers.

From the New Mexican story:

The Obama administration audits estimated that four New Mexico home care providers submitted $16.7 million in questionable claims during a period of two years and five months beginning in October 2006. The four providers are Ambercare Home Health, Coordinated Home Health, Clovis Homecare Inc. and Heritage Home Healthcare.

It was a year later that a controversial audit found alleged overbilling by 15 mental health providers. The HSD citing a portion of federal health care reform said these showed “credible allegations of fraud” and cut off Medicaid funding.

Many providers could not operate without the Medicaid funding and shut down; firms from Arizona were brought in to take over the load, but they have begun to leave over fiscal issues.

The comparison between the two is not entirely apples-to-apples. Again, from the New Mexican report:

For the home care providers, federal auditors used a smaller sample of claims — 100 claims worth $115,053 — for its audits. From those samples, they identified $17,242 in questionable payments. They extrapolated that amount to the total number of claims submitted by each provider during the audit periods to estimate the providers were overpaid for providing Medicaid treatments by $16.7 million.

The rationale for the $16.7 million overbilling was criticized by Julie Weinberg, the former Medicaid director for the state, even as similar rationale was used a year later in relation to behavioral health firms.

State Sen. Jerry Ortiz y Pino, D-Albuquerque, has been a frequent critic of the Martinez administration, particularly on the behavioral health audit issue. In an email to the paper, Ortiz y Pino said, “even the casual reader has to be struck by the incredible double-standard and cynicism that Julie Weinberg’s letter reveals.”