For several weeks now, New Mexico has been under criminal investigation into 15 of its biggest mental health providers for its alleged involvement on the $36 million Medicaid fraud for over three years, the N.Y Times reports.
While companies from Arizona had been hired to temporarily fill in, many patients have already been struggling with not getting regular treatment. This causes turmoil in the state’s behavioral health system and Gov. Susana Martinez’s administration under sharp attack.
Laura Bruening’s son, 12, has autism and has not been seeing his therapist for two months now ever since funding had been frozen at the Albuquerque provider where the latter worked. The mother is deeply concerned that nobody is there to intervene if something should happen to him at school. She even added that her son had obviously become more agitated.
State officials had been placed under pressure from affected families like the Bruenings. They had minimal choice but to take drastic measures once the extent of the fraud accusations became evident.
In the latter part of the previous year, an audit by the contractor reviewing Medicaid payments for the behavioral health system in New Mexico revealed systemic billing problems. Alarmed by the finding, the state decided to get the services of Boston-based Public Consulting Group which specializes in investigating Medicaid fraud.
The auditing showed what seemed to be widespread overpayments for medical services that had in fact never been provided. Moreover, a quarter of claims filed by patients had been wrongly processed, according to the audit.
Diana McWilliams, the state’s chief executive of the behavioral health system, gave other examples of misconduct cited by whistle-blowers during and after the audit. She has also pointed out a "suspicious business arrangement" among a group of providers wherein executives appeared to have been shuffling funds from Medicaid away from their respective agencies to a corporation they had established.
The full audit, referred to attorney general Gary King of New Mexico, has been kept secret while investigation goes on. The Medicaid providers involved already denied the allegations. All 15 providers asked for exceptions from the state for the purpose of restoring their Medicaid funding while the investigation goes on. Only three of these exceptions have been granted.
