There’s no getting around it. Four years after Gov. Susana Martinez’s administration charged 15 behavioral health organizations with potentially defrauding the state’s Medicaid program, its case has experienced a slow-motion unraveling. No Medicaid fraud was ever found. And those eye-popping estimates that added up to $36 million the organizations had overbilled Medicaid? In the summer of 2017, the Human Services Department (HSD) is seeking drastically lower reimbursements for overbilling the public health insurance program for low-income residents, a review of public records and state court documents has found.
As Gilda Radner’s Emily Litella might have said, “Nevermind!”
More than four years after accusing Southwest Counseling Center of overbilling the state by $2.8 million in Medicaid reimbursements, the Human Services Department has settled with the former Las Cruces behavioral health provider for $484.87. SWCC was one of 15 health organizations accused of overbilling and potential fraud by Gov. Susana Martinez’s administration in 2013. The state suspended Medicaid payments to the organizations pending an investigation, and outsourced behavioral health contracts to five Arizona companies, which effectively crippled the network of New Mexico behavioral health providers. All the while, the state kept an audit they used to justify the move secret, making it impossible for each organization to know what they were being accused of specifically. See a timeline and read of coverage of the Medicaid freeze here.
After testimony from officials from three nonprofits that provided behavioral health services which were targeted with fraud allegations but later cleared by the Attorney General,a second New Mexico lawmaker called for state Human Services Department Secretary Brent Earnest to resign. “This is just morally repugnant behavior that this administration, this department, has done,” state Rep. Christine Trujillo, D-Albuquerque, said Wednesday at an interim Legislative Health and Human Services Committee meeting. “It’s criminal and obscene.”
Trujillo and eight other state lawmakers listened to the heads of three of the 15 behavioral health organizations that were infamously accused of “credible allegations of fraud” in 2013 by HSD’s then-Secretary Sidonie Squier. The department cited an audit from Boston-based Public Consulting Group that found $34 million in Medicaid fraud between the 15 providers. Squier cut off Medicaid funding from the providers, but the Attorney General’s Office has since cleared all from any wrongdoing.
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.”
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.