Health care

AG clears one health organization in fraud probe

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.

  • BillH0415

    Now that the Attorney General has cleared TCC of fraud, HSD needs to move immediately to help TCC with the other part of a Medicaid law, also required by the Affordable Care Act–namely, the right to appeal the audit findings in detail so that errors in the audit or their files can be corrected. Since HSD already put them out of business for no reason, they should go to extraordinary lengths to help TCC with this due process step that they should have done in the first place. Done right, this step would have saved jobs and more importantly preserved the ongoing care for TCC’s clients. HSD has completely ignored those clients in this entire, ill-conceived and poorly executed process.

  • Save Behavioral Health NM

    The “audit” was for the period of 2009-2012 (4 years)… so, even if the $19K ($5K/year) figure was accurate, that would be what… 1-2% error? Kennicott is trying his best to save face, but the reality is they crushed all of the providers (including TCC), and handed over these agencies to La Frontera (plus $3 or $4 MILLION) and put a company that had been a part of the community for 25 YEARS OUT OF BUSINESS and never afforded them DUE PROCESS. Investigate that Mr. King!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    • FlameCCT

      You do your cause no good by stating inaccurate information. The audit was for 3 years with part of 2009 and part of 2012 depending on the agency’s filing month. As an example, the City of Albuquerque has programs that are audited and their fiscal year starts on July 1st of one year and runs to June 30th of the next. So if a similar 3 year audit was done, it would include records from July 2009 to June 2012.

      I would also suggest that if these agencies had cooperated like Presbyterian and YDI, they would have been fined and continued operations. I would also note that it is not just $1,873 or $19,000 that has been over billed, those are the amounts that have been found through a random sampling of records and review not all the billing.

      BTW, that is DUE PROCESS. If an agency refuses to cooperate with an investigation, that is their right; however they do not have a right to continue collecting funds when there is clear evidence of over billing.

      • Save Behavioral Health NM

        Presbyterian has deep pockets and paid what they were told they owed back. The providers that were shut down were already on the brink because of the ridiculously complex reporting requirements and the ineptitude of Optum and HSD themselves. For YEARS, Optum was unable to properly process the claims sent to them by the providers.

        and “BTW” that IS NOT due process. Even during the “investigation”, the providers have NEVER been asked specific questions regarding the SPECIFIC allegations against them. The ONLY provider so far that has been asked SPECIFIC questions about the SPECIFIC allegations against the has been The Counseling Center in Alamogordo… and guess what? They were found to NOT HAVE COMMITTED any fraud, and the amount of “errors” was MUCH MUCH lower than the inflated “extrapolated” value that PCG found… but the “funny” thing is, The Counseling Center IS STILL OUT OF BUSINESS, and their business was STOLEN from them, and given away with a no bid contract to another company from Arizona… and even “funnier” is that even though they have been found to have NOT COMMITTED FRAUD, THEY ARE STILL OUT OF BUSINESS and have been told by the State of NM that THEY ARE NEVER getting their business back that was STOLEN from them WITHOUT DUE PROCESS (they were NEVER provided the specific allegations against them until AFTER they were already put out of business).

        And guess what? The AG has not moved on to another agency yet. So, they other agencies STILL TO THIS DAY, HAVE NEVER been provided with the exact allegations against them so they can provide evidence that clears their name… and the longer this goes on, it becomes less and less likely that the other agencies will ever get to refute the allegations against them, because they are OUT OF BUSINESS and have NO EMPLOYEES anymore, and NO MONEY. Most of their former staff now works for the Arizona companies that were given their business after it was STOLEN from them.

        So, now where’s the due process FlameCCT?

        You should understand what has actually happened in this situation before you try to respond with your so called “facts”.

        • FlameCCT

          I would suggest you attempt to understand both the regulations under which the funding was provided and how the audit process works.

          You can yell and scream and play semantics all you want, they did not cooperate with the auditors. They were asked to provide specific files and specific documentation during the audit. They knew what was being audited and could have easily checked the files themselves.

          Why do you continue to make false statements? The AG office did not audit all the records like you claim. They checked the records that were in the report and “new” documentation was “found”. If this had been provided during the audit, there would have been no issue.

          Curious, if the AG has only looked at just one agency then how did “Presbyterian and YDI” not lose their funding? Once again, you make claims that no one was told about anything and no one else has been checked by the AG without facts to support your contention.

          Sorry but incompetence is not an excuse.