AG clears one health organization in fraud probe

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The Attorney General’s Office says it found “insufficient evidence to support allegations of fraud” against one of 15 health organizations it was asked to investigate more than six months ago.

Probes of the other 14 providers continue, the AG’s Office said in a news release.

While it found no evidence that The Counseling Center in Alamogordo committed Medicaid fraud, the AG’s Office said it identified just over $19,000 in Medicaid overbilling. The state’s Human Services Department (HSD) will attempt to recover not only the overbilling the AG identified, but hundreds of thousands of dollars in overbilling that an audit alleged, spokesman Matt Kennicott said.

There’s a difference between the overbilling found by the AG and by the audit because the audit appears to have tested more of The Counseling Center’s billing claims, Kennicott said.

The Counseling Center will have an opportunity to contest the amount HSD seeks to recover if it chooses.

The Counseling Center and the other 14 organizations had their Medicaid payments frozen in June by HSD, which announced that an audit flagged the providers for problems including overbilling and potential fraud and asked the AG to investigate. At the time, those organizations were providing services like drug treatment and suicide counseling to an estimated 30,000 New Mexicans.

Most of the 15 organizations handed over Medicaid-funded services to providers from Arizona last year. Some shut down. The transition, which was overseen by HSD, was chaotic and led to service disruptions for some clients around the state.

Two of the audited providers – Presbyterian Medical Services and Youth Development, Inc. – agreed in November to repay $4 million and $240,000, respectively, to settle Medicaid overpayment claims. Once they did that, HSD restored their funding. They continue to provide services in New Mexico.

The AG’s Office and HSD have released portions of the audit used to justify the payment freezes, but they have refused to release hundreds of pages that detail specific findings against each of the providers, saying secrecy is necessary to protect the criminal investigations. NMID and the Las Cruces Sun-News sued last year to try to win release of the audit under the state’s Inspection of Public Records Act, but to date have been unsuccessful.

Now the the investigation into The Counseling Center is complete, NMID has again requested the release of the section in the audit detailing findings against that organization. It has also requested the AG’s file for its investigation into The Counseling Center.

Federal agencies are also investigating at least some of the 15 organizations flagged in the audit. Whether The Counseling Center is among them isn’t known publicly.

A prior version of this posting incorrectly stated that HSD would attempt to recover only the $19,000 in overbilling identified by the AG’s Office.