HSD, providers must put clients first

— Albuquerque Journal

In 1965, Title XIX of the Social Security Act created Medicaid “to assist states in furnishing medical assistance to eligible needy persons” — not to keep health-care providers in business, much less in golden parachutes.

Yet that’s where the focus of discussion has been too often since the state Human Services Department suspended federal and state Medicaid funding to 15 mental-health providers.

The action came after an audit found alleged mismanagement and possible fraud has cost taxpayers more than $36 million. An HSD news release says “the audit revealed that even after removing unintentional claims errors — in other words — simple human mistakes, more than 1 in 4 of the audited claims failed, meaning they should not have been billed at all.

“On further evaluation, HSD found an error rate above 57 percent on cases that could have impacted the health and safety of individual consumers.”

Providers have said they have not been given details of their alleged wrongdoing. Some have already scaled back services and threatened to shut their doors. Some have asked a federal judge to reinstate their payments.

Sen. Bill O’Neill of Albuquerque, in an op-ed, published in the Albuquerque Journal, voiced concern about “the effect that these accusations have had already on their staffs, their clients, and perhaps most importantly on their ability to survive financially.”

But what about the client in the audit who reportedly committed suicide because after six visits the provider hadn’t done a safety assessment? Aren’t the clients really the reason New Mexicans will shell out nearly $1 billion for these services this year?

HSD should release the audit, which was paid for with $3 million in tax dollars and whose findings are projected to cost taxpayers up to $18 million to rectify.

Attorney General Gary King certainly is treating this seriously. He says HSD had “very little discretion” under federal law except to stop funding once it concluded there were credible allegations of fraud. He has 17 staff members working on the investigation.

Providers should be given the chance to clear their names/clear up problems — but they must join HSD in putting clients first.

HSD says providers are contractually barred from shutting down; it did not want to tip off providers; and that the worst-case scenario would have one of the five contracted Arizona providers taking over management of client cases.

And it’s those vulnerable people who should be the focus, be it under new management, with new oversight or with a referral to a new provider.


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