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.

NM Attorney General Exonerates 10 Behavioral Health Providers

UPDATED: 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 many out of business.

“While we did find some regulatory violations, there did not appear to be a pattern of fraud for any of the ten completed investigations,” Attorney General Hector Balderas said in a two-page letter released this morning.

Balderas’ announcement means 13 of the 15 organizations accused of fraud have been cleared of wrongdoing.

The state’s decision to shut off government dollars to the organizations because of the fraud accusations disrupted care to tens of thousands of vulnerable New Mexicans struggling with mental illness or drug addiction. It also caused staff layoffs and at least one pharmacy’s temporary shutdown.