State lawmakers back accused health providers

Steve Hansen
CMI Staff Writer

Support from state legislators, and local health officials, and a lawsuit against the state’s secretary of Human Services have gotten behind 15 behavioral health providers who are facing a criminal investigation after an audit ordered by the Human Services Dept. One of those providers is Teambuilders Counseling Services, which serves Clovis, Portales, Tucumcari and other Eastern New Mexico communities.

State Sen. Bill O’Neill (D-Albuquerque) has joined State Sen. Mary Kay Papen (D-Las Cruces) in asking HSD to reinstate payment to these providers while the investigation continues. All but three have had payments suspended while the criminal investigation continues, HSD officials said. Teambuilders has asked for payment through the “good cause exception” status that the three providers who are being paid used, but HSD has denied Teambuilders and others this status, according to Matt Kennicott, HSD spokesperson.

O’Neill said he does not understand the “extreme measures” that HSD took after the audit results were announced.

Without warning, he said, the providers’ names were “dragged through the media as if they had done something fraudulent.”

He said that accusing the providers of fraud without providing any information about why was “not leadership at all.”

The lawsuit, filed by eight of the providers, not including Teambuilders, seeks an injunction, temporary or permanent, on HSD to stop denying payment to the providers. A hearing for a temporary restraining order to halt the suspension of payments was set for today in U.S. District Court, Albuquerque.

Last week, the New Mexico Attorney General’s office said their investigation would take months and additional resources beyond the office’s current capacity. This week, the Attorney General’s office could not confirm or deny that the investigation’s status had changed, Lynn Southard, attorney general’s office spokesperson, said. Once a case is opened, she said, the office cannot comment on its status.

In response to allegations that the Public Consulting Group, which conducted the $3-million audit of the state’s mental health providers, was criticized for audit results in North Carolina, Kennicott forwarded a statement from PCG that said, “The vast majority of PCG’s clinical findings have been upheld by the North Carolina Department of health and Human Services during their due process hearings.”

Further, the statement said, the overpayment reviews in North Carolina “have resulted in significant results contributing to the overall management of their provider group,” and resulting in a 23 percent improvement in provider compliance.

In its summary of audit findings, HSD said “each of the fifteen providers audited failed to meet minimal compliance standards, with error rates far exceeding national documented averages, and $36 million in definitive overpayments have been identified.”

The $36 million represents 14 percent of payments made to the agencies, the report said. The 14 percent rate of overpayment exceeds the federal General Accounting Office’s standard of 3 percent to 9 percent of all payments that are found to be fraudulent, the summary stated.

Meanwhile, HSD has made preliminary arrangement with five Arizona-based behavioral health providers to take over services for HSD programs in New Mexico, Kennicott said. These providers include Southwest Behavioral Health Services, Inc.; Southwest Network, Inc.; Lifewell, Inc.; and Valle del Sol, Inc., all of Phoenix, and La Frontera, Inc., of Tucson.

In FY ’13, TeamBuilders served 849 individuals (children and adults) from Curry County, 253 from Roosevelt County and 147 people from Quay County, Teambuilders CEO Shannon Freedle said.

Freedle did not return a phone call or an e-mail inquiry made on Friday, seeking comments on the support for the providers and Teambuilders’ current funding status. Freedle said last week that that Teambuilders could operate for two months on its reserve funds.

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