Feds want NM to pay back $16M in bonuses

Payments made for children’s health plan

Investigators have recommended that New Mexico repay the federal government nearly $16 million they say the state should not have received under a health insurance program for lowincome children.

The U.S. Health and Human Services’ Office of Inspector General made the recommendation recently after a review of enrollment over a five-year period beginning in fiscal year 2009.

According to the findings, released earlier this month, New Mexico overstated the number of children in the program, compared with enrollment data maintained by the Centers for Medicare and Medicaid Services.

New Mexico received nearly $24 million in bonus payments over five years for enrollments that ranged from more than 305,000 to 332,000 children.

“Most of the bonus payments that New Mexico received for the audit period were not allowable in accordance with federal requirements,” the inspector general said in the report, noting that only children in specific eligibility categories can be counted.

State officials have argued that their method for determining enrollment was correct and that New Mexico had sought guidance from federal officials as to whether it was in compliance.

State Human Services Department spokesman Kyler Nerison said the agency explained its method and included supporting documentation with each application submitted under the program.

Despite the state’s claims, the Inspector General’s Office said it was standing by its findings.

It would be up to the Centers for Medicare and Medicaid Services to act on the recommendation.