Commentary: U.S. Sens. Tom Udall and Martin Heinrich, and U.S. Reps. Ben Ray Luján and Michelle Lujan Grisham introduced the Medicaid Program Integrity Enhancement Act of 2016. The bill protects Medicaid patients by establishing clear guidelines that ensure that state agencies investigating allegations of fraud do so in a manner that both protects health care consumers and affords due process of law to the health care provider.
The introduction of the bill comes after the New Mexico Human Services Department (HSD) unnecessarily suspended Medicaid payments to 15 behavioral health providers claiming allegations of fraud nearly three years ago. This decision upended New Mexico’s behavioral health system overnight, disrupting care to some of our state’s most vulnerable residents. Since then, and following an investigation by New Mexico Attorney General Hector Balderas, 13 providers accused of fraud have been cleared. Additionally, the First Judicial Court of New Mexico has ruled that HSD violated the due process rights of several of the behavioral health providers when it withheld payments indefinitely without an opportunity to appeal the state’s decision.