FYI building in Las Cruces, NM.

With agreement in hand, behavioral health CEO believed vindication was inevitable

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.

New Mexico behavioral health care system gets federal review

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.

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.

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.