What’s Up With That Behavioral Health Investigation?

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Hear an update on the behavioral health investigation from Attorney General Gary King (9:46), here.

One of the biggest stories going viral these days is the Martinez administration’s abrupt halt of Medicaid funding to providers who were audited by a Boston firm called Public Consulting Group.  That audit and a new software program implemented by the state’s private manager of behavioral health, OptumHealth, set off alarm bells that the 15 targeted providers had allegedly incorrectly billed Medicaid for $36-million.  Those 15 agencies had been serving 30,000 of New Mexico’s most fragile patients with behavioral health and drug abuse issues.

Here’s a list of what you need to know – a program, so-to-speak – about this topic:

What exactly is behavioral health?  In short, it’s a newer name for mental health, which is defined as a state of well-being, absent feelings of depression and anxiety disorders.

How much are the new execs earning?  Around $300 per hour; more than some of the ousted execs (one current provider was earning $60,000), less than others (Presbyterian Medical Services CEO’s salary is around $400,000 per year).

How long are the new contracts for?  They end at the end of  this year, but the head of the Behavioral Health Division of the State Human Services Department says in January, the new firms will be part of Centennial Care and will continue managing behavioral health services in New Mexico.

What exactly did the audit find?  We don’t know, since it is being kept under lock and key, with Martinez administration leaders saying it cannot be released until the AG’s investigation is complete.


o   December 2012 – OptumHealth installs a new software program that begins flagging potentially problematic billing practices among New Mexico nonprofits whose businesses predominantly bill Medicaid for services.

o   February 2013 – the state contracts with Public Consulting Group of Boston for more than $3-million; 71-percent of reviewed claims failed the audit.

o   In late June providers were notified – the state meets with chief executive officers of the 15 providers and says all Medicaid payments will be immediately suspended.

o   June 23 – State Attorney General Gary King undertakes a review of the allegations, assigning 17 staff (more than four times as many as usual) to investigate – still, the process could take more than one year.

o   End of July to present – Executives of five new providers from Arizona move into the offices of NM firms, vowing to hire all front–line counselors and social workers, holding job fairs, but limiting information about benefits and other basic policies affecting employees.

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