Feds to review availability of behavioral care in N.M.

Investigation comes 4 years after shake-up affecting 15 providers

A federal inspector general has agreed to investigate the level of mental health services available to low-income residents in New Mexico, more than four years after the administration of Gov. Susana Martinez cut off Medicaid payments to 15 providers based on allegations of fraud that have since fallen apart.

The review comes at the urging of Democrats in New Mexico’s congressional delegation who called on the U.S. Department of Health and Human Services to examine the availability of care as the governor’s claims of overbilling by service providers have steadily eroded.

Though the Martinez administration maintains that more New Mexicans than ever before have access to behavioral health care following an expansion of the state’s Medicaid program, Democratic lawmakers say the review will cast light on a system they describe as “decimated” by the governor’s shake-up.

“It’s clear that this was a manufactured crisis that dangerously left patients without the care they deserved and had come to rely on, caused hundreds of New Mexicans to lose their jobs, and wasted tens of millions of taxpayer dollars,” Sen. Martin Heinrich said in a statement Friday announcing the probe. “I’m glad the Office of Inspector General has agreed to review whether the state is still failing to provide New Mexicans with mental health services they need.”

The New Mexico Human Services Department suspended payments to the 15 behavioral health service providers in June 2013 following an audit that the Martinez administration said pointed to credible allegations of fraud.

The department accused the providers of overbilling Medicaid by as much as $36 million.

As many of the providers shut down for lack of funding, the state recruited five organizations from Arizona to step in and provide care.

Four of those agencies have ended operations in New Mexico, however.

And the allegations of fraud have unraveled.

Attorney General Hector Balderas has cleared the providers of fraud, writing in a letter to legislators last year following a three-year probe that his staff found a total of $1.16 million in overbilling among the 15 providers in what amounted to regulatory violations.

And the amount recouped from the state is still far less than the Martinez administration initially said was bilked from New Mexico’s Medicaid program.

Most recently, one organization accused of wrongfully charging the state $2.8 million resolved the dispute by paying a mere $485 for wrongful billing. Many of the claims have come down to disputes over documentation.

In a May 24 letter calling for an inspector general review of the state’s behavioral health system, Democratic lawmakers said their staffs continue to hear stories from constituents about treatments delayed and disrupted or, in the worst cases, lives lost due to access to care.

“This move decimated the behavioral health system in a state where there are already significant provider shortages and almost four years later, significant access issues remain,” said the letter, signed by Sens. Heinrich and Tom Udall as well as Reps. Michelle Lujan Grisham and Ben Ray Luján.

In a June 28 letter, Inspector General Daniel Levinson said his office will review the availability of behavioral health care and the types of services offered, the length of time patients must wait to get care as well as other issues. The review will not include what led up to the allegations of fraud, leaving unresolved the validity of Martinez administration’s claims against the providers.

Levinson wrote that his office will begin its review in the fall and include a review of behavioral health care in four other states.

The Martinez administration has stood by its handling of the allegations.

The Governor’s Office maintains that the overhaul improved access to behavioral health services.

“The reality is, under this administration’s leadership more New Mexicans are receiving behavioral health services than ever before,” said Joseph Cueto, a spokesman for the governor.

The state Behavioral Health Collaborative says the number of New Mexicans using mental health and substance abuse services grew from 87,000 in fiscal year 2013 to about 153,000 in calendar year 2015. But that coincides with a sharp increase in the number of New Mexicans enrolled in the state’s Medicaid program following its expansion under the Affordable Care Act.