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HSD report not showing fraud: Auditor

By    Matt Grubs

ALBUQUERQUE (KRQE) - As the controversy continues over the state cutting funding to 15 behavioral-health providers, the state auditor is concerned that move may be a bad and expensive decision.

The burning hot ember at the center of the political blaze is actually something the Office of the State Auditor, the Attorney General's Office and the Human Services Department agree on

"We should be doing everything we can to investigate and prosecute Medicaid fraud," State Auditor Hector Balderas told KRQE News 13.

"We found $36 million in overpayments to these agencies," added HSD spokesman Matt Kennicott said.  "That's a lot of money that could have gone to help additional low-income New Mexicans with these services."

A highly-redacted audit plan released by the AG's office shows HSD hired a company to investigate potential waste, fraud and abuse among 15 providers.  After the audit those 15 providers had their funding cut off.

"We've got a responsibility to protect those taxpayer dollars, but we also have a very deep responsibility to ensure that consumers are receiving the access to care that they need," Kennicott said.

According to Balderas HSD also has a responsibility to make sure the audit was done the right way.

"They're required to do this job very accurately but also very fairly and diligently so they don't disrupt services for New Mexicans," Balderas said.

Balderas said he tried to get the audit report, first through a letter to the HSD cabinet secretary.  But department wouldn't give him the report citing concerns that it could compromise the attorney general's investigation if it leaked to the public.

So Balderas took his request to court and won.

"We did not see enough in that report to establish credible allegations of fraud," he said.

Balderas warns if the state's standards for doing an audit weren't up to snuff, billions of dollars in Medicaid funding could be at risk.

"We want to make sure that we're testing and auditing their fraud detection that they're relying upon to make these life-changing decisions for citizens of New Mexico," Balderas said.  "And what I've seen so far in that report is just not enough."

Balderas said he wants more evidence, and HSD says it won't hold back

"No, we're cooperating with what the auditor is requesting," Kennicott said.

Balderas is waiting, and so, too, is the behavioral health community.

"So there's a lot of fear; there's a lot of uncertainty," said Dr. Susan Cave of the New Mexico Psychological Association.  "Patients are very afraid, family members are concerned.

"There are fears that people are going to lose their therapists, people with whom they may have worked for years."

While Cave said he has not seen those fears realized, she still worries HSD acted too fast in stopping payments to providers.

The New Mexico Foundation for Open Government, which also has pressed for release of the audit, isn't ready to say the funding freeze happened too fast.

"If there is proper justification, we haven't seen it because the details of this audit are being concealed," Terry Schleder of NMFOG said.

Federal rules say the Human Services Department is the only state agency that can decide if the audit findings rise to the level of a credible allegation of fraud.  HSD says its audit met federal standards and then some.

Attorney General Gary King was not available for an interview.

See link below for the video.

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Categories: Medicaid Watch