Behavioral health services at risk during Medicaid probe

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Posted: Thursday, June 27, 2013 7:00 pm | Updated: 11:58 pm, Thu Jun 27, 2013.

The state’s suspension of Medicaid payments to 15 behavioral health providers during the attorney general’s investigation of overbilling and other issues could disrupt services, including drug abuse and suicide counseling, for thousands of patients across the state.

“I’m very, very concerned,” said Patsy Romero, chief operating officer for Santa Fe-based Easter Seals El Mirador, one of the providers under investigation following state-ordered audits. “The potential disruption of care is incredible.”

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  • Kenneth Davis posted at 4:57 pm on Mon, Jul 8, 2013.

    concerned and confused Posts: 43

    I'm afraid I'm a bit confused about this investigation the process brings to mind several questions.
    First: this is theoretically a random selection of all providers receiving payment for services from Medicaid. Bearing this in mind why were no for profit organizations selected?
    Second: 100% of the agencies audited were found to not be in compliance, Wouldn't that indicate that the actual problem is with the organizations issuing the instructions to the agencies on how they require things to be done?
    Third: Does anyone else find it odd the the alleged dollar amount of the infractions is exactly the same as the auditing company found in the state of Missouri when the reality was there was no fraud and the investigation there found three million dollars in overpayment by honest mistakes.
    Fourth: Doesn't the state refusing to pay for services rendered absolve these agencies from continuing to provide these services while not being paid for them? In the real world A) money has to come in the door in order to keep the door open and B) If you don't pay for something you don't get it.
    I don't see how the state can expect these agencies to continue to provide services while paying the costs out of the reserves that are already strained due to the state neglecting to include psychiatric billing codes in their code revision of this year and the agencies have been continuing to provide these services in good faith.
    These are just a few of the many questions that have arisin for me.
    A final question is if only non profit providers were singled out for this audit when they had passed an unprecidented amount of previous audits by the State and Federal governments along with numerous audits by the MCO in charge of state behavioral health funds with very high marks could the state possibly be singleing out the non profits in the same manner as the IRS did recently?

  • michael dowling posted at 2:00 pm on Fri, Jun 28, 2013.

    Mental Health Association of New Mexico Posts: 8

    My suggestion if these allegations are true they may end up owning your building or offices if Easter Seals actually has the deed. Ms. Romero being the State President of NAMI New Mexico and an appointee to the State Insurance Exchange Board spent the first half of the year working on failed mean spirited legislation that went no where All the time under the mantle of NAMI New Mexico.. All these entities and politicians that stood behind her have had their reputations tainted every time she speaks. Her disabled customers are being levereged as gives the message that all her wards are dependent on her and would perish without her skill.Taunting HHS and scapegoating OPTUM Health is ironic since she worked for the previous single entity who was sued for their terrible handling of John Hyde's Psychiatric care.Too many hats, baggage and poor outcomes. Take care of your sisteer who you always use as a diagnostic example without knowing if you have even shared with her that you are blowing her privacy to the entire world wide web on the Legislative Live Web Stream. The NAMI National Convention is underway right now. Your many affiliates will convene blindly behind you and your current soap opera. If you actually fess up to your troika of responsibilities maybe someone could lesson your load of a 3 or 4 front war. Quit fighting and act like a compassionate caregiver. Your managed care days are over but the insurance salesman still holds sway.


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