State suspends payments to 15 largest behavioral health service providers

July 11, 2013

The state’s suspension of Medicaid payments to the largest behavioral health service providers in Taos County has imperiled access to those services for hundreds of children and their families, according to the administrators of those organizations.

The Human Services Department announced the move June 24 after the state’s 15 largest behavioral health service providers failed an audit by a private consultancy.
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Casa de Corazón and Teambuilders, Inc., which both serve children in Taos County, were included in the audit. Staff at those agencies said the state’s decision to suspend their Medicaid payments could have a significant impact on their operations in Northern New Mexico.

“The effect here in Taos will be tremendously adverse for these families,” said Mark Johnson, CEO of Easter Seals El Mirador, which operates Casa de Corazón.

About 200 children in the Taos area are currently served by Casa de Corazón, which provides psychiatric services, outpatient therapy and treatment foster care while working closely with the special education departments of local schools.

Without the Medicaid payments that provide about 40 percent of the agency’s budget, however, the organization is uncertain how it will continue to operate.

“We have already delivered two weeks of services we have not been paid for,” Johnson said, adding the agencies whose payments had been suspended by the state continued to operate as required by the Human Services Department.

Questions abound, however, now that the Human Services Department has referred the results of the audit to the Attorney General’s office while providing only a summary of their analysis and declining to specifically explain how any of the 15 organizations failed to meet their criteria.

“We have not received individual findings,” said Shannon Freedle, CEO of Teambuilders, Inc., which serves 3,000 clients across the state including hundreds of children in Taos County. With little indication as to why their agency failed the audit or what recourse they can pursue, Freedle said “the situation is pretty dire.”

A summary of the audit’s findings allege fraudulent billing practices and what were characterized as “extremely excessive” compensation packages at some of the agencies.

“The audit results indicate that each of the 15 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,” according to a statement from the Human Services Department. The document did not make allegations against any specific organization, however.

“It is pretty scary when you hear the word fraud,” Johnson said, that the lack of details merely contributed to confusion among administrators, staff and clients.

Easter Seals El Mirador received highly favorable results following an audit in April 2012, Johnson said, with 93 percent compliance and no action required.

“We never saw what they were grading us on,” said Dorothy Forbes, quality management coordinator at Casa de Corazón.

Forbes said she had doubts about the auditor contracted by the state to conduct the analysis. Auditors from the Boston-based Public Consulting Group only spent three days with Easter Seals El Mirador despite scheduling seven days at the agency, Forbes said.

“It is heartbreaking because we do not have any information,” Johnson said, emphasizing he was eager to work with the state to remedy any issues or liaise with other service providers to ensure clients could continue to receive care.

The Attorney General’s office is only beginning to investigate the 15 agencies involved in the audit, according to a spokesperson. The next steps for each organization will not be clear until investigators can determine what if any legal action should be taken.

“There is just no way to put a timeline on it,” said Phil Sisneros, director of communications for the Attorney General’s office.

Medicaid payments will remain suspended for each agency until an investigation is completed as required under federal law.

The New Mexico Human Services Department has been consulting with several behavioral health service providers based in Arizona “that can help maintain services.”

The prospect of organizations from outside the community serving the clients of existing agencies in Northern New Mexico concerned some Easter Seals staff, however.

“We really look at cultural competency in each of the communities we serve,” said Patsy Romero, chief operating officer at Easter Seals El Mirador. “Bringing in a company from Arizona is not respectful of the local culture.”

Easter Seals El Mirador has the resources to maintain a presence in Northern New Mexico, according to administrators, with clinical teams who could treat clients in crisis. Comprehensive services, Romero said, would have to be reduced if Medicaid funding is not restored.

Casa de Corazón plans to hold a community meeting about the state’s decision Tuesday (July 9), 5:30 p.m. at 629 Adrienne Road in Taos.

The suspension of Medicaid payments has affected more than 90 percent of the budget for Teambuilders, Inc., according to the organization’s administrators.

“We need action now to allow us to do the work we do while we work through these issues,” Freedle said.

Source: Andrew Oxford, "Agencies seeking answers after Medicaid payments suspended," The Taos News, July 3, 2013.


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