E-mail: Optum suggests bringing in Arizona providers in October 2012


Previously, New Mexico In Depth has reported that Optum Health New Mexico contacted Arizona health organizations in late 2012 to ask if they might consider helping out in the state after Optum believed it had uncovered over-billing problems.

Now an Oct. 25, 2012 e-mail from then-Optum CEO Elizabeth Martin to New Mexico state officials has surfaced, which NMID has obtained and which the Santa Fe New Mexican reported on today. The correspondence provides the earliest glimpse of an idea that eventually became a reality: bringing in Arizona providers to take over administration of services for tens of thousands of vulnerable New Mexicans.

We’re posting the e-mail for anyone who wants to read the four-page correspondence, but for those of you who don’t click on the link, here’s an excerpt of Martin’s e-mail:

Option two: Depending on post investigation results and appropriate State review, issue
pay-holds for all offending large agencies and “import” from a neighboring state
accredited provider(s) of greater or equal size fully vetted by the State.
For example, OHNM has in its Arizona network outstanding behavioral health providers with over
$200,000 in revenue who could assume wholesale management. While conditions of
management would have to be negotiated including the repayment of alleged fraudulent
overpayments, this option would secure client care and protect, on an ongoing basis that
prior bad actors were no longer managing providers of Behavioral health services in NM.