E-mail: Optum suggests bringing in Arizona providers in October 2012

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Previously, New Mexico In Depth has reported that Optum Health New Mexico contacted Arizona health organizations in late 2012 to ask if they might consider helping out in the state after Optum believed it had uncovered over-billing problems.

Now an Oct. 25, 2012 e-mail from then-Optum CEO Elizabeth Martin to New Mexico state officials has surfaced, which NMID has obtained and which the Santa Fe New Mexican reported on today. The correspondence provides the earliest glimpse of an idea that eventually became a reality: bringing in Arizona providers to take over administration of services for tens of thousands of vulnerable New Mexicans.

We’re posting the e-mail for anyone who wants to read the four-page correspondence, but for those of you who don’t click on the link, here’s an excerpt of Martin’s e-mail:

Option two: Depending on post investigation results and appropriate State review, issue
pay-holds for all offending large agencies and “import” from a neighboring state
accredited provider(s) of greater or equal size fully vetted by the State.
For example, OHNM has in its Arizona network outstanding behavioral health providers with over
$200,000 in revenue who could assume wholesale management. While conditions of
management would have to be negotiated including the repayment of alleged fraudulent
overpayments, this option would secure client care and protect, on an ongoing basis that
prior bad actors were no longer managing providers of Behavioral health services in NM.

2 thoughts on “E-mail: Optum suggests bringing in Arizona providers in October 2012

  1. I read the full e-mail. The crux of the story is that there was an option 1 which would have kept the NM providers in place, with monitors. That would have avoided the disruption of services while still moving toward maintaining fiscal integrity. Guys, you are journalists. Find the Optum Health contract with NM and see what we were paying them for–did it not include things like monitoring and technical assistance for providers who were having documentation problems? What was the financial benefit to Optum of the AZ solution?

  2. drip, drip,drip. Why didn’t OptumHealth give up the $3 million from its contract to do the PCG audit as required. Why was PCG hired with a no bid contract when another recovery auditor was already contract to do this work?

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