Audit Finds New Mexico Medicaid Failed To Follow Procedures In Fraud Investigation

The New Mexico Human Service Department (HSD) failed to follow its own Medicaid fraud investigation procedures before suspending Medicaid reimbursements in June 2013 to 15 behavioral health provider organizations for alleged Medicaid fraud. Most notably, HSD contracted with Public Consulting Group (PCG) to conduct an audit of the organizations instead of involving the state’s Program Integrity Unit (PIU).  This came after the state’s behavioral health administrative services organization (ASO) OptumHealth New Mexico, reported questionable billing patterns.  Additionally, the PUI was not involved in the investigative process nor did it perform the initial investigation of the allegations related to . . .