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MEDICAID AUDIT State didn’t have to halt Medicaid payments to providers

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Posted: Thursday, July 11, 2013 7:00 pm | Updated: 11:42 pm, Thu Jul 11, 2013.

Contrary to claims by the Martinez administration, the state Human Services Department could have chosen not to abruptly suspend all Medicaid payments to 15 behavioral health providers last month.

The state suspended payments to the agencies, which provide services such as drug abuse and suicide counseling to thousands of New Mexicans, while the Attorney General’s Office investigates allegations made in a state-ordered audit, including overbilling and potential fraud.

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1 comment:

  • Kenneth Davis posted at 6:39 am on Fri, Jul 12, 2013.

    concerned and confused Posts: 38

    I find the entire proceedings in this matter to be questionable the source of the audit and the reasons for the audit still elude me. First: why an audit when all of these agencies passed up to 12 audits in the preceding year with very high scores? Second why were only nonprofit agencies targeted? Third the suspension of payment while the agencies are required to continue supplying services doesn't make sense especially viewed in the light of the federal governments state discretion policy, any organization requires cash flow to stay open.
    Then there are the results that were obtained by the same auditing company in it's audit of the behavioral health system in Missouri . It claimed to have found exactly the same dollar amount and attributed it to fraud when the reality after investigation was 3 million due to documentation error.
    A final note is that a 100% failure rate would indicate a fault in the supervisory authorities requirements. 100% of any population group do not perform a wrong act unless directed or instructed to as the correct way to do things. Could it be that there was a problem in the manner these agencies were instructed to document and that secretary Squier is shifting the blame from herself and the managing MCO onto the providers?
    I also find it very suspicious that "Arizona" providers have been contracted to enter the state to provide these services rather than restoring funding pending full investigation in order to protect New Mexican jobs and keep the tax money in the state where it benefits the residents of the state. Could secretary Squier possibly have a tie to these companies?
    in addition many of the penalized agencies have been active advocates in defending the rights of the behavioral health consumers and fighting to be allowed to provide the level of services required to maintain their stability. Could this actually be a "Punishment" for standing up for what is right? Every behavioral health agency has had consumers who were re-hospitalized or whom have committed suicide due to denial of services as not of clinical necessity by the managing MCO over the last four years.

     
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