New Mexico AG makes behavioral health audit public

ALBUQUERQUE (KRQE) – State Attorney General Hector Balderas released the 300-plus page audit on Thursday that caused a shake up in New Mexico’s behavioral health services, while taking aim at how alleged Medicaid fraud is investigated.

The June 2013 audit, that focused on 15 behavioral health providers, alleged $36 million in the mishandling of Medicaid funding from 2009 to 2012. The report also found widespread issues, including problems in billing processes and poor documentation.

A spokesperson for the state’s Human Services Department told KRQE News 13 a contractor’s report in 2012, identifying rampant over-billing, sparked the lengthy audit.

The audit sparked allegations Medicaid funding was mishandled, prompting Governor Susana Martinez’s administration to freeze Medicaid payments while the attorney general’s office investigated.

The audit was kept under wraps for a year and a half. Balderas said he determined it was prudent to release a minimally-redacted audit to increase transparency.

Balderas said in a press conference on Thursday that investigations into three out of the 15 providers have wrapped up. A provider in Santa Fe and another in Alamogordo have been cleared of criminal wrongdoing. Balderas said results of the investigation into the third provider should be released soon.

The attorney general’s office hopes to expedite the remaining investigations and complete them within the next eight months. In order to do this, Balderas said he has asked the legislature to shift $1 million within his office’s budget.

“We still have to complete 12 investigations, but we need additional resources, so we’re asking the governor and New Mexico legislature to help us with this investigation,” Balderas said.

Any criminal activity that’s uncovered will be brought in front of a grand jury, Balderas said.

Balderas said investigations into the 15 providers are the tip of the iceberg; his office has more than 350 active Medicaid fraud cases.

In the press conference, Balderas also said he wants to change the way fraud allegations are investigated. He intends to create a task force and increase transparency.

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