Editorial: Don't repeat mental health fiasco
Now that all 15 of the state’s mental health agencies accused of fraud by the Martinez administration have been cleared by the attorney general, it’s time to consider how we can prevent a similar debacle from happening in the future.
In the summer of 2013, the state Human Services Department froze Medicaid funding for 15 state agencies as the result of an audit conducted by Boston-based Public Consulting Group that allegedly showed some $36 million in Medicaid overpayments.
Gov. Susana Martinez insisted at the time that new anti-fraud provisions in the Affordable Care Act left the state no choice but to immediately freeze funding for suspected agencies once they had knowledge of credible allegations of fraud. Had the state declined to act, it risked losing all of its Medicaid funding, Martinez contended. Others disagreed, saying the state could have received a waiver.
In an attempt to clear up that confusion, the four Democrats in New Mexico’s congressional delegation have backed legislation to revise the credible allegation of fraud standard in the health care bill.
The Medicaid Program Integrity Enhancement Act of 2015 would establish new requirements to determine what qualifies as a credible allegation of fraud and a new process for suspending payments.
Before freezing payments, the state would be required to receive written verification of the allegations from the attorney general or a Medicaid fraud unit, followed by quarterly reports. If the investigation is not completed in a timely manner, the state would be required to disclose the specific allegations to providers.
Rep. Steve Pearce, the lone Republican in our congressional delegation, said it is the state’s responsibility to investigate fraud, but took no other position on the bill.
Sen. Mary Kay Papen, D-Las Cruces, proposed similar legislation at the state level in 2015. Her bill would have given providers the right for a court hearing before payments could be suspended. The bill passed easily in the Senate. But without the support of Martinez, it died in the Republican-controlled House of Representatives.
With the benefit of hindsight, we now know this was a costly mistake. Five Arizona-based companies were brought in to take over services, causing incredible disruption to a vulnerable population. Three of those companies have since pulled up stakes and retreated back to Arizona, causing a second round of disruption to that same vulnerable population.
Just how costly the mistake will be won’t be determined until all of the court cases against the state have been settled. A tort notice sent last week by Roque Garcia of Southwest Counseling suggests he will soon be the latest to file suit.
In announcing his decision, Attorney General Hector Balderas said, “It now falls to the Human Services Department to take timely and appropriate administrative action to resolve this regrettable situation to ensure that tens of thousands of vulnerable New Mexicans receive their critical services.”
But the response by the governor made it clear she trusts the audit rather than the more than two years of work by investigators for the AG.
The governor should reconsider, but likely won’t. Nonetheless, all involved should try to ensure that this never happens again.
This editorial was written by the Las Cruces Sun-News.