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Tuesday, September 3, 2013 - 7:02pm
LAS CRUCES, N.M. — The Behavioral Health Subcommittee made up of state legislators questioned the leaders of New Mexico's Human Services Department on the allegations of fraud involving 15 mental healthcare providers in the state.
Earlier this summer when 15 providers were were found to have been allegedly committing fraud of up to $36 million in an and the state removed the heads of those companies with the attorney general has sealing the audit.
"Everyone is concerned that people are being accused without the opportunity to even know what they're being accused of," said Senator William Soules of District 37.
HSD first heard of possible fraud allegations from Optum health in late 2012.
Optum runs behavioral health in New Mexico and also conducts data auditing as a part of their contract.
"When you see that one CEO is flying around to vacation spots in his personal plane that's paid for by medicaid dollars you have a problem there that needs looking at," said HSD Spokesperson Matt Kennicott.
Due to the nature of the allegations and after consulting with the Attorney General's office HSD contracted a firm to conduct a separate audit.
The audit found $36 million in fraud and over payments and the state proceeded to remove the CEOs of 15 providers.
HSD officials testified before the committee saying federal guidelines have been followed as outlined and providers can apply for exceptions.
A lawsuit was also filed in federal court and a judge ruled HSD had followed the proper steps.
The lawsuit went to appeals court where it was dismissed and some legislators at the hearing still feel the state might by liable to be sued by providers who have had their reputation damaged.
"Certainly if there's illegal activities they should be dealt with, but until that's shown we need to make sure people are getting the health and services they need," Soules said.