Thursday, July 25, 2013

Judge Denies Restraining Order for Behavioral Health Providers

Federal District Judge Christina Armijo has denied a petition from eight behavioral-health providers under investigation for possible fraud. The petition attempted to force the state Human Services Department to restore their Medicaid funding.

The department froze the funding for 15 providers last month after an outside audit reported possible fraud.

"The Court concludes that Plaintiffs' deprivation of property claim has no realistic likelihood of success on its merits," Armijo wrote.

Referring to the audit by the Boston-based Public Consulting Group that last month found evidence of over-billing and "credible allegations of fraud," Armijo wrote, "Plaintiffs' principal line of attack has been to attack the credibility of PCG based on the results of an audit PCG conducted for the State of North Carolina. [swt note: See my story on that HERE] Although this evidence would be fodder for cross examination at trial, it is insufficient to establish that PCG's New Mexico audit was unreliable."

Armijo noted "since the suspension of payments has not been shown to be wrongful, the consequences of the suspension are not legally cognizable harm."

The judge, however, expressed concern for the thousands of clients of the providers.

The providers' "clients include individuals with homicidal and suicidal ideation, children in foster care homes, and individuals dependent on psychotropic drugs," Armijo wrote. "Many of these clients have developed beneficial therapeutic relationships with Plaintiffs’ health care clinicians, who have not been accused of any wrongdoing by (Human Services). ... it is a concern of this Court that despite (Human Services') efforts to ensure continuity of care ... there could be a disruption of the delivery of critical mental health services in some instances. The Court is not insensitive to this outcome, but is constrained by the prevailing law and the credible allegations of fraud against Plaintiffs, all as explained above."

Below is a copy of Armijo's decision (Hat tip to New Mexico Watchdog whose Scribd link I'm using)