An Alamogordo health organization cleared of Medicaid fraud by the Attorney General’s Office is disputing a bill from the state of New Mexico saying it owes hundreds of thousands of dollars.
The bill for $343,000.49 arrived last week and said that The Counseling Center of Alamogordo had overbilled Medicaid, the government’s health insurance program for the low-income, by that amount, said James Kerlin, the center’s executive director.
How much the Alamogordo organization overbilled Medicaid over several years is a matter of debate. To help him contest the state’s estimate, Kerlin said he has contracted with North Carolina attorney Knicole Emanuel.
“The state says we owe them this much money. We want them to demonstrate what the problem is,” Kerlin said.
As you might recall, Emanuel appeared before New Mexico state lawmakers last year to talk about her state’s experience with Public Consulting Group Inc. (PCG), the Massachusetts consulting firm that the state of New Mexico hired to audit 15 New Mexico health organizations in 2013.
New Mexico’s Human Services Department used the results of last year’s PCG audit, in part, to find “credible allegations of fraud” against The Counseling Center and 14 other health organizations.
The audit results also played a role in the state agency’s decision to freeze The Counseling Center’s Medicaid funding and forward the audit to several law enforcement agencies, including the New Mexico Attorney General’s office, requesting that they investigate issues including potential Medicaid fraud.
Without the funding, The Counseling Center closed its doors last fall.
Last September, Emanuel told state lawmakers and New Mexico media that other PCG audits in her experience have been inaccurate at their initial stage. A representative of PCG told state lawmakers that his firm’s results are 95 percent accurate when they receive all the requested documents.
In recent months, questions have arisen surrounding the PCG audit here in New Mexico. In its audit, PCG found $1,873 in questionable Medicaid payments to the Alamogordo organization.
Using a statistical formula, PCG then extrapolated from that $1,873 figure to come up with approximately $612,000 in potential Medicaid overpayments by The Counseling Center over several years, a released portion of the PCG audit shows.
But the New Mexico AG’s office flagged only $375 in questionable costs from the same batch of claims during its investigation, not $1,873, Jody Curran, the head of Attorney General Gary King’s Medicaid Fraud Control Unit, told NMID last month.
A synopsis of the AG’s report on The Counseling Center indicates that its investigators were able to resolve some of the issues the PCG audit flagged by reviewing records and interviewing staff. By contrast, PCG and HSD never gave Kerlin an opportunity to respond to the audit’s findings before the report was finalized and made public, Kerlin says.
If PCG had been working from $375 instead of $1,873, its estimate of Medicaid overbilling likely would have been less than the $612,000 the audit claimed.
That raises questions about the process the Human Services Department (HSD) used to ensure the audit was accurate before deciding to suspend Medicaid dollars to the Alamogordo organization.
Matt Kennicott, a spokesman for HSD, said Friday the state’s new estimate is based on the AG’s investigation and includes some of PCG’s findings as well.
The letter to The Counseling Center requesting payment went out Feb. 20, but so far HSD hasn’t received a request from the Alamogordo counseling center for a hearing to challenge the state’s estimate, Kennicott said.
“They have 30 days from when the letter was sent out to request an administrative hearing,” Kennicott said.