Workers demand updates on mental health funding freeze

Posted at: 08/30/2013 1:30 PM
Updated at: 08/30/2013 4:15 PM
By: Nikki Ibarra and Elizabeth Reed, KOB Eyewitness News 4

SANTA FE -- Dozens of mental health workers protested outside the Roundhouse in Santa Fe on Friday, demanding answers about the state's decision to suspend funding to mental health providers.

In July, New Mexico's Human Services Department suspended Medicaid funding to 15 providers while conducting an investigation into allegations of fraud. An out-of-state consulting group released an audit in June accusing the mental health providers of overbilling the federal and state government by tens of millions of dollars.

On Tuesday, KOB Eyewitness News 4 learned the Human Services Department will testify in front of the legislature about their investigation.

Mental health workers at today's protest spoke about clients affected by the cuts, citing cancelled appointments and no medication.

"Individuals with mental illness really require service from people that they trust and any disruption in that care is very detrimental to them," said Patsy Romero, who works in the mental health field.

Most of the 15 providers are still without funding, the Human Services Department confirmed to KOB.

Matt Kennicott, Director of Extrnal Affairs for the NM Human Services Department emailed KOB a statement Friday afternoon, which reads:

"We have a duty and important responsibility to protect taxpayer dollars and root out any abuse of Medicaid funding, while ensuring that consumers continue to receive uninterrupted access to care.

The audit revealed $36 million in improper payments made to these companies, which is funding that could have gone to provide services to New Mexicans in need.  Along with other documentation that examined questionable business practices and deep financial conflicts, whistleblowers have also come forward to indicate that, in many cases, they were told by executives to commit various fraudulent acts.  For example, workers have reported the spending of funds by one CEO out of personal consumer accounts, and some have said that they were told to bill the Medicaid system for services that weren’t provided, intentionally up-code for services as a means of siphoning additional money out of the behavioral health care system, and provide and bill for continued services despite knowledge that the patient wasn’t improving or no longer needed the services, among other charges.  Some were also told not to report critical incidents or problems to regulators, or otherwise cooperate with authorities.

Financial conflicts, workers alleging fraudulent acts on the parts of executives, reports detailing claim mismanagement, and an audit totaling $36 million in improper payments … these are significant problems, and we are working within the framework of the law to address them.  

As for proposed legislation, these are federal Medicaid dollars, subject to federal law.  And the new federal health care reform law was crystal clear that it was deliberately designed and written to stop payments to companies that are the subject of credible allegations of fraud.  This was upheld in New Mexico by a federal judge just a few weeks ago.  And, here is some of what Secretary Sebelius and others at the federal level have said with respect to this issue:

“By expanding our authority to suspend Medicare payments and reimbursements when fraud is suspected, the law allows us to better preserve the system and save taxpayer dollars.” – Secretary Kathleen Sebelius (Tuesday, May 14, 2013)
“In addition to these arrests, we used new authority from the health care law to stop all future payments to 52 health care providers suspected of fraud before they are ever made. Today’s actions are another example of how the Affordable Care Act is helping the Obama Administration fight fraud and strengthen the Medicare program.” – Secretary Kathleen Sebelius (Wednesday, May 2, 2012)
“…HHS used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place.” – Secretary Kathleen Sebelius (Thursday, October 4, 2012)
“As we stop payments to these providers suspected of fraud, we continue our efforts to move from a pay-and-chase model to one where we stop fraudsters before they can successfully bill Medicare and Medicaid.” – CMS Deputy Administrator for Program Integrity Dr. Peter Budetti (Thursday, October 4, 2012)

Furthermore, in 2012, in a report that CMS published about New Mexico’s administration of the Medicaid program, New Mexico was specifically cited and told to put in place pay-holds when allegations of fraud arise."