Audit finds likely theft, other problems at Northern New Mexico College

An audit released Monday revealed serious problems at Northern New Mexico College, including probable theft of $200,000. State Auditor Tim Keller said the likely theft by the college’s former director of financial services was among 37 findings in an independent audit of the Española college. Since the college didn’t have enough documentation for the audit to reliably score the school’s finances, the audit received a “disclaimer of opinion,” which is negative. In addition to theft, the audit found “excessive” honorariums paid to the former president, “a general lack of controls over accounting practices, cash handling and capital asset,” and a lack of required code of ethics and/or conduct that all employees would sign. The audit was for the fiscal year ending on June 30, 2016.

APS defends changes to audit group

The Albuquerque Public Schools Board responded to the letter from a national auditing group regarding concerns that the district is weakening its internal audit function. APS Board President Dr. David Peercy’s letter addressed concerns raised by David Jones, a city auditor in Seattle and the Advocacy Committee Chair of the Association of Local Government Auditors. Besides addressing Jones’ concerns, Peercy also took the opportunity to question why APS has become a focus of the national group. “I’m not sure why our internal APS organization has become a national concern of ALGA, as well as perhaps other school districts, but we do appreciate being made aware of concerns from any organization,” Peercy wrote. NM Political Report first reported on the letter from the national organization on Monday.

Lawsuit: $14 million in new Medicaid fraud ignored in botched behavioral health audits

A former investigator for one of the country’s biggest health managed care providers is accusing that company of profiting from turning a blind eye to fraud against the state. 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 OptumHealth took home 28 percent of the wrongly reimbursed Medicaid claims.

OptumHealth is the subsidiary of UnitedHealth that manages New Mexico’s Medicaid dollars. Clark faults OptumHealth of never having a proper system in place to perform her chief task—catching Medicaid fraud. “Optum was not set up to detect the fraud claims submitted by providers,” Clark’s attorney, Maureen Sanders, told NM Political Report.

Audit: Lovelace Health Plan overbilled Medicare Advantage

An audit that included a healthcare plan in New Mexico found overbilling of a Medicare program. The healthcare plan in question is from Lovelace Health Plan. The audit showed that the overbilling occurred through Medicare Advantage Plans, which use a risk score to determine how much to bill. The Center for Public Integrity originally requested the audit findings under the Freedom of Information Act, but didn’t receive anything until the organization filed a lawsuit to see the records. Fred Schulte, the reporter who has been at the forefront of the battle to obtain the records, spoke with New Mexico Political Report over the phone about the audit and what he finally received.