New Mexico In Depth
The Medicaid Freeze
In June 2013, Gov. Susana Martinez’s administration decided to freeze Medicaid funding to 15 health organizations after an audit found problems including over-billing and potential fraud and asked the attorney general to investigate. New Mexico In Depth has been covering the fallout. Here’s a timeline of events constructed with our media partner Fronteras Desk:
Gov. Michelle Lujan Grisham signed into law this week a bill (SB41) that ensures service providers accused of overbilling or defrauding Medicaid can review and respond to allegations of wrongdoing before state action is taken.
It’s a response to the bombshell announcement the administration of Gov. Susana Martinez made in June 2013. That summer, the Human Services Department publicly accused 15 organizations treating New Mexicans for addiction and mental illness of overbilling Medicaid by up to $36 million. There was even a chance, the agency said, the organizations had defrauded the government’s health insurance program for low-income people. The organizations weren’t allowed to review or respond to audit findings that led to the allegations – a break with normal auditing practices – or dispute the state Human Services Department’s decision to cut off Medicaid funding to a dozen or so of the 15 providers.
Two more behavioral health providers are contesting in state court how much, if anything, they owe the state of New Mexico for allegedly overbilling Medicaid, the Santa Fe New Mexican reported this weekend. The appeals are the latest in the drawn-out unraveling of the case Gov. Susana Martinez’s administration made in public four years ago when it charged 15 behavioral health organizations with potentially defrauding the state’s Medicaid program.
Even in his final days of battling leukemia in early 2016, Jose Frietze was fighting for the youth services agency he founded in 1977. The state Human Services Department had accused the organization — Las Cruces-based Families and Youth Inc. — of potential Medicaid fraud and overbilling by $856,745 in 2013. A stop payment of $1.5 million in Medicaid funding for services already provided crimped FYI’s cash flow, leading to layoffs. And because of the accusations, FYI was forced to hand off part of its business to an Arizona company brought in by Gov. Susana Martinez’s administration. Frietze’s daughters Victoria and Marisa remember how tough the allegations were on Frietze and their family.
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.
ByTrip Jennings and Sylvia Ulloa, New Mexico In Depth |
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.
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.
As news of the exoneration of all 15 health organizations accused of Medicaid fraud sinks in, I’m struggling to understand it all. With so many questions, I e-mailed the spokesperson for the one official who might have some answers — Gov. Susana Martinez.
Attorney General Hector Balderas’s office announced today it has cleared TeamBuilders and Pathways, the final two behavioral health organizations the state of New Mexico accused of ‘credible allegations of fraud’ in 2013. This is a developing story.
The New Mexico Attorney General exonerated 10 health providers of fraud charges Monday, a significant reversal for Gov. Susana Martinez’s administration, which accused 15 organizations of wrongdoing more than two years ago and forced some out of business after stopping the flow of government dollars to them.