December 28, 2016

2016 Top Stories #3: AG clears final behavioral health providers

Attorney General Hector Balderas

Years after the state cut off Medicaid funding to 15 behavioral health providers, citing “credible allegations of fraud,” the Attorney General cleared all providers of the alleged fraud.

AG Hector Balderas made finishing the investigation into the providers a key goal when he entered office in 2015.

Previously: Top ten stories of 2016: 10-6; #5: NM Dems buck national trend, retake House#4: Demesia Padilla resigns

In April, Balderas announced the investigation was complete, with no evidence of fraud in the final two companies.

Balderas previously cleared ten providers in February, and had already cleared two others in 2015.

The allegations of fraud came from a 2013 audit for the state Human Services Department by Boston-based Public Consulting Group.

But Balderas clearing them came too late for some providers, who shut their doors after losing the Medicaid funding for behavioral health services.

The AG’s investigation found $1.16 million in overbilling between the 15 companies. The audit alleged $36 million in overbilling.

HSD has said it will continue to seek recouping the overbilled funds.

“It now falls to the Human Services Department to take timely and appropriate administrative action to resolve this regrettable situation to ensure that tens of thousands of vulnerable New Mexicans receive their critical services,” Balderas said at the time. “The department must find a way to fight fraud that does not put services to the most vulnerable at risk or result in hundreds of New Mexicans losing their jobs.”

Balderas also released the PCG audit, which former AG Gary King and HSD had kept from the public. Even providers who lost their funding said they never saw the audit that led to the allegations of fraud against them before the state cut off their Medicaid funding.

And more news came late in the year.

To fill the hole made by cutting off funding to the 15 New Mexico providers (some New Mexico organizations later resumed providing services), Arizona providers were brought in.

In December, news broke that the fourth of the five Arizona providers was leaving the state.