AG Clears Final Two Behavioral Health Providers of Wrongdoing


AG Clears Final Two Behavioral Health Providers of Wrongdoing

Staff Report

Early Tuesday New Mexico Attorney General Hector Balderas released the last of fifteen audits on New Mexico based behavioral health providers , clearing all of them of fraud charges. In 2013 these fifteen New Mexico basedbusinesses were abruptly dropped from their contracts with the state’s Human Services Department after Governor Susana Martinez’s administration claimed they had uncovered evidence of fraud and overbilling.

The fraud allegations forced the fifteen New Mexico based providers to close their doors, many going out of business. Independent investigations identified over 3,000 patients who lost services with the disruption, many of who have not returned to the system.

To fill the gap in services left after the charges were made, the administration brought in three Arizona based companies to take their place. The rapid switch to three providers from Arizona and chaos it caused is estimated by several media sources to have cost the state over $28 million.

Today’s announcement brought rapid reaction from four of the state’s five members of Congress. In a joint statement, U.S. Sens. Tom Udall and Martin Heinrich, and U.S. Reps. Ben Ray Luján and Michelle Lujan Grisham issued the following statement after New Mexico Attorney General Hector Balderas cleared the remaining providers in the Behavioral Health Investigation of fraud:

“Every single one of the providers that the State unjustifiably suspended in its behavioral health shakeup three years ago has been cleared of allegations of fraud by the Attorney General’s Office. It’s clear that this was a manufactured crisis that dangerously left patients without the care they deserved and had come to rely on, caused hundreds of New Mexicans to lose their jobs, and wasted $28.8 million in taxpayer dollars. To make matters worse, with the behavioral health care provider, Agave, leaving New Mexico, only two of the five companies brought in to replace New Mexico-based providers remain in the state, creating additional uncertainty for thousands of New Mexicans. A thorough investigation into New Mexico Human Services Department’s suspension of Medicaid payments to these providers is needed to determine how the decision to upend the behavioral health system was made.”

Last month, the lawmakers introduced the Medicaid Program Integrity Enhancement Act of 2016, which would protect Medicaid patients by establishing guidelines that attemot to ensure that state agencies investigating allegations of fraud do so in a manner that both protects health care consumers by ensuring continuity of care and affords due process of law to the health care provider. They also wrote a letter to Centers for Medicare and Medicaid Services (CMS) in February calling for an investigation into the suspension of payments to behavioral health providers and a response from Secretary Burwell detailed which oversight options are available and what actions the agency plans to take in response to this serious situation.