Neighboring states battle Medicaid fraud

The war against Medicaid fraud continues but prosecutors in several states are experiencing mixed success.

New Mexico has had some initial successes clamping down on mental health providers, but so far regulators in neighboring Texas are stymied in their efforts to collect alleged overpayments.

In the Land of Enchantment, two mental health service providers agreed to repay $4.2 million to the state's Medicaid program due to overbilling for services, the Albuquerque Journal reported. Prebysterian Medical Services in Santa Fe will repay $4 million, while a much smaller provider, Youth Development Inc. of Albuquerque, will repay $240,000. Both parties admitted to overbilling New Mexico's Medicaid program between 2009 and last year. In addition to repaying the money, the Journal reported that both providers agreed to sever a partnership initiative with TeamBuilders, Inc., another agency that remains under investigation.

State regulators in New Mexico suspended payments to 15 mental health service providers earlier this year due to suspected overbilling. The Presbyterian and Youth Development settlements are the first in the investigation, according to the Journal.

Meanwhile in the Lone Star State, the Office of the Inspector General of the Texas Health and Human Services Commission has lost multiple court battles against orthodontic providers accused of engaging in Medicaid fraud, the Texas Tribune reported.

Its most recent setback occurred earlier this week, when a state administrative court ruled that it did not provide enough evidence of wrongdoing to cut off Medicaid payments to the Antoine Dental Center in Houston, which was among the state's biggest billers for orthodontic work.

"The state hasn't shown any sign of changing its position or recognizing what the judges have found in earlier cases. Frankly, they appear incorrigible," Jason Ray, one of Antoine's attorneys, told the Texas Tribune. "Judges have told them what the truth is, and the state continues to propound a fiction that these dentists have done something wrong."

According to the Texas Tribune, the state spent more on Medicaid-funded orthodontics between 2008 and 2010 than the other 49 states combined.

To learn more:
- read the Albuquerque Journal article
- read the Texas Tribune article