The slow-motion unraveling of New Mexico’s Medicaid crackdown

There’s no getting around it. Four years after Gov. Susana Martinez’s administration charged 15 behavioral health organizations with potentially defrauding the state’s Medicaid program, its case has experienced a slow-motion unraveling. No Medicaid fraud was ever found. And those eye-popping estimates that added up to $36 million the organizations had overbilled Medicaid? In the summer of 2017, the Human Services Department (HSD) is seeking drastically lower reimbursements for overbilling the public health insurance program for low-income residents, a review of public records and state court documents has found.

NM settles $2.8M Medicaid overpayment claim for $485

As Gilda Radner’s Emily Litella might have said, “Nevermind!”

More than four years after accusing Southwest Counseling Center of overbilling the state by $2.8 million in Medicaid reimbursements, the Human Services Department has settled with the former Las Cruces behavioral health provider for $484.87. SWCC was one of 15 health organizations accused of overbilling and potential fraud by Gov. Susana Martinez’s administration in 2013.  The state suspended Medicaid payments to the organizations pending an investigation, and outsourced behavioral health contracts to five Arizona companies, which effectively crippled the network of New Mexico behavioral health providers.  All the while, the state kept an audit they used to justify the move secret, making it impossible for each organization to know what they were being accused of specifically. See a timeline and read of coverage of the Medicaid freeze here.

Closed loopholes, Medicaid cuts and potential higher health insurance costs buried in Gov. supported bill

A piece of legislation moving through the New Mexico Legislature offers a window into how difficult it is to pay for and deliver healthcare during a state budget crisis, particularly at a moment when uncertainty in Washington clouds the future of healthcare in the U.S.

Sponsored by Republican Rep. Paul Bandy of Aztec and supported by GOP Gov. Susana Martinez,  House Bill 316 seeks to reduce state spending on Medicaid by pushing hundreds of people off a little-known state program – the New Mexico Medical Insurance Pool, also called the “high risk pool” — and onto the state’s health insurance exchange. The high risk pool currently offers health coverage for the sickest of the sick, more than 2,700 people who suffer from heart disease, cancer, Hepatitis C, neurological disorders and HIV/AIDS. The bill is one of many proposals that would save money as New Mexico attempts to survive a state budget crisis. The legislation, in effect, is a one-two punch to  health insurance companies, closing what Martinez considers a tax loophole by phasing out a tax credit for health insurers. It would trim Medicaid costs in a way that would end up increasing some health insurers’ costs, too.