Please we need your help. Texas can once again lead the way....
Tilted Axis Writes
Earlier this year, Secretary Sidonie Squier, Secretary of the New Mexico Human Services Department (HSD), via a no-bid “emergency” contract, paid 3 million dollars to a Boston-based consultant, “Public Consulting Group” (PCG), to perform an audit of15 vital safety net behavioral health providers in the State of New Mexico.
The PCG audit did not apply to any for-profit or state-run Behavioral Health providers, only to non-profit agencies. These non-profit agencies make up nearly 90% of the Behavioral Health capacity in the State of New Mexico, providing essential services to thousands of New Mexicans impacted by behavioral and mental health issues.
The PCG audit found a 100% failure rate, which in practice declared almost 90% of the Behavioral Health industry in New Mexico to be criminals, and as such the results have been sent directly to the Attorney General. All government payments to these agencies, approximately 80% or more of their revenue, has been immediately frozen; which in turn has put the services these companies provide to thousands of New Mexicans into jeopardy.
This action was all taken under a veil of secrecy and emergency. Neither PCG’s audit methodology, nor the audit results have been released to anyone; not to the public nor to the providers in question.
We should ask ourselves what is more likely.
A - The secret PCG algorithm is correct in finding a 100% failure rate, and is correct that 90% of the Behavioral Health providers in New Mexico are criminals.
B - The secret PCG algorithm is flawed and 90% of the behavioral health providers in New Mexico are not criminals, but are in fact victims.
There are good reasons to question such unprecedented results.
The providers indicted by the PCG audit regularly receive audits from state, federal, and private organizations. The providers in question have been subject to up to 30 days of audits in the past year alone. In other words, the providers in question have spent over 15% of available work days participating in audits. None of these audits found the criminal results that the Boston firm PCG was able to find; yet they all audited the same time period and activities. In fact, public records show that many of these audits have resulted in these providers receiving an exemplary rating; a process that can take years to achieve. Audits by Optum Health during this time period for these providers resulted in scores anywhere from 90-100%.
Why were the PCG audit results so different from all of the other audits that have taken place over the past 3 years? Could it be a problem with the algorithms that PCG uses to determine fraud and overbilling?
In 2012 the same Boston firm, PCG, made similar promises to the government of North Carolina. North Carolina was promised $36 million in recoupment, including claims of fraud. After the dust settled, only $3 million in overpayments were recouped, and no evidence of fraud was found (WRAL News, July 26, 2012)
If PCG’s algorithm was that wrong in North Carolina, is it plausible that it could be equally wrong in New Mexico? Is it coincidence that PCG found another $36 million dollars of overpayment in New Mexico just as they did in North Carolina?
Given these facts, which are the only facts we have as the results of the audit remain a State secret, it seems far more likely that the New Mexican’s that make up the Behavioral Health industry in New Mexico are the victims in the situation rather than the criminals they have been made out to be by HSD and PCG.
At the end of the day, the New Mexicans that make up the Behavioral Health providers in question have spent their lives dedicated to providing treatment and counseling to those in need. Whether it is after a loved one passes away, or when someone is addicted to drugs or alcohol. Whether it is a child with thoughts of suicide, or young adults that have been admitted to the corrections system. Whether it is providing life skills education to the mentally handicapped, or treating a child that is a member of an abusive home.
These are the essential services that are in question. These are the New Mexicans that work on the front lines trying to prevent the next Columbine, Sandyhook, Gabby Giffords, or movie theatre tragedies from happening here in New Mexico. Are they perfect? No, of course not. Is the Medicaid system perfect? No, of course not. But these providers deserve our respect and admiration, and at a minimum the benefit of the doubt, just as we respect and admire the firefighters and policemen that serve our local communities. They are not criminals, and the public and this paper should not assume as much in its coverage of the issue.
The New Mexico Attorney General should immediately approve all letters of good cause that these providers submit, which would allow government funding for essential Behavioral Health services to resume.
Secretary Sidonie Squier and Human Services Department should lift the veil of secrecy by immediately releasing the PCG audit results and methodology. This would allow public review of the data in question and allow the providers in question to address the charges they face.
In this situation, sunlight truly is the best disinfectant. The facts must be known to identify the problems, and the problems must be identified to create solutions. And when all of this is done together, as a community, we will emerge out of the other side stronger and more united.
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