Three more nonprofits that had Medicaid funding cut off by the Human Services Department in 2013 have filed suit against the state. The Albuquerque Journal reported on the new lawsuits. The three new nonprofits suing the state bring the total to ten. The Journal reports that it is likely the three suits will be consolidated in federal court with the other seven. More from the paper: The lawsuits contend the nonprofits – which provided services to the mentally ill and addicted – were denied basic due process when the department cut off their funding, determined there were “credible allegations of fraud” against them and referred them to the attorney general to be investigated. The department said an audit of 15 providers it commissioned from Boston-based Public Consulting Group identified more than $36 million in overbilling from 2009 to 2012, widespread mismanagement and possible fraud.
The Attorney General’s office has cleared the Service Organization for Youth in Raton from Medicaid fraud allegations, though it did find that there was some overbilling. The news came on Wednesday, as Balderas sought bids from forensic accounting firms to look into the remaining 12 providers under investigation. In all, three firms have been cleared from charges of Medicaid fraud after allegations of fraud from the state following a 2013 audit that the Human Services Department showed “credible allegations of fraud.” A former therapist with the Service Organization for Youth was charged with Medicaid fraud six weeks ago. According to the office of the attorney general spokesman James Hallinan, this fraud was from an employee who was not in management was it was “not systemic.”
New Mexico Attorney General Hector Balderas announced on Wednesday that his office is looking for private investigation firms to help with the investigation of 12 behavioral health providers in New Mexico. According to a statement from the Attorney General’s office, a request for proposals (RFP) was issued earlier this month for forensic audit firms. Balderas said the RFP is an effort to expedite his investigation into providers accused of fraud by the Human Services Department. “Expanding the pool of expertise to work with our staff will allow our investigation to proceed even more quickly and efficiently, which has always been my priority,” he said. The investigation of 15 behavioral health providers goes back to an HSD audit that found possible cases of client overbilling and misuse of Medicaid funds. Soon after the audit, the state froze payments to the providers accused of fraud, and companies from out of the state were brought in to take over.
Nearly two years after a Medicaid funding freeze sent New Mexico’s behavioral healthcare system into a tailspin, the full Senate on Tuesday lent bipartisan support to a bill meant to stave off such crises in the future. Senate Pro Tem Mary Kay Papen, D-Las Cruces, sponsored HB 55, which she said will improve the way the state deals with healthcare providers. Responding to questions from Sen. Gay Kernan, R-Hobbs, Papen said the primary differences between her proposal and the paradigm in which the state’s been operating boil down to a few key words: transparency and due process. Current law, said Papen, “is tilted in favor of state, and it’s calculated to make providers’ responses onerous.”
For example, when the state Human Services Department conducted an audit of 15 behavioral health providers back in February 2013, the results pointed to problems including Medicaid overbilling and possible fraud. The state’s response was to immediately freeze payments to all 15 affected agencies.
The Human Services Department is the part of the executive branch that is tasked with deciding what “credible allegations of fraud” are for organizations that use Medicaid funds. New Mexico learned that after the funding was cut off for 15 behavioral health providers following an audit in 2013. The audit remained largely under wraps until Attorney General Hector Balderas released the audit on Thursday afternoon. New Mexico Political Report asked the Human Services Department for a reaction to the news. Here is the emailed response from department spokesman Matt Kennicott, in full:The AG is the investigative entity.
Attorney General Hector Balderas released a version of the behavioral health audit, the most complete version released so far. At the press conference on Thursday, Balderas also spoke about his request for additional funding that he said would speed forward the investigation by years. The controversial audit took place in June of 2013 and efforts by media and open government advocates to force the release of the audit through the state’s Inspection of Public Records Act have largely fallen short. Courts have said the state does not have to release the audit under the open records law’s “law enforcement” exception. This makes documents part of an ongoing investigation not subject to release through IPRA.
The state Medicaid director is leaving her position to take a job with a private contractor that was prominently involved in the controversial takeover of behavioral health providers that took place last year. The Santa Fe New Mexican first reported the news that Julie Weinberg will be moving to a position with OptumHealth. From the Santa Fe New Mexican story:Mark Johnson, CEO of Santa Fe-based Easter Seals El Mirador, one of the ousted providers, said Weinberg’s move from state Medicaid director to Optum raises ethical questions. “There certainly would be an appearance of a conflict of interest in [Weinberg] going to work for a contractor that Medicaid contracted with,” Johnson said.A spokesman for the Human Services Department says that there is no conflict of interest.No state personnel rules forbid someone in Weinberg’s position from taking a job with a government contractor, a Human Services spokesman said. “[Weinberg] will work as an executive client manager with Optum — not with their health program, but on the IT analytics side of their business,” Matt Kennicott said.