Tuesday, July 14, 2009

Auditing ValueOptions

Thirteen state legislators are asking state Auditor Hector Balderas to conduct an audit of ValueOptions, the company that ran the state behaviorial-health program for the past four years. ValueOptions lost the contract to a company called OptumHealth, which took over the program on July 1.

Here's the text of that letter.
Dear Mr. Balderas:

We are writing to request that the State Auditor undertake a special programmatic and financial audit of the behavioral health statewide entity contract with ValueOptions New Mexico ... . This request is being made pursuant to a great number of complaints that we, as state legislators, have received from our constituents who have suffered both as clients and providers since ValueOptions began performance pursuant to its contract as the behavioral health statewide entity. Recently, complaints have been made regarding ValueOptions' transition of services to the new statewide entity, OptumHealth of New Mexico ... .

These complaints involve allegations that ValueOptions has:

• been untimely in its payments to providers, resulting in the loss of some providers in areas where there are few or no behavioral health services;
• made inappropriate and untimely denials for services to clients;
• failed to provide adequate access to care to clients;
• failed to ensure that services of adequate quality have been provided to clients;
• failed to pay providers at adequate reimbursement rates;
• failed to provide adequate information to clients and providers on its protocols, procedures and means of contacting its personnel;
• retaliated, in the form of more dilatory payment and denial of reinvestment funds, against providers who have complained of its policies and performance;
• failed to maintain adequate and timely documentation, as required by federal and state law and regulation;
• ignored input from providers on policies and procedures;
• failed to provide services that are culturally appropriate to New Mexico's diverse populations; and
• unfairly increased the administrative burden on providers.

Regarding the transition of services to OptumHealth, we have received reports from providers that telephone service has been cut to certain ValueOptions offices and that these providers are having difficulty reaching any ValueOptions personnel.

We are also concerned with the response of the responsible state agencies to complaints such as these. Some providers and clients have complained that the New Mexico Behavioral Health Collaborative, the Human Services Department and the Department of Health have not been responsive to their complaints about ValueOptions.

We are also seeking a review of the terms of the contract with the behavioral health statewide entity and a determination as to whether due diligence has been exercised to enforce the contract's terms.

Moreover, we are concerned about reports, such as that of the Legislative Finance Committee in August 2008, that behavioral health costs have risen drastically since the contract with ValueOptions began, while the number of clients served has apparently decreased.

We ask that this special audit of the programmatic and financial aspects of the state's contract with ValueOptions be reviewed as soon as possible and that recommendations be made for enforcing the rights of New Mexico state government and the intended beneficiaries of its contract, New Mexico's behavioral health clients and providers.

The letter was signed by State Reps. Nathan Cote, Mary Helen Garcia, Mimi Stewart, Gloria Vaughan, Danice Picraux, Bill O’Neill and John Heaton and Sens. Cynthia Nava, Steven Fischmann, Jerry Ortiz y Pino, David Ulibarri, Dede Feldman and Mary Jane Garcia.
A spokeswoman for Balderas said the auditor intends to seek funds for such an audit from the Legislature.

ValueOptions spokesman Lon Wagner told me Tuesday that his company already was audited earlier this year by the state Behavioral Health Collaborative and came up clean. In a prepared statement, Wagner said,
“It was resolved earlier this year through an audit by the collaborative, which examined dozens of our claims on a case-by-case basis. The conclusion? ValueOptions did not deny services and that we did properly grant authorization."

ValueOptions spokesman Lon Wagner said Tuesday that his company already was audited earlier this year by the state Behavioral Health Collaborative and came up clean. Wagner said in a prepared statement “It was resolved earlier this year through an audit by the collaborative, which examined dozens of our claims on a case-by-case basis. The conclusion? ValueOptions did not deny services and that we did properly grant authorizations.” To conduct another audit, Wagner said would be a waste of taxpayer money.

Betina Gonzales McCracken, spokeswoman for The Behavioral Health Collaborative -- which consists of 15 state agencies -- released a statement defending the collaborative's actions.

The Behavioral Health Collaborative is happy to work with the State Auditor to review the contract between the state and ValueOptions New Mexico in its very unique and new process in administering behavioral health services for New Mexicans.

The Collaborative quickly acted on complaints from behavioral health providers and consumers about inadequate payments and inappropriate and untimely denials for services which led to several Directed Corrective Action Plans. Failure to fully comply with the corrective action plans has resulted in more than $1.5 million in sanctions. The Collaborative is determined to hold ValueOptions accountable for the sanctions.

The Collaborative, which is comprised of 15 state agencies, has a standing oversight committee that is responsible for ensuring the statewide entity is held in compliance with the contract. This committee has exercised oversight, plans of corrections, directed plans of corrections and has recouped funding when appropriate.

Under the Collaborative, New Mexico has been able to get a true indication of the unduplicated number of people being served with publicly behavioral health services across several state agencies. This had never been done prior to this Collaborative approach which began in 2005. Therefore, the conclusion the LFC staff drew in their 2008 review was incorrect.

ValueOptions and its top brass have contributed thousands of dollars to Gov. Bill Richardson’s political campaigns.

The Associated Press reported in November 2007 that Richardson’s presidential campaign received nearly $25,000 from executives, officers and state lobbyists for ValueOptions. Some of that money later was refunded.

On the state level, ValueOptions gave $2,000 to Richardson’s first gubernatorial campaign in 2002, while Beth Dozoretz, wife of ValueOptions CEO Ron Dozoretz, gave Richardson’s re-election campaign $3,983 in 2006

The company contributed $2,300 to various lawmakers’ campaigns in 2008 and $500 to Lt. Gov. Diane Denish in 2006.

More in tomorrow's New Mexican.