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.
New Mexico legislators want the Department of Justice to look into the behavioral health shakeup from 2013 after the state Attorney General found no fraud. Senate President Pro Tem Mary Kay Papen of Las Cruces, Senate Majority Leader Michael Sanchez of Belen, House Minority Leader Brian Egolf of Albuquerque, all Democrats, sent the letter. The three received letters from providers who had Medicaid funding cut by the state, and forwarded these letters to the three members of the U.S. House and two members of the U.S. Senate from New Mexico. “The contents of these letters greatly concern us,” the three legislative leaders wrote. “We have also been contacted by constituents, requesting our assistance with accessing behavioral health services over the past two years.”
All 15 of the behavioral health providers that the state Human Services Department cut Medicaid funding from in a controversial action three years ago have now been cleared of allegations of fraud. Attorney General Hector Balderas told legislators Tuesday his investigation into the final two providers found no allegations of fraud. These final two providers are Pathways and TeamBuilders. HSD cut off Medicaid funding to the state’s 15 behavioral providers in 2013, citing “credible allegations of fraud” after the state department contracted an audit with Boston-based Public Consulting Group. Some of the providers shut their doors after the state halted their federal Medicaid funding, causing a shakeup in the behavioral health system around New Mexico.
Another Arizona-based behavioral health provider is leaving New Mexico, officials announced Friday. In the latest departure, 3,000 patients currently in substance abuse, mental health and other behavioral health programs—mostly in Northern New Mexico—will have to find a new provider in 90 days, according to a report in today’s Santa Fe New Mexican. The newspaper reported that Agave Health, Inc. is leaving the state, the third of five behavioral health providers from Arizona to leave the state since the shakeup in 2013. “Today, Agave is faced with an insurmountable obstacle, and after many months of undue financial hardship and the foreseen rate reductions in Medicaid rates, the board of directors has regretfully decided to close Agave Health,” Dr. Heath Kilgore, chief executive officer of Agave, and Jeff Jorde, president of the firm, said in a statement. Agave Health is the third of the five Arizona firms to leave New Mexico since the state signed contracts with them for more than $17 million.
Democratic members of New Mexico congressional delegation announced they are calling on the federal government to investigate the behavioral health shakeup from two years ago. The call came in the form of a letter from two U.S. Senators and two of the three members of Congress. All four are Democrats. The letter to U.S. Department of Health and Human Services Secretary Sylvia Burwell cites Attorney General Hector Balderas’ investigation that cleared 13 of 15 providers; the investigation into the final two providers is still ongoing. Last week, Balderas announced ten more providers were cleared, in addition to the three who had been cleared the year before.
U.S. Rep. Michelle Lujan Grisham said she is “angry” over the behavioral health crisis, a day after the Attorney General released a report clearing ten more providers. Lujan Grisham had previously said in statements to other outlets that she supported an investigation into what went wrong, but spoke to NM Political Report on Tuesday while in a car in Washington D.C. on her way to a vote. “The state needs to investigate exactly how we got here,” she said. State Sen. Howie Morales, D-Silver City, also called for an investigation into the situation. The Democrat from Albuquerque added “someone needs to be held accountable” for the shakeup that put many providers out of business.
Former behavioral health providers and lawmakers spoke out against Gov. Susana Martinez and her administration Monday afternoon over a shutdown of behavioral health providers in 2013. They spoke after a letter from the Attorney General’s office announced an investigation found no fraud from another ten behavioral health providers, bringing the total to 13. Sen. Jerry Ortiz y Pino, D-Albuquerque, a former social worker, said the results are relieving, but came too late. “The news that the Attorney General has exonerated ten more of the agencies accused of fraud two years ago was very welcome but unfortunately comes about two years late,” Ortiz y Pino said during a press conference. He praised the work from the AG’s office since Balderas took over, but also criticized former Attorney General Gary King for not taking swift enough action on the investigation.
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.”
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.
Auditors found over $16 million in alleged overbilling of Medicaid by providers in New Mexico and sought to recoup the funds. But 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.
A behavioral health provider had overbilling issues, but nowhere near the level the state originally claimed when it shut off Medicaid funding to the non-profit. The Santa Fe New Mexican reported that Easter Seals El Mirador, a behavioral health provider had $127,240 in overbilling. The state originally accused the provider of $850,000 in overbilling. The state cut off Medicaid funding from the provider, and more than a dozen others, when it found “credible allegations of fraud” in an audit of behavioral health providers according to then-Human Services Department Secretary Sidonie Squier. Easter Seals was cleared of fraud by the office of Attorney General Hector Balderas in January of this year.