ALBUQUERQUE, N.M. — Copyright © 2013 Albuquerque Journal
Attorney General Gary King’s office on Thursday released a heavily redacted portion of the controversial Behavioral Health Provider Audit that has been referred to his office by the Human Services Department for investigation and possible criminal prosecution.
Human Services Department Secretary Sidonie Squier has said the audit revealed an estimated $36 million in improper payments, fake billing, potential shell companies and nonprofit executives improperly getting rich off Medicaid funds.
The heavily redacted document released Thursday was titled “Audit Protocols,” and it outlines types of billing issues with 15 New Mexico providers serving almost 30,000 people in need of behavioral health treatment. In general, it dealt with how the audit would be conducted and what general areas would be examined, but information on specific providers was blacked out.
Among the general items auditors were asked to look at included:
• Cross-billing at different locations for the same person at overlapping times.
• Cross-billing and double-billing, for example, for individual and group therapy.
• Billing excessive hours.
• Forging clinician records to incorporate more time for services than truly performed.
The audit conducted by Public Consulting Group Inc. of Boston was a follow-up on preliminary findings of excessive Medicaid billings by nonprofit providers.
An earlier review of billings from the nonprofits providing behavioral health services led HSD to seek the more in-depth audit.
In response to a Journal request under the Inspection of Public Records Act, King’s office also released several redacted emails.
But notes on the documents released Thursday show that even auditors’ “methods” were redacted.
Legislators have been critical of the secrecy surrounding the audit, and the criticism continued this week at a meeting of the Legislative Finance Committee in Chama.
Emails obtained by the Journal in an earlier records request show the Attorney General’s Medicaid Fraud Division’s director attended planning meetings with the Humans Services Department on how the audit should proceed.
Emails between the Attorney General’s Office and the Human Services Department, released Thursday, were completely redacted. The AG’s office also edited out roughly half of the Human Service Department’s “talking points” for a presentation to the Legislative Finance Committee in July.
Of the 13 pages of the audit plan, eight are completely blank, four are almost completely blank and one page, not including the cover page, isn’t redacted at all.
The audit led HSD to make major changes in management of the behavioral health care providers.
Twelve of the 15 New Mexico providers are being replaced by Arizona companies, two are under temporary management by Arizona companies and one is getting on-site assistance from an Arizona company.
The full audits have not been released to the nonprofits being replaced by the Arizona firms.
In response to Journal requests under the Inspection of Public Records Act, both the attorney general and the Human Services Department have cited the law enforcement record exception to the public records act to keep most of the audit secret.
The New Mexico Foundation for Open Government’s executive director, Terry Schleder, said the organization disagrees with the attorney general.
“Just because the audit was sent to the Attorney General’s Office doesn’t make it a law enforcement document,” Schleder said.