ABQ Health Partners Fined Over Claims

ABQ Health Partners has agreed to reimburse about $755,000 to the federal government for improperly billed services and pay a $341,000 fine, according to the Health and Human Services Department’s Office of the Inspector General.

The OIG said ABQ Health Partners “submitted claims to federal health care programs for services performed by pharmacy clinicians during new and established patient visits based on (evaluation and management services) codes that ABQ knew or should have known were not reimbursable.”

OIG said ABQ Health Partners reported the problem to the government.

Valerie Leyder, ABQ Health Partners executive director of health care operations, said the practice discovered the problem last year during an internal audit and reported its findings to the OIG.

Leyder said pharmacy clinicians monitor patients’ medications. She said ABQ Health Partners no longer performs such services because the practice now focuses on primary and specialty care.

“We do a routine internal audit,” Leyder said. “The sole purpose is to audit existing business practices to be sure we are doing the letter of the law.”

“This is the way we operate,” Leyder said. “We don’t hide things like this. We’re going to report it and fix it.”

ABQ Health Partners with about 180 physicians is the largest medical practice in the state that is not owned by an integrated health system. It was sold this year to a California-based practice.

Lovelace Health Plan and ABQ Health Partners last month acrimoniously ended a long-standing medical services agreement, forcing health plan members to decide between changing insurance companies to remain with ABQ Health Partners or find a new medical provider and stay with Lovelace.