More than two years after the state froze Medicaid payments to 15 behavioral health providers, the initial audit that led to the freeze continues to come under scrutiny. Some New Mexicans say they’re upset with how the Martinez administration handled the situation.
The latest news is that one of the providers that lost Medicaid funding, Easter Seals El Mirador in Northern New Mexico, didn’t overbill the state nearly as much as the state originally claimed.
From The Santa Fe New Mexican:
Public Consulting Group — a Boston company hired by Gov. Susana Martinez’s administration to audit mental health care providers in New Mexico — estimated two years ago that between July 1, 2009, and Jan. 31, 2013, Easter Seals El Mirador overbilled taxpayers by $850,870 for providing services to patients enrolled in Medicaid.
But Nancy Smith-Leslie, the Human Services Department Medicaid director, wrote in recent letter to Easter Seals officials that “based on the documentary evidence” and arguments presented during an administrative hearing this spring, “Easter Seals El Mirador was overpaid in the total amount of $127,240.40.”
Easter Seals continues to dispute even the lowered number.
State still defends actions
Though it repeatedly insisted otherwise, the state’s Human Services Department (HSD) didn’t have to halt Medicaid payments to the 15 providers during investigations of possible overbilling and fraud.
Heath Haussamen / NMPolitics.net
This building used to house Families and Youth, Inc., which provided behavioral health services for youth in Las Cruces. After the Arizona-based company La Frontera took over services in Las Cruces, it kept this facility open for a time but later closed it, consolidating services in another building. La Frontera later left the state. Families and Youth, which is still providing some services without Medicaid funding, is once again operating in this building.
But HSD did freeze payments, with consequences for many New Mexicans: Most of the 15 health organizations, which were providing services like drug treatment and suicide counseling to an estimated 30,000 New Mexicans, went out of business. The state brought in Arizona companies to fill the gap, but the transition was chaotic and there were disruptions in service.
The dust hasn’t yet settled: Some Arizona providers have pulled out of New Mexico, sparking new transitions.
Investigations by the attorney general and reporting by New Mexico In Depth, among other things, have raised questions about the integrity of the audit that sparked the freezing of Medicaid funds to the agencies.
It’s also true that officials have found some alleged fraud. HSD spokesman Matt Kennicott continued to defend the agency’s actions.
“If it weren’t for the audit and tips received by whistleblowers, the overpayments to Easter Seals El Mirador would likely not have been discovered,” The New Mexican quoted Kennicott as saying. “The behavioral health audit found examples of overbilling, unbundling of services, missing documentation and other issues with [Easter Seals].”
True, perhaps — though Easter Seals continues to dispute that. And what’s now agreed upon is that the Easter Seals overbilling is a fraction of what HSD originally alleged when it froze payments and sent a system designed to aid some of the most fragile New Mexicans into chaos.
Voicing concerns
NMPolitics.net asked people on Facebook for their thoughts on the situation. Several expressed upset at the way the Martinez administration handled things. One active Democrat, Violet York Cauthon of Las Cruces, also pointed a finger at former Attorney General Gary King, a Democrat.
“I was shocked, as were lots of New Mexicans, at the disruption of service caused by Governor Martinez’s closing of agencies and contracting with Arizona providers,” Cauthon wrote. “For two years I expected AG King to investigate the governor, but for whatever reason King failed to do so. The entire episode is a disgrace, one that should have been thoroughly investigated.”
Barbara Alvarez of Las Cruces, a former social worker, wrote that she has “some serious, serious questions” about how HSD handled the situation after learning that some of the providers have since been cleared of wrongdoing. She called the freezing of Medicaid funds a “big mistake.”
“I question the motivation for doing so,” Alvarez wrote. “Further, I question why all the business was shifted to out-of-state providers from Arizona. In too many cases, these providers have picked up and left, which put their clients in a horrible spot.”
Valerie Romero of Santa Fe used to work for Casa de Corazon, which was part of Easter Seals. She recalled being furloughed and then fired as the agency shut down services. She wrote on Facebook that the situation is still causing problems, and she has started a Facebook page to raise awareness.
“As long as this reality exists, more people are going to be left without imperative services in our state,” Romero wrote.
Brandi McAlexander of Farmington, who has worked in Medicare and Medicaid billing, said she suspects the state may not have clearly set expectations about billing requirements. If that’s the case, it could indicate that there wasn’t an intent to commit fraud even when overbilling occurred — it may simply have been that health organizations were inadvertently billing incorrectly.
“It was not a failure on the part of the behavioral health organizations but a failure at a governmental level to set those expectations,” McAlexander said she believes. “…Clear expectations and regulations or promulgations need to be set to avoid this in the future and to give the current providers peace of mind.”
A prior version of this posting failed to mention, in the photo cutline, that Families and Youth is once again providing services, albeit without Medicaid funding, in the building pictured in the photo.