The federal Health and Human Services Department will inspect if New Mexico is properly serving New Mexicans in need of mental illness and addiction services.
The review by the Inspector General of the federal Health and Human Services Department, confirmed in late June and made public Friday afternoon, comes roughly four years after Gov. Susana Martinez’s administration disrupted care for tens of thousands of New Mexicans when her Human Services Department accused 15 organizations of Medicaid fraud and potentially overbilling the government by nearly $36 million.
Citing the fraud accusations, the Human Services Department suspended the flow of ‘behavioral health’ Medicaid dollars to many of the organizations in the summer of 2013. Unable to stay in business without the Medicaid dollars, many had to shut their doors and are no longer in business.
Ultimately no Medicaid fraud was ever found. And the estimates of overbilling Medicaid have been dramatically reduced; in one case, the state reduced to $484.71 what it said Las Cruces-based Southwest Counseling Center owed after accusing it of overbilling Medicaid by as much as $2.8 million as recently as January.
The Inspector General of the federal Health and Human Services Department confirmed the review to four members of New Mexico’s congressional delegation in a June 28 letter made public Friday afternoon.
The IG’s letter was in response to a May 24 letter U.S. Senators Tom Udall and Martin Heinrich and U.S. Reps. Michelle Lujan Grisham and Ben Ray Lujan, sent in May to the federal agency asking the Inspector General to perform the review.
The May letter from New Mexico’s federal lawmakers alluded to the state’s 2013 suspension of Medicaid dollars flowing to a number of the providers based on ‘credible allegations of fraud that were later shown to be untrue and entirely unfounded.’
The letter writers went on to lay out the consequences of that decision:
‘This led to the closure and partial replacement of accused providers, all of whom were later cleared of wrongdoing by New Mexico’s Attorney General. This move decimated the behavioral health system in a state where there are already significant provider shortages, and almost four years later, significant access issues remain.
HHS Inspector General Daniel Levinson said in response his office would review behavioral health systems in New Mexico and four other states, including in New Mexico “the capacity of those providers to meet the health care needs of the Medicaid population.”
Levinson went on describe some of his office’s work plan as it endeavors toward that goal:
“OlG’s work will include enrollees in New Mexico and four other States. Specifically, OIG will review the extent to which behavioral health providers are included in the States’ managed care plans and the types of care offered by these providers. We will also assess the extent to which behavioral health providers have available appointments for new patients, the extent to which behavioral health providers have waiting lists, and the extent to which behavioral health providers are able to make referrals to other behavioral health providers for needed care.
Finally, we plan to address ways to improve the continuity of care for Medicaid enrollees in the five States.”
Below are remarks from New Mexico’s federal lawmakers who requested the IG review:
“This was a manufactured crisis that has had tragic consequences for children and families struggling with mental illness, behavioral health issues and substance abuse, who lost access to care altogether or haven’t been able to find steady care. It has also wasted tens of millions of taxpayer dollars and cost dedicated health care workers their jobs as behavioral health clinics across New Mexico have been forced to close or lay off staff due to the disruption caused by the state’s actions,” Sen. Udall said. “Our fragile network of behavioral health providers is still struggling to meet the needs of these patients. I look forward to the results of this study and will continue fighting for improved behavioral health access in New Mexico.”
“New Mexico’s behavioral health system was turned upside down overnight when the state unilaterally suspended Medicaid payments for vital services. It’s clear that this was a manufactured crisis that dangerously left patients without the care they deserved and had come to rely on, caused hundreds of New Mexicans to lose their jobs, and wasted tens of millions of taxpayer dollars,” Sen. Heinrich said. “I’m glad the Office of Inspector General has agreed to review whether the state is still failing to provide New Mexicans with mental health services they need.”
“Ever since New Mexico’s behavioral health system was needlessly thrown into chaos a few years ago, my colleagues and I have been working to rebuild this aspect of our system of care and ensure steps are taken to prevent such a crisis from happening again,” said Rep. Luján. “While we cannot undo all the damage that was done, we can take steps to protect continuity of care for those who need it, provide due process for providers, and prevent such a crisis from happening in the future. Hopefully, the results of this study will help us improve the behavioral health situation in our state in both the short and long term.”
“Governor Martinez’s Administration not only failed to take responsibility for dismantling the state’s behavioral health system; the Governor refuses to ensure vulnerable New Mexicans have access to services,” Rep. Lujan Grisham said. “I pushed the federal Office of Inspector General since the beginning of this crisis, and we finally succeeded in convincing investigators to conduct a thorough review of those services. I want the OIG to determine where the state continues to fail its mission of providing mental health services.”