Reposted from the Saturday, August 10, 2013 Santa Fe New Mexican
Gov. Susana Martinez’s administration faced a dilemma at the beginning of this year: A new computer program designed to detect Medicaid fraud had sounded alarms at more than a dozen of the state’s behavioral health care providers, including some of the biggest and most reputable names in mental health care in New Mexico.
What administration officials did next is both telling and troubling.
They didn’t sit down with officials from Presbyterian Medical Services, Hogares Inc., TeamBuilders, Youth Development Inc. or any of the other providers to examine finances and practices. That would have helped determine whether taxpayers might have been defrauded or whether it was more likely that the new computer program had some glitches. Instead, top officials in the state’s Human Services Department — presumably with the blessing of the Governor’s Office — quietly hired a New England company to examine a sample of the providers’ financial transactions spanning several years.
Shortly after getting a report on that relatively small sample, state officials not-so-quietly announced they had uncovered $36 million worth of fraud and were immediately cutting off funding to the providers. A handful of Arizona companies would be brought in, for an estimated $17.9 million, to take over the treatment of patients. It has since been revealed that similar findings by the New England company in another state were grossly inflated.
The decision immediately caused a crisis in New Mexico’s behavioral health care system. Patients were left wondering who would provide them with care; the ability to write and fill prescription drug orders was threatened; and clinicians were laid off as their employers — none of whom to this day has been given even a hint of the specific allegations against them — struggled to pay employees. Gov. Martinez and Secretary of Human Services Sidonie Squier continued to assure New Mexicans that there would be no interruption of services, despite reports to the contrary from around the state. They insisted they had no choice under federal law but to do what they did.
In fact, it is clear that under federal law, the administration did have a choice. It still does if it exercises even a bit of common sense. Secretary Squier can and should immediately restore Medicaid funding to the providers and end the crisis that she created while instituting an extremely strict review process of every reimbursement claim submitted by behavioral health care providers. This would ensure that behavioral health services continue to be provided to the state’s most fragile citizens and that no Medicaid reimbursement claims are approved unless they are in order. Such a prepayment review is not unusual and should be standard practice.
At the same time, fraud investigators at the Attorney General’s Office should and certainly will vigorously pursue their own investigation to determine whether any of the providers should be prosecuted or pay restitution. The attorney general’s investigation, which could last more than a year, will no doubt be more thorough than the one conducted by the Human Services Department and the New England company that triggered this crisis.
Will Rogers once said, “Common sense ain’t common.” We had no idea how right he was until now.
State Senate President pro Tempore Mary Kay Papen represents State Senate District 38 in Doña Ana County