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AG Clears Medicaid Providers

AG Clears Medicaid Providers

In the summer of 2013, HSD suspended payments to the 15 behavioral health providers saying an audit found they had collectively defrauded or overbilled the state by more than $30 million


New Mexico Attorney General Hector Balderas has cleared 10 of the 12 behavioral health providers that had been under investigation for allegedly overbilling the state’s Medicaid program.

“While we did find some regulatory violations, there did not appear to be a pattern of fraud for any of the ten completed investigations,” Balderas said in a letter to state legislators. “Since we received these referrals from HSD [New Mexico Human Services Department] as credible allegations of fraud, we primarily based our investigations on issues raised in the referral … and ultimately did not find that the violations that we were able to substantiate reflected a deliberate or intentional pattern of fraud.”

In the summer of 2013, HSD suspended payments to the 15 providers saying an audit found they had collectively defrauded or overbilled the state by more than $30 million. After their Medicaid payments were suspended, some of the providers went out of business. Several have since sued the state.

When the payments were suspended, HSD brought in five Arizona companies to provide the services that the New Mexico firms had been providing. That caused a backlash among the providers and many of the more than 30,000 New Mexicans who were getting behavioral health services through Medicaid.

Three providers previously had been cleared of any wrongdoing. The providers cleared by Balderas Monday were Border Area Mental Health Services, Partners in Wellness, Youth Development, Inc., Southern New Mexico Human Development, Hogares, Families and Youth, Inc., Counseling Associates, Southwest Counseling Center, Presbyterian Medical Services, and Valencia Counseling Services.

Two providers remain under investigation: TeamBuilders and Pathways, Balderas said. “These two investigations are ongoing and will require that we take additional time in order to ensure that our conclusions are sound,” Balderas said.

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Dennis Domrzalski is managing editor of ABQ Free Press. Reach him at dennis@freeabq.com.

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  • Patrick Maniscalco
    February 9, 2016, 3:18 pm

    And these companies r to just not care that they were investigated and weren’t guilty

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