Two Behavioral Health Providers Get Funding Restored

UPDATED 

Human Services Secretary Sidonie Squier

(See below the Human Services release)

 In the latest development in the behavioral health shakeup, the state has agreed to restore Medicaid funding to two New Mexico providers under investigation. 

Here's the press release from the state. . 

Santa Fe – Today, the New Mexico Human Services Department (HSD) announced the release of two additional Medicaid pay-holds to agencies audited by the State earlier this year.  Both agencies are severing ties with TeamBuilders and its various corporate and non-profit affiliates and will together agree to repay $4,240,000 in behavioral health funding alleged to have been improperly billed to the Medicaid system.  

Presbyterian Medical Services (PMS) and Youth Development, Inc. (YDI) received the lift on their pay-holds after agreeing to pay back overpayment amounts found by a recent audit of behavioral health companies in New Mexico.  PMS will repay $4,000,000 and YDI will repay $240,000.  PMS and YDI will also be subject to intensive new training and oversight of its management until billing and management systems are fully operational and determined to be sound.  

Each of the companies will continue to provide behavioral health services to their clients, though Valle del Sol will provide temporary oversight of YDI and La Frontera will provide temporary oversight of PMS.  Among other tasks, Valle del Sol and La Frontera will train and provide technical assistance to staff members at each company, ensure program compliance with state and federal laws and rules, require accurate and timely billing (including pre-submission review of claims), and assist in developing new performance measures.    

“We have a responsibility to protect taxpayer dollars and to ensure that consumers are receiving continued access to care. This is a positive outcome that allows us to recoup a significant portion of the Medicaid funding that has been identified as overpayments,” said HSD Secretary Sidonie Squier. “PMS and YDI should be commended for working with the State from the get-go to improve service delivery, acknowledge the need to repay overpayments assigned to their work, and sever ties with other troubled entities.” 

PMS and YDI are not among the behavioral health companies with the most serious or numerous whistleblower complaints against them, which include allegations that, in other companies, employees were told to intentionally up-code services as a means of siphoning extra money out of the Medicaid system, told to bill for services never provided, or told to obstruct the reporting of critical incidents to proper authorities and regulators. 

Additionally, neither PMS nor YDI are as deeply engrained in the complex financial relationships and potential conflicts of interest that exist around the entities that comprise the seven Rio Grande behavioral health care companies and the numerous not-for profit and for-profit companies that are closely related to TeamBuilders.  

Today’s announcement is separate and distinct from, and has no bearing on, the continuing criminal investigation being conducted by state and federal authorities into the conduct of all 15 companies audited this year.

UPDATE 3:35 p.m. Some new information since I first posted this.

Human Services spokesman Matt Kennicott said that there are no other settlement negotiations with any of the other providers under investigation.

Unlike other providers under investigation, both PMS, which operates statewide, and YDI, which has facilities in Albuquerque and in Valencia County, have remained open seeing their clients for the past several months. Kennicott said they have been using their cash reserves to stay afloat.

PMS serves 3,400 behavioral health clients on Medicaid, while YDI serves about 260.

Sen. Bill O'Neill, D-Albquerque, who has been one of the leading critics of the administration over the mental-health shakeup, had the following statement about today's developments:

"To me, this is just more of the same attempt at positive spin by the Martinez Administration. Whatever the ultimate resolution of this (Human Services Department) induced audit crisis is, there was absolutely no reason to destroy our existing state's mental health system in the process. The 15 non profit behavioral health providers were not given the chance to review the findings and respond accordingly. They were denied due process. We still do not know what the actual allegations are -- none of us do. I have also noticed that (Human Services) is very fond of the word `siphon.' Well, how about the word, `hijacked'? Or `hostile takeover', by out-of-state, Arizona companies?"

Youth Development Inc. just sent this news release:

After four months of working with the Human Services Department on the behavioral health audit conducted by PCG, YDI and the Department have reached a settlement.    However, YDI did not fully agree with the processes employed by the State and PCG.  Seeking resolution, YDI fully cooperated with HSD in this matter and continued to provide services while payments to it were suspended. 

In the interest of resolving all differences between YDI and HSD amicably, and in order to avoid the time, trouble, expense, delay and uncertainty of the time litigating this matter we believed this was the most prudent path for YDI to take. 

The amount settled for is about 8 percent of the amount billed over the last 3 years.  According to the GAO, the National average claim failure rate is between 3 percent  and 9 percent .  We are working diligently with the State and Valle del Sol to improve to our behavioral health systems in order to reduce that rate to zero.   

We look forward to continue to serve the many people who are our consumers and who have put their faith and confidence in the critical services YDI has provided for over 42 years.

UPDATE: 5:15 pm  PMS just issued a statement quoting CEO Steve Hansen saying, "While we have never agreed with the State’s contentions, allegations, or actions, PMS’s primary motivation in settling was to preserve its critical safety net behavioral health services and over 200 New Mexico behavioral health jobs.”

The statement also said, "This settlement resolves all potential civil and administrative disputes with the State. PMS was unwilling to sacrifice services to so many New Mexico communities, choosing resolution instead of a long legal battle."

More in tomorrow's New Mexican.