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Providing behavioral health care services to New Mexicans is an important responsibility, and it’s critical that the funding used to provide these services be spent properly. This administration has kept its word to protect those most in need by not tolerating fraud, waste, or abuse of Medicaid funds.
That’s why it’s so concerning that an in-depth audit, commissioned by the Human Services Department of 15 behavioral health care agencies in New Mexico, revealed an estimated $36 million in improper payments: fake billing, potential shell companies and CEOs improperly getting rich off Medicaid funds.
This money was supposed to pay for treatment for low-income New Mexicans, but was instead misspent. In some cases, services were overbilled, and in others, funds were paid out for services that never should have been billed. Looking strictly at the most egregious payment errors, the audit indicates that New Mexicans in need of behavioral health care services were greatly shortchanged by the companies tasked with managing this funding.
During this investigatory period, Medicaid funding will continue to be provided to New Mexico clients through an alternative source. We are not cutting behavioral health care services to New Mexicans who rely on them, nor are we cutting funding for those services. Patients in need of treatment can and should continue to see their therapists and other providers, just as they always have. That patient/therapist relationship does not change. But if the federal government believes New Mexico is not protecting Medicaid dollars or services, they can stop all of our Medicaid funding. For that reason, we are transitioning services to different Medicaid agencies to satisfy the federal government that Medicaid dollars are spent properly while these credible allegations of waste and possible fraud are investigated by law enforcement.
Whether the result of gross mismanagement of public money, or more deliberate efforts to misuse funding by managers at these companies, two things are clear: the money must be repaid so that it can be spent properly on behavioral health care services, and the allegations in the audit must be investigated by law enforcement authorities to determine the extent of any potential fraud committed.
The audit has been provided to the attorney general, the U.S. attorney and the FBI.
The law provides for the continued withholding of funding from Medicaid agencies once a law enforcement agency charged with investigating Medicaid fraud accepts a case for investigation. The agencies can then appeal those suspensions and ask for good cause exceptions, which have been granted in whole, or in part in three cases. A federal judge upheld the actions of HSD in withholding these Medicaid funds while the attorney general completes his investigation.
We believe the public has a right to see this information, but we also respect the need for law enforcement to conclude their investigations and make final prosecutorial decisions. The attorney general’s office has stated repeatedly — to the legislature, to the state auditor and to our office — that releasing it would jeopardize their investigation; that is certainly not our intention, and we defer to their guidance. The attorney general and the state auditor have worked out a resolution so the state auditor can view the audit without jeopardizing the investigation. We fully support this agreement.
Given the number of New Mexicans who rely on our behavioral health services, I feel it’s important to put the audit results into perspective. The $36 million could provide all of these services combined: 2,500 adults with intensive outpatient services for substance abuse for 30 days. More than 5,000 individuals could receive outpatient mental health services for 20 hours each. Up to 1,500 children could be provided shelter for 30 days after being dislodged from their home setting. We could provide 4,500 individuals with methadone maintenance for opioid treatment with 60 days of refill. And 3,500 individuals could be provided inpatient psychiatric hospitalization for 10 days.
It is critical to ensure that any funding being used to provide these services be properly spent, in accordance with the law, and for the intended purpose — helping to treat those in our communities who suffer from drug and alcohol addiction, mental health afflictions, and a large array of other behavioral health issues.