The now-infamous 2013 audit of 15 nonprofit New Mexico behavioral health providers has finally been released to the public by our new Attorney General, Hector Balderas. You remember: that\u2019s the audit that led the Human Services Department to accuse all 15 of massive fraud and stop paying them for services under Medicaid, which led to 12 of those providers being starved out of business, a behavioral health system thrown into chaos and several thousands of very vulnerable clients \u2013 including many children and a few possibly dangerous individuals \u2013 abandoned. Sudden forced withdrawal from psychotropic medications, because there wasn\u2019t anybody left to write the prescriptions, was just one of the disastrous consequences of this event.<\/p>\n
Among the 15 providers, over a three-year period, there were $36 million in cost overruns, the audit claimed. That\u2019s a lot of taxpayer money. But I wonder if there might be other explanations for some of this spending.<\/p>\n
Under the managed care system, providers had to get approval from the state\u2019s official managed care contractor before they could provide treatment for clients. The managed care contractor, Optum Health, had a financial incentive to minimize or deny treatment. Less money for the providers meant more money for Optum \u2013 which was also getting something like $40 million a year in fees. That\u2019s more each year than the alleged total $36 million.<\/p>\n
The providers were being nickel-and-dimed constantly.<\/p>\n
I\u2019d hear stories like this: a seriously troubled client needed six weeks of residential treatment but Optum would only authorize weekly counseling sessions. So, while tearing their own hair out in frustration, the provider would have to go through an appeals process which ate up more of their time and resources, and which was not billable. \u00a0The provider looks administratively inefficient but that\u2019s because it is fighting for its clients.<\/p>\n
To figure this out, somebody will have to go back through the 300-plus-page audit and see what really happened. Balderas is asking for a million dollars to hire extra people to do this. Maybe if he gets the money, this catastrophe can be properly investigated before the next millenium, and we can find out whether factors other than fraud played any part in the alleged overbilling.<\/p>\n
Another question needs to be asked \u2013 maybe by AG Balderas, maybe by legislators who are now in session. Why did the Human Services Department have to destroy those 12 organizations?<\/p>\n
It was claimed that just a few individuals were responsible for the fraudulent overbillings. Throughout the public hearings in 2013, then-Secretary Sidonie Squier and other officials repeatedly emphasized that the frontline staff \u2013 the counselors — were not the perpetrators. In the godawful transition to a group of out-of-state providers imported from Arizona, those staff theoretically could have been hired by the new organizations so they could keep treating these fragile mental health patients without disruption. That never happened, as we know.<\/p>\n
Nonprofits have boards of directors. Boards are often volunteers, not involved in day-to-day operations, but they have ultimate responsibility. When an executive of a nonprofit is allegedly misbehaving, the right action is for the complaining party to contact the board. If the board has to fire or temporarily suspend an executive director, the board can do so.<\/p>\n
Boards of directors generally detest having all that responsibility thrust upon them, but that\u2019s what they signed up for. If that had been done in 2013, the organizations could have continued to function, staff could have been retained, licensure could have remained intact, client relationships could have continued without interruption, prescriptions could have continued to be written and filled. All those fragile clients could have continued to be served.<\/p>\n
Ever since this fiasco happened, I have been wanting to know why the boards of directors were not called into action. \u00a0It\u2019s past time for answers.<\/p>\n
Triple Spaced Again, \u00a9 New Mexico News Services 2015<\/p>\n","protected":false},"excerpt":{"rendered":"
The now-infamous 2013 audit of 15 nonprofit New Mexico behavioral health providers has finally been released to the public by our new Attorney General, Hector Balderas. You remember: that\u2019s the audit that led the Human Services Department to accuse all … Continue reading