NM lawmaker proposes bill to help providers appeal state fraud cases

Last year’s shake-up of behavioral health providers in New Mexico drew comparisons to the Salem witch trials and injustices perpetrated by rulers of the Roman Empire on Wednesday at a hearing where a state lawmaker unveiled proposed legislation that would guarantee due process to agencies suspected of Medicaid fraud.

State Sen. Mary Kay Papen, D-Las Cruces, said Gov. Susana Martinez’s administration’s abrupt halt of payments to 15 agencies that provided mental health and substance abuse treatment and their subsequent replacement by five Arizona companies inspired the draft legislation.

Suspicions of fraudulent billing by the providers in New Mexico surfaced in the fall of 2012, when OptumHealth New Mexico, the contractor that oversees Medicaid behavioral health services for the state, brought them to the attention of the Human Services Department.

In October 2012 — months before an audit of the providers was launched — OptumHealth and the Human Services Department were mulling strategies for sanctioning the providers if fraud was detected, according to an email obtained by The New Mexican that lays out two paths forward, including the route the department ultimately chose eight months later.

via Lawmaker proposes bill to help providers appeal state fraud cases – The Santa Fe New Mexican: Local News.

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