A prominent state senator is calling for Gov. Susana Martinez’s administration to be investigated for shutting down Medicaid funding from 15 behavioral health providers in 2013. Sen. Howie Morales, D-Silver City, made the statements following an investigation by Attorney General Hector Balderas’ that cleared 10 of the providers of fraud this week. Three others had already been cleared by Balderas’ office. “The public deserves some answers of what took place, why did it took place and the justification of this tremendous impact to the state of New Mexico,” Morales told NM Political Report Tuesday. The state Human Services Department shut off funding from the 15 providers in 2013 after an audit from Boston-based Public Consulting Group found “credible allegations of fraud” in an audit that year.
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.”
Attorney General Hector Balderas announced Tuesday that his office filed Medicaid fraud charges against an apparently now-defunct health center in Carlsbad. Balderas’ charges against four employees of Carlsbad Mental Health Center and the center itself revolve around allegedly falsifying documents, knowingly conspiring to commit fraud and stealing more than $20,000 worth of value from non-Medicaid funds. The employees, Michael Byron Stoll, Noel Clark, Darrill Woodfield and John Bain, each face one second-degree felony charge and nine fourth-degree felony charges, as does Carlsbad Mental Health Center. From the Associated Press: “A person who answered to a listing formerly for Carlsbad Mental Health Center says the center no longer exists and she didn’t have any contact information for those still connected with it.” Balderas, in a statement, said he will “aggressively defend victims of fraud and abuse by prosecuting providers who violate the public trust.” He adds that his office is currently investigating other Medicaid fraud referrals “to keep pressure on New Mexico medical and behavioral health providers to work honestly on the public’s behalf.”
Two years ago, the state Human Services Department accused 15 of the state’s main behavioral health providers of fraudulently overbilling Medicaid $36 million. These allegations stemmed from an audit conducted by Boston-based Public Consulting Group on behalf of the Human Services Department which didn’t become public until Balderas released it earlier this year.