Sunshine group calls for release of health audit

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The state must publicly release an audit that flagged 15 New Mexico health organizations for problems including overbilling and possible fraud, the N.M. Foundation for Open Government says.

Two state agencies – the Human Services Department (HSD) and Attorney General’s Office (AG) – have failed to release the full audit of the 15 behavioral health providers, which serve thousands of New Mexicans struggling with issues such as mental illness and drug addiction. The open government foundation (FOG) says the state is required by law to release the full audit along with information that deciphers a code used in the audit to identify the 15 organizations.

The stakes are high. The administration of Gov. Susana Martinez has frozen Medicaid payments to most of the 15 providers while the AG investigates, even though federal regulations give the state flexibility in deciding whether to suspend payments. The administration has said it had no choice, but federal regulations say a state can decide whether freezing funding is in the best interest of the Medicaid program.

Some advocates say stopping payments has put some of New Mexico’s most vulnerable citizens at risk by threatening critical services such as drug abuse and suicide counseling.

“The AG and HSD are withholding specific details that would allow New Mexicans to see through the fog on why certain behavioral health services are being defunded,” said FOG’s executive director, Terry Schleder. “This is the opposite of transparency. New Mexico can’t afford to operate in the dark this way.”

Both state agencies have released parts of the audit to New Mexico In Depth, which requested the report, but they have withheld the majority of the document, including portions that would detail specific problems with each of the providers.

While HSD has named the 15 providers targeted in the audit, it has refused to release information that would decipher a code used in the summary portion to protect the organizations’ identities. That code identifies the agencies as “Provider A” through “Provider O” instead of naming organizations so they can be connected to specific audit findings.

The summary portion, which the AG released, suggests that allegations against some providers may be more serious than others. For example, “Provider N’s” overpayments amounted to nearly $9.6 million between 2009 and 2012, while “Provider F’s” added up to less than $22,000 during that time period.

Critics of the administration’s action have said it’s possible some providers’ transgressions aren’t serious enough to justify stopping Medicaid payments, and complained that, by not detailing specific allegations against each provider, the Martinez administration has painted all 15 as criminals.

The providers who are under investigation receive 85 percent of the dollars spent on behavioral health services in New Mexico.

Some providers have struggled to continue operating without the Medicaid funding. The state has contracted with five Arizona organizations to pick up the slack. Two New Mexico providers whose Medicaid payments have been frozen are planning to hand over services to Arizona companies as soon as this weekend.

Martinez promised last week that the state is “not going to leave people without services,” but New Mexico providers and patient advocates worry that the Arizona providers won’t be ready to step in so quickly.

The situation’s abrupt nature makes it critical that the state release all information to help the public understand actions taken by HSD, Schleder said.

HSD spokesman Matt Kennicott defended the agency’s withholding of information, saying the audit is “the subject of an ongoing investigation and represents the direct evidence gathered for the investigation.”

HSD used that reason to deny NMID’s request for the full audit under the state’s Inspection of Public Records Act. The act lets governmental agencies keep secret law enforcement records “that reveal confidential sources, methods, information or individuals accused but not charged with a crime.”

That exemption doesn’t apply to the audit, Schleder said.

“A financial audit isn’t a typical law enforcement record, like a police report,” he said. “Just because the HSD handed their audit over to the AG, that doesn’t automatically convert it into a law enforcement record.”

Thus far, the agency has also refused to give the audit to Hector Balderas, the state auditor. Last week a judge ordered HSD to give Balderas the document by 10 a.m. Monday, but HSD let the deadline pass without turning over the audit.

When the attorney general provided NMID with the audit’s summary, the agency said it was considering NMID’s request for the rest of the audit. The AG promised a final response by July 29.

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