Many have questioned the tactics the Martinez administration employed in June 2013 to withhold funding from 15 behavioral health providers throughout the state – some of which were forced to close their doors.
Those questions resurfaced last week when the state accepted a $484.71 settlement from a provider the state originally said owed it $2.8 million.
In hindsight, did Martinez use a chainsaw – when a scalpel would have sufficed – to address claims of overbilling, mismanagement and possible fraud by the contractors paid to deliver mental health services to needful New Mexicans?
In June 2013, the state Human Services Department abruptly halted Medicaid and other funding to the 15 behavioral health providers statewide, saying an in-depth audit by a Boston firm showed $36 million in overpayments over three years, widespread mismanagement and possible fraud. (The state had asked for the audit after OptumHealth, the state’s former overseer of behavioral health services, flagged irregularities and questionable billings.)
When the dust settled, the state collected only about $4.4 million from the providers and, by April 2016, all 15 of those had been cleared of fraud charges by the state Attorney General’s Office.
The audit cost $3 million, meaning the state netted roughly $1.4 million for this four-year upheaval. Meanwhile, the state’s tactics put some providers out of business, including Southwest Counseling Center in Las Cruces, which provided services to mentally ill clients and addicts. When the provider failed to produce billing documentation sought by the state, it was hit with a $2.8 million demand. Once the paperwork was provided, the state dropped its demand to $484.71 – an amount the center agreed to pay rather than continue fighting.
Granted, there was plenty of smoke to give skeptics reason to believe there was a Medicaid-fraud fire in need of dousing – the audit cited golden parachutes for nonprofit CEOs, $1.5 million annual salaries to CEOs and their family members, even Southwest Counseling’s former head reportedly purchasing an airplane with a $200,000 loan from his nonprofit. (He says no Medicaid money was used for the plane.)
But four years – and multiple lawsuits from the targeted providers – later, average clients, their family members and other taxpayers have to be wondering if anyone really got to the bottom of the allegations, and if there was a better way to handle the subsequent investigation.
For its part, the state has said it had to take such drastic action to comply with the Affordable Care Act, which requires funding be halted when there are “credible allegations of fraud.” OK, except the language also gives the state the option of not doing so if officials believe there is “good cause” for several reasons, including jeopardizing access to services.
The state says it is now providing more mental health services than ever before – though some lawmakers question that claim. It bears noting that of the five Arizona behavioral health companies the Martinez administration contracted with to take over mental health services for the state, four have since left the state or announced plans to do so.
Regardless, the flap caused disruption not only of the 15 businesses accused of wrongdoing, but also the lives of those living with mental illness and/or addiction, as well as those caring for them.
If the state has learned anything from this saga, it should be that using the least amount of “force” necessary to effect change – especially when dealing with vulnerable populations – is preferable to using the largest weapons in the arsenal.
This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.
