Clinic files suit over Medicaid cutoff

Myo Cardiovascular says HSD halted payments over fraud allegation

SANTA FE — A cardiovascular clinic with offices in Rio Rancho and Roswell alleges the state Human Services Department improperly cut off its Medicaid payments after an undisclosed allegation of fraud — echoing the 2013 shake-up that critics say disrupted New Mexico’s behavioral health network.

Myo Cardiovascular Clinic LLC filed a lawsuit in state District Court this month accusing the state Human Services Department and the Medicaid Fraud Control Unit of the Attorney General’s Office of failing to provide enough information for the clinic to respond to the fraud allegation or defend itself.

The state agencies, in turn, say they’re simply following their obligation to investigate and root out fraud, if there is any.

In its lawsuit, Myo estimates the state has withheld at least $500,000 from the clinic for its work with Medicaid patients — financially devastating for the clinic, which provides cardiovascular care and vein treatment, the lawsuit says.

The allegations mirror the 2013 upheaval in New Mexico’s behavioral health network — when Gov. Susana Martinez’s administration cut off Medicaid and other funding to 15 providers, citing allegations of overbilling, mismanagement and possible fraud, as outlined in an audit.

The Attorney General’s Office later cleared the providers of fraud, though it found some instances of overbilling.

Families and patients said the

shake-up disrupted services, and some providers went out of business.

Joseph Cueto, a spokesman for the Human Services Department, said the state is still reviewing the Myo complaint.

The department “believes it is critically important to protect New Mexico’s Medicaid program from fraud, waste, and abuse,” he said in a written statement.

Matt Baca, senior counsel in the Attorney General’s Office, said his agency is legally obligated to investigate the case and will carry out the work as effectively as it can.

“It is our top priority to ensure that every Medicaid dollar goes to serve the vulnerable populations in New Mexico that rely on quality health care and services,” he said in a written statement.

The Myo lawsuit centers on allegations that emerged earlier this year. The clinic said its payments were suspended in February, based on an allegation of fraud.

The allegation involves improper billing practices, billing for services not provided and “the possible use of deception to obtain an unauthorized benefit from the Medicaid program,” according to a letter from the Human Services Department. But that explanation isn’t specific enough to allow the clinic to follow up on its own and determine what happened, the suit says.