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OptumHealth Agrees to $1M Fine

By Dan Boyd
Journal Capitol Bureau
       SANTA FE — The contractor that was awarded a $1.1 billion behavioral health services contract last year agreed Wednesday to pay a fine of $1 million by mid-February for being delinquent in its processing of provider claims.
    The sanction agreement, which was announced Thursday, comes as a compromise of sorts after the state's Behavioral Health Purchasing Collaborative had announced its intent last October to levy an even larger fine against OptumHealth of New Mexico.
    The fine will be distributed to providers of substance abuse treatment and medical health care across the state network, although the details of how the money will be paid out is still being worked out.
    "We just are beginning to figure out with Optum and providers how to make this work," said Linda Roebuck, the collaborative's CEO, during a Thursday meeting.
    In addition to the $1 million fine, which will have to be paid in full by Feb. 11, OptumHealth also agreed to pay $30,000 to cover consulting fees as well as the cost of a state-appointed monitor hired to oversee the company.
    Providers lodged numerous complaints last year about delayed reimbursement payments from OptumHealth, which took over the state's behavioral health contract last July. OptumHealth eventually made changes to its claim processing system to speed up payments.
    Under the terms of the sanction agreement, the Behavioral Health Purchasing Collaborative isn't barred from pursuing future action against OptumHealth.
    The collaborative was created in 2004 to allow 15 state agencies involved in behavioral health treatment and recovery to act as one entity. Money for the treatment and programs stem from various sources, including Medicaid, federal grants and state appropriations.



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