Two more mental health providers settle claims with NM - Albuquerque Journal

Two more mental health providers settle claims with NM

SANTA FE – Gov. Michelle Lujan Grisham’s administration has entered settlement agreements with two more New Mexico behavioral health care providers whose Medicaid funding was frozen in 2013 due to alleged fraud and overbilling.

The latest settlements, which were completed this week, bring the number of mental health providers that have settled with the state to five. They are also the latest sign of the Lujan Grisham administration’s push to end long-running lawsuits that have cost the state millions of dollars.

“New Mexico deserves and needs stability in our behavioral health network,” Human Services Secretary David Scrase said Wednesday. “These settlements reflect a shared commitment to rebuild what was lost.”

Scrase said the agency was also working with other providers that filed lawsuits against the state in response to the 2013 funding freeze in an attempt to rebuild the state’s system for treating mental illness and drug addiction.

Lujan Grisham, a first-term Democrat, has said the disruption to New Mexico’s behavioral health system caused by the shake-up has had ripple effects on many families and businesses, while also causing private health care costs to increase.

Under the terms of the settlements, one of the providers, TeamBuilders Counseling Services, will receive more than $1.9 million from the state while agreeing to pay slightly more than $107,000, according to a copy of the agreements obtained by the Journal.

In addition, the Human Services Department cleared the way for TeamBuilders to resume its operations, while also pledging that HSD staffers would expedite the provider’s paperwork. Before its Medicaid funding was frozen, TeamBuilders was one of the state’s largest behavioral health providers, operating in 23 counties and employing about 400 workers.

In the other settlement, Counseling Associates will get more than $173,000 from the state while agreeing to pay nearly $11,900.

Under the terms of both settlements, neither the state nor the providers admit any liability or fault.

“Basically, there are good-faith arguments on both sides, and rather than going down the long, drawn-out path of litigation, the parties decided to settle,” HSD spokeswoman Jodi McGinnis Porter said.

Retired New Mexico Supreme Court Justice Edward Chávez is helping the Human Services Department negotiate the agreements with behavioral health care providers, and the agency already entered settlements with three other providers earlier this year.

The five providers that have settled with the state were among 15 nonprofits whose Medicaid funding was cut off by former Gov. Susana Martinez’s administration in 2013, due to allegations of potential overbilling and fraud.

Attorney General Hector Balderas’ office eventually cleared all 15 providers of any wrongdoing after investigations, but many were driven out of the behavioral health business.

Meanwhile, six behavioral health nonprofits still have active claims under a consolidated lawsuit pending in the 1st Judicial District Court, based in Santa Fe.

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