February 8, 2016

AG clears ten behavioral health providers of fraud allegations

Courtesy photo

New Mexico Attorney General Hector Balderas.

The Attorney General’s office cleared ten more behavioral health providers of allegations of fraud years after a shakeup of the state behavioral health system based on “credible allegations of fraud.”

New Mexico Attorney General Hector Balderas. Courtesy photo.

Courtesy photo

New Mexico Attorney General Hector Balderas. Courtesy photo.

A letter from Attorney General Hector Balderas to legislators delivered Monday morning announced that his office’s investigation found no “pattern of fraud for any of the ten completed investigations.”

This brings the total amount of firms cleared to 13.

Balderas’ letter said that his office did find “some regulatory violations” but nothing that rose to the level of what the Attorney General’s office could prove as fraud.

“We came to different conclusions on many of the alleged violations cited in the [Public Consulting Group] report, and ultimately did not find that the violations that we were able to substantiate reflected a deliberate or intentional pattern of fraud,” the letter says.

The letter goes on to say the results will be referred to the state Human Services Department for administrative action on that department’s behalf.

A statement from the HSD public information officer vowed to continue to fight fraud.

“The undeniable facts are that a significant amount of public funding was misspent, and that shortchanged those in need in New Mexico,” a statement by Kyler Nerison said. “The Human Services Department will continue to work diligently to recoup the misspent and overbilled Medicaid dollars that were squandered by the agencies referenced in today’s decision by the AG.”

“The decision to not prosecute clear over-billing and misusing Medicaid funds on things like private planes and luxury travel in the tropics belongs to the Attorney General,” Nerison continued. “We respect but disagree with that decision and continue to believe that those funds should be used to help the people who need it the most.”

HSD shut down Medicaid funding to 15 behavioral health providers in 2013, citing “credible allegations of fraud” in 2013. The “credible allegations” came from an audit of behavioral health providers conducted by Public Consulting Group, or PCG.

The federal law that allows the HSD Secretary to cut off funding also allows for some discretion in cutting off funding.

The ten providers now cleared by the Attorney General’s Office are Border Area Mental Health Services, Partners in Wellness, Youth Development, Inc., Southern New Mexico Human Development, Hogares, Families and Youth, Inc., Counseling Associates, Southwest Counseling Center, Presbyterian Medical Services and Valencia Counseling Services.

Previously, Balderas’ office cleared Easters Seals El Mirador, The Counseling Center and the Service Organization of Youth, of fraud.

Balderas’ office is still looking into two providers, TeamBuilders and Pathways. The letter does not give any indication into when those investigations may be completed.

The investigations came after Balderas sought more funding for outside forensic audit services and issued a request for proposals. RSM was selected after that process.

Balderas filed fraud charges against a now-defunct behavioral health firm last year and a former therapist with a Raton medical provider earlier this year.

HSD previously fought against allegations of overbilling by providers of in-health services, a sharp contrast to the action taken against behavioral health providers.

Balderas released the most-complete version of the behavioral health audit, which was conducted by PCG last year.

HSD has said that there was no interruption in services and pointed to figures that show more people accessing mental health services after the audit and Medicaid freeze than before.

Update: Added statements by Human Services Department spokesperson.

Balderas letter, behavioral health audit