Suspected of Medicaid fraud, 15 providers lose payments

A wide ranging billing probe of mental health services has led to what will likely be a long-term suspension of Medicaid payments to 15 providers in New Mexico, the Santa Fe New Mexican has reported.

According to summaries of the probe to date by the New Mexico Attorney General and the state's Department of Human Services, the providers may have overbilled the Medicaid program as much as $36 million between 2009 and last year. The ongoing investigation could take nine months or longer--with payment suspensions remaining in effect until then.

According to the Associated Press, the audit is targeting about 85 percent of the state's providers, and that billing discrepancies were widespread among those being audited.

One mental health provider, the hospital-based Presbyterian Medical Services, told the New Mexican that its long-term prospects are in doubt. "(We) have to tighten our belt and hunker down to make sure we can survive it," Chief Executive Officer Steve Hansen said. Another organization, Easter Seals El Mirador, said it would not be able to operate without Medicaid payments. It provides housing for dozens of developmentally disabled adults. Both agencies are appealing the payment suspensions, according to the New Mexican.

To learn more:
- read the Santa Fe New Mexican article
- read the Associated Press article