Auditing nonprofits that have high dollar contracts with the state makes good government sense.
But such audits – public records of public spending – should not be hidden; not from the taxpaying public and not from the behavioral health providers working under contract for the state’s Human Services Department.
Medicaid and other funding to 15 behavioral health care providers has been stopped, although the providers can apply for exceptions to keep supplying services to their clients, most of whom have substance abuse problems or mental illnesses.
The department says a $3 million no-bid audit by a Boston firm found $36 million in overpayments to the providers in a three-year period, along with mismanagement and possible fraud. The audit was commissioned after OptumHealth, which runs the state Behavioral Health Collaborative under contract, installed new software to spot problems.
HSD plans to bring in contractors from Arizona at a possible cost of $17.8 million to train and oversee the providers.
The attorney general’s Medicaid Fraud Unit now has the audit, but only a summary has been made public. An HSD spokesman cited federal regulations for not disclosing the final audit and its potential affect on the AG’s investigation.”
Several lawmakers understandably want answers. “I don’t believe you should be able to spend $17 million of taxpayers’ money rectifying problems you’re not willing to specify,” said state Sen. Gerald Ortiz y Pino, D-Albuquerque.
Some legislators, including Senate President Pro Tem Mary Kay Papen, D-Las Cruces, have suggested the Behavioral Health Collaborative and OptumHealth should be doing a better job of overseeing providers instead of bringing in outside contractors to do their jobs.
During a contentious interim legislative committee hearing last week, HSD Secretary Sidonie Squier abruptly walked out after defending her department and OptumHealth. Yes, legislators can at times be difficult and even obnoxious or rude in their questioning. But even if that’s the case, and they dispute that, they are the people’s elected representatives and if Squier can’t deal with that you have to wonder if she should be in this job.
Meanwhile, some of the state’s biggest providers are in the hot seat: Team Builders Inc., which raked in nearly $42.5 million from July 2009 to August 2011; Hogares Inc. in Albuquerque; Families and Youth Inc. in Las Cruces; and Santa Fe-based Presbyterian Medical Services, which serves about 60,000 clients a year in 17 counties.
And some of the alleged abuses are rather startling.
A CEO and family members were paid up to $1.5 million a year; a provider bought services and rented space from a firm partially owned by its own CEO and COO; and a golden parachute was provided for a CEO that would have paid $60,000 a year for seven to 10 years.
The providers, some of whom say they have had very good audits in the past, are in the dark with their reputations on the line. They deserve to know what has gone awry – if anything – and be able to clear their names, or clean up their acts if they have erred. If money has been misspent, it should be recovered. If laws have been broken, there should be prosecutions.
In the meantime, the public deserves a clear picture of its behavioral health system. The audit should be made public, and all parties should stop squabbling and start cleaning up a mess that’s running a tab of millions of dollars.
This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.
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