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Confronting abuse in our behavioral health system

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As the former CEO of the New Mexico Behavioral Health Collaborative and Director of the Behavioral Health Services Division of the Human Services Department, I was interested, but unfortunately not surprised, to hear about the recent indictment of a top finance official at Easter Seals El Mirador for embezzlement of public money. Easter Seals El Mirador is one of several New Mexico behavioral health entities that are currently being investigated by state and federal authorities for significantly overbilling Medicaid for services.

According to the incident report filed with the Santa Fe County Sheriff’s Office, Easter Seals El Mirador waited months – until well after the state’s contractor completed its on-site audit – to report the suspected embezzlement to law enforcement authorities. The incident report also states that, according to Patricia Romero, COO for Easter Seals El Mirador, the embezzlement is alleged to have been ongoing since 2010. However, based on her own timeline, it wasn’t until months after the state had initiated its investigation that Romero felt the need to conduct a routine audit of her own entity’s finances. It is unconscionable, and completely unacceptable, that Romero did not tell the state or its auditors about the misuse of public money by an officer within her entity. And so I ask Romero and her allies in the Legislature the same question that was asked of HSD: What took you so long to uncover these alleged crimes?

The mismanagement of Easter Seals El Mirador did not stop there, however. Rather than lawfully transferring patients’ files to the state in accordance with the terms of a federal court order, management ordered the files locked in a truck and stored off-site in an undisclosed location. Senior management also laid off all of the behavioral health workers employed by her entity and intentionally misrepresented to them that it was the state’s intention to stop providing services. Easter Seals El Mirador continuously interfered with the state’s audit, as senior management took actions that could only have been intended to cause a temporary disruption of behavioral health services to its clients and the transition of those services to responsible providers.

It is ironic that news reports describe the process of looking into the embezzlement issue at Easter Seals El Mirador as simply a matter of identifying irregularities, conducting a sample audit, referring to law enforcement and dealing with those involved. This is precisely the process the state followed in conducting its program integrity audit of Easter Seals El Mirador. After a report authored by OptumHealth New Mexico in October 2012 identified rampant overbilling and indicated potential fraudulent activity by Easter Seals El Mirador, HSD conducted an audit. Upon the completion of the audit, we referred the findings to federal and state law enforcement agencies. Each law enforcement agency accepted the referral of credible allegations of fraud and is currently in the process of investigating them. In accordance with the requirements of the federal Affordable Care Act, Easter Seals El Mirador is no longer permitted to continue spending Medicaid money – taxpayer dollars – on behavioral health services while under investigation for potential fraud and overbilling. Knowing that investigations might potentially be launched into fraudulent activity, HSD worked night and day to prepare for a scenario in which an entity might cease providing services, and made certain that other providers would be in place to address any emergency and to ensure that no recipient of these vital services would become the victim of their entity.

Finally, let me just say how sickening it was to hear Romero compare being investigated for Medicaid fraud to being raped. This type of insensitive comment is appalling, particularly from someone in her position.

I believe that history will look back on the decision to confront long-standing abuses in our behavioral health system as the right one. Certain well-connected individuals have been profiting from and misusing funds designated to help those most in need for far too long.

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