Government Power Grab of Fellow San Antonio Sister Mental Health Agency in New Mexico
Unjust Draconian Measures Taken Against Mental Health Non-Profits
NM Capitol Report | A view from the New Mexico state capitol
State didn?t have to halt Medicaid payments to providers | New Mexico In Depth
Group decries ?witch hunt? against New Mexico behavioral health providers - The Santa Fe New Mexican: Local News
The damage being caused is immeasurable and will take a generation or more to heal. This is not the way to go about Medicaid reform. The targeted agencies themselves are instruments of change in New Mexico. You can help!
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KDBC 4 CBS: N.M. State audit could put thousands of mentally ill patients at risk
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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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Along with other nonprofits in New Mexico offering behavioral health services, we now face our 4th week of payment holds imposed by HSD, results of the audit remain undisclosed, and we continue to be denied due process or the opportunity to take corrective action if needed.
Worse yet, we have been publicly branded as criminals and are being told by HSD that our life’s work will be handed over to Arizona companies. These companies have not been properly vetted, do not have the credentials to provide services in New Mexico, and they are strangers to our communities, the New Mexico system and the people we serve. The transition plan is poorly constructed and will decimate our behavioral health system. New Mexico is paying these companies over $17 million of taxpayer money.
Eighteen years ago, when I was pregnant with my youngest child, my husband Shannon and I started TeamBuilders in Tucumcari. Using the spark of a $10,000 planning grant, we mobilized others to meet the needs of young people impacted by grief, trauma, violence, mental illness and addiction.
Today, TeamBuilders is a designated Children’s Core Service Agency serving 23 historically under-served counties and 15 Native American communities throughout New Mexico. In the past year we served 6,750 of our state’s most vulnerable children and their families, including many children in state custody. We employ over 650 staff and foster parents who heroically work 24/7, responding to crises in homes, schools and detention facilities. We come together to help our communities in times of natural disasters and critical need.
TeamBuilders regularly receives over 30 days of audits per year from state, federal and private entities. None of these audits identified the concerns claimed by the HSD audit. In fact, during the same review period, our agency achieved “exemplary status” for all of our children’s Medicaid programs by CYFD Licensing and Certification Authority; international awards of excellence in our evidence-based multi-systemic therapy program (top 1 percent); and grades of over 95 percent for audits conducted by OptumHealth.
Naturally, we have a lot of questions:
We question Optum’s new algorhythmic software, put to widespread use before it was tested.
We question the agency selection criteria.
We question Public Consulting Group’s 24-point audit tool and the fact that not meeting one of the 24 criteria – a 96 percent compliance rate – constituted failure.
We question why there was no examination of the instrument, the process or the larger system when all 15 agencies failed.
We question Public Consulting Group, which has made a business of promising millions in Medicaid/Medicare recoupment and delivering only a small fraction of the savings.
We question a department that takes drastic action under a veil of secrecy and urgency without seeking first to understand.
And we question a system that could allow this to happen to people and organizations who, for decades, have cared for thousands of New Mexicans with the greatest needs.
Through multiple state administrations, many iterations of managed care, a web of competing regulations and increased demands to do more and more with less and less, the nonprofit providers have remained steadfast in our commitment. We have been the constant. We have been the instruments of change for important initiatives.
Now we are facing annihilation at the hands of a government we have been faithful to.
We welcome an impartial review by the Attorney General’s Office. If this is indeed a legitimate process, we also implore HSD to utilize its discretion to provide an immediate release of funding without contingencies while the investigation takes place.
We are committed to identifying and resolving all concerns, while maintaining continuity of care. Time is of the essence.
And, please, help me explain to my daughter who leaves for college next month, why we must trust this process.
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Court asked to restore mental health funding
State stops federal money to major local care providers
By Todd G. Dickson
Las Cruces Bulletin
The fate of mental health services for at least 5,000 people in southern New Mexico now lies with a federal judge who heard arguments Wednesday, July 17, from eight of 15 behavioral health providers that the state suspended funding to due to the findings of a controversial audit.
Among the eight asking for a temporary restraining order (TRO) from presiding federal Judge Christine Armijo are Southwest Counseling Center(SCC), which provides services to 3,000 people, and Families & Youth Inc. (FYI), which provides behavioral health services to more than 1,800 people.
They are the two largest local providers among 15 of the state’s largest nonprofit mental health companies that the state Human Services Department (HSD) is withholding funding from following a Boston-based audit firm’s claim they engaged in fraudulent practices involving Medicaid and Medicare funds.
Public Consulting Group
(PCG), the Boston-based company contracted by HSD, claims to have found $36 million in Medicaid overpayments to 15 New Mexico mental health and drug abuse providers as well as other acts of fraud between 2008 and 2012.
Some of the audit claims include staff not keeping “line of sight” observation of suicidal patients, company CEOs and family members being richly compensated, provider administrators giving contracts to businesses they or family members had a financial stake in and that there was double billing, over billing or billing for services not rendered.
“The audits have uncovered systemic problems in billing for services, many willful, some through poor business practices,” the audit summary states.
HSD officials say they are required by federal regulations to withhold funding in the light of such findings, but there are conflicting statements from federal regulators about how much latitude is given to the state to work with providers so services aren’t interrupted.
State Human Services Secretary Sidonie Squier said providers would be brought in from Arizona to avoid disruption of services.
The affected providers are crying foul, saying they have not been given the chance to respond to the audit’s claims – or even been given specific information about which of the claims belong to which provider.
Closures and furloughs
FYI CEO Jose Frietze said Armijo didn’t give a ruling on the TRO immediately after arguments, but that legal counsel expectsthe judge to act on the request, hopefully by Friday, July 19. A favorable ruling by Friday couldn’t cut it any closer for SCC Executive Director Roque Garcia, who said SCC may have to close its doors because it only has enough money to pay its workers through Friday.
Both Frietze and Garcia say the audit was highly unorthodox in the way the information was compiled, and they resent being accused of criminal actions without a chance to answer specific claims. Frietze said PCG didn’t even hold an exit interview – a common audit practice in which auditor findings are announced with immediate actions to be taken for serious concerns.
“We’re all being painted with the same brush,” Garcia said. “We’re all considered guilty and we’re telling them, ‘Tell us what it is we did.’” As for “golden parachutes” to provider CEOs, that isn’t the case in southern New Mexico, Garcia said.
Frietze said it is quite possible that many of the audit findings will be just human error, possibly even caused by OptumHealth, the company hired by the state Mental Health Collaborative – headed by Squier – to manage payments to providers. Both Garcia and Frietze said OptumHealth changed its billing systems and requirements frequently.
When OptumHealth got the state contract in 2009, “they had no idea how to handle the billings,” Frietze said.
“We have the emails that show things such as OptumHealth telling us, the providers, to put all the billings under one person’s ID code – now that’s fraud,” he said. “If there’s any fraud to be found, it’s because Optum ordered it.” Both Frietze and Garcia doubt PCG’s audit claims will be proven because the company – which makes its money on a commission basis for finding fraud and recieving a percentage of recovered funds – has a history of its claims being disproven in North Carolina. FYI’s youth group homes, multi-systemic therapy, problematic sexual behavior treatment, foster care and outpatient care programs are impacted by the state’s withholding of federal money, Frietze said. For those programs, workers will begin taking oneday- a-week furloughs beginning Friday, July 19. “We’re going to do everything we can to keep our services open,” he said.
Garcia said the combination of the explosive audit findings, the abrupt suspension of payments and the quick hiring of out-of-state providers “doesn’t pass the smell test.”
“I just don’t understand how we can haveclean audits every other year – not only good audits, but excellent audits – and then we fail one audit and we’re out of business,” Garcia said.
Frietze said the accused providers needed only fail one of the 24-point audit, another unusual practice by the PCG firm.
Providers aren’t the only with unanswered questions. Squier recently walked out on a legislative mental health subcommittee amid tough questions. State Sen. Mary Kay Papen said the record shows that it was Squier who was rude and made unsubstantiated statements, such as branding all the providers as criminals.
Papen said she is concerned about uncovering fraud that takes money away from needed services for people with mental illness, but she doesn’t see how bringing in out-of-state providers amid disruption to those services helps anyone.
“Are they actually saying there is no one in the state of New Mexico who can do this?,” Papen said. “This is very serious business, no question. But we still have an obligation to take care of the most fragile people in this system.”
The same day as a federal judge was hearing arguments in Albuquerque, Squier was again being called before legislators to explain her actions – this time the powerful Legislative Finance Committee, of which Papen is a member. Paper said Squier will again face tough questions about why the usual procurement procedures were sidestepped in these events under the guise of it being “an emergency.”
“This has all been handled very punitively,” Papen said. “There’s a big difference between errors and fraud. … Where was OptumHealth all this time? Where was HSD?”
This is very serious business, no question. But we still have an obligation to take care of the most fragile peoplein this system.
MARY KAY PAPEN, state senator
Keep the faith, hopefully justice will prevail.
Cash-starved NM agencies file emergency court appeal
July 31, 2013 by Dennis Grantham, Editor-in-Chief SHARE ON FACEBOOK SHARE ON LINKEDIN SHARE ON TWITTER SHARE ON GOOGLE MORE SHARING SERVICES | REPRINTS
Facing ouster, CEOs ask to see New Mexico’s fraud allegations before agencies are taken over
Eight of 15 New Mexico behavioral health agencies whose Medicaid payments have been held since June 24 based on “credible allegations of fraud” by state Human Services Department (HSD) Secretary Sidonie Squier have appealed a July 25 decision by federal Judge Christina Armijo to the Tenth Circuit Court. Last week, Armijo denied the agencies' request for a temporary restraining order that would have forced New Mexico to reinstate their funding and make available the details of an audit that is said to document millions in waste, fraud, and abuse.
Armijo’s decision stated that the agencies’ request for a temporary restraining order was denied because “plaintiffs have failed to fulfill their heavy burden to establish that they are entitled to the extraordinary remedy” that the TRO and a resumption of payments to them would provide. While Armijo noted that the agencies made a “substantial” case in support of two of the four points necessary to win such an order, she ultimately ruled against the agencies on all four points in the brief containing her decision.
However, in emergency appeal documents filed with the US Tenth Circuit Court on July 29, plaintiffs’ attorney Patric Hooper argued that “something is very rotten in the State of New Mexico’s Medicaid program.” In the appeal, Hooper stated that since the agencies’ initial July 3 filing in Armijo’s court, HSD’s payment stoppage—affecting $ 7 million in 2013 claims so far— has “made it virtually impossible for the organizations to continue to provide services.” It also has forced the closure of one agency and the impending closure of several more.
In the appeal, Hooper alleges that the agencies are being driven out of business. Their vulnerability to cash-flow problems “gave HSD the chance to commandeer their programs by installing five handpicked Arizona organizations to take over Plaintiffs’ businesses.” At the same time, the appeal argues that the agencies continue to suffer harm as referrals dry up, employees are laid off, and the details of alleged fraud remain hidden from view or from reply. To date, he says that none of the agencies have been given “any meaningful notice or opportunity to discuss any of the specific allegations against them.” ...
Cash-starved NM agencies file emergency court appeal
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