In the summer of 2013, 15 behavioral health providers in New Mexico were suspected of Medicaid fraud based on an audit by a Boston-based consulting group contracted by the state. The audit, which prompted state officials to suspend Medicaid funding to the providers, was finally unsealed last week after nearly two years of protests from the providers in question as well as public advocacy groups.
Newly appointed Attorney General Hector Balderas released the 300-plus page audit with minimal redactions, according to KUNM. Balderas also requested $1 million from the Consumer Protection Fund in order to complete the full investigation in the next six to eight months.
"New Mexico, moving forward, must learn how to attack waste, fraud and abuse in a way that does not harm its own citizens," Balderas said in a press conference. "I don't anticipate any pushback. I'm actually requesting support from the governor, and the Legislature and HSD."
The audit has been embroiled in controversy since its announcement in 2013. Three investigations into the 15 providers already are complete, according to KUNM, and two of those providers have been cleared of wrongdoing. The results of the third investigation will be announced later, while four other investigations are ongoing and eight have yet to begin.
Earlier this year, former Attorney General Gary King released a portion of the audit that revealed more than $4 million in overbilling by Santa Fe-based Presbyterian Medical Services. Although Presbyterian settled with the state in 2013, some questioned the legitimacy of the audit's findings. Last week, a New Mexico district judge called for a full hearing regarding evidence the state brought against another behavioral health provider, Easter Seals El Mirador, indicating the Human Services Department may have violated due process rights.
Easter Seals CEO Patsy Romero told KUNM that the previously unsealed audit has hurt the provider's reputation and forced the provider to cut 160 employees.
"For months and months we've been in the dark," she told KUNM. "Being accused of fraud, being accused of being criminal and being corrupt, and not knowing why has been very very difficult."
Additionally, Turquoise Health and Wellness, an Arizona based-mental health provider that was contracted by New Mexico to take over services for behavioral health patients in the state, announced it was halting operations in New Mexico, according to the Santa Fe New Mexican. The announcement left managed care contractors scrambling to find replacement providers throughout the state.