State Senator Linda Lopez: Behavioral health system under attack

Reposted from the Friday, August 2 Santa Fe New Mexican

Claiming “credible allegations of fraud,” Human Services Department Secretary Sidonie Squier recently suspended payment indefinitely to 15 well-respected New Mexico behavioral health service providers, deliberately driving them out of business for all intents and purposes. She told the Legislative Health and Human Services Committee that she is basing her accusation of “widespread and egregious fraud” on the findings of Massachusetts-based Public Consulting Group.

State Senator Linda Lopez

State Senator Linda Lopez

Since she has yet to inform the providers, the Legislature or the state auditor of specific findings, we remain unable to evaluate her claims.

Public Consulting Group itself has a history of dubious audits. After being contracted by the state of North Carolina in 2012, it determined the state had overpaid providers $38 million, but only $3 million of this amount was ever confirmed.

According to the North Carolina Bar Association, PCG uses a system known as “extrapolation,” in which the auditor examines a relatively small number of files, often using incorrect definitions, policies and other criteria, to identify overpayments. Then the company infers that the inflated “error rate” for the small file sample can be broadly applied to that provider’s total Medicaid billing, demanding that amount be repaid to the state.

An observer with a modicum of common sense might question whether this methodology falls within the parameters of generally accepted accounting principles. When one legislator at a subsequent Legislative Finance Committee hearing brought PCG’s poor North Carolina performance to Squier’s attention, she responded blithely that the faulty North Carolina audit was OK because, unlike North Carolina, New Mexico is not providing PCG with financial incentives to inflate its fraud findings.

It seems to me that if an auditor is going to impeach respected New Mexico providers, then that auditor’s past conduct should be absolutely unimpeachable.

When Secretary Squier appeared before a legislative interim committee, she treated New Mexico’s elected representatives crassly, refusing to answer questions and repeatedly stating that it was necessary for her to transfer behavioral health services to the five Arizona providers because of New Mexico’s “culture of corruption.”

When we continued to question her, she stormed out.

Secretary Squier later appeared before the LFC, asserting that all 15 providers had initial error rates in their billing of 75 percent to 97 percent. She offered, as an example of fraud, nine providers who had billed for the same client on the same day at the same time in very different parts of the state.

Had Squier taken the time to learn from these providers — or, even better, to read her own policy — she might have noticed that when two providers engage in TeleHealth, they may both bill for the service. TeleHealth allows two providers at remote locations to consult on a single client via Internet, making psychiatry and other specialty services available to frontier communities.

The only evidence of criminality in this billing is Secretary Squier’s breathtaking ignorance of the Medicaid system she oversees and her contempt for New Mexico and its cultures.

It is incredible to me that Secretary Squier has not only proposed contracts but has already signed them with providers from the state of Arizona; Arizona has repeatedly targeted Hispanics and Native Americans with laws so unjust they have earned the disgust of the nation.

Gov. Susana Martinez’s continued support for the blatantly unjust and ignorant practices of her Human Services secretary proves that she also holds New Mexico and its cultures in contempt. Her clever use of loopholes to close the doors of respected nonprofits resembles a hostile takeover of New Mexico’s nonprofit sector, draining local money and resources from our state. She is endangering New Mexico’s jobs and infrastructure.

I call upon Gov. Martinez to reinstate payments to the 15 providers and resume delivery of needed services. Let’s put the well-being of New Mexicans first!

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State Senator Linda M. Lopez serves District 11, Bernalillo County.