New Mexico Attorney General Says Medicaid Fraud Investigations Clear 12 Behavioral Health Provider Organizations; Two Investigations On-Going

On February 8, 2016, New Mexico Attorney General Hector Balderas said that his office's recently completed fraud investigations of 12 behavioral health provider organizations found no pattern of criminal fraud, although there were regulatory violations. The organizations were among a group of 15 provider organizations accused of Medicaid fraud in June 2013 following an audit conducted by Public Consulting Group that estimated that since 2009, the state had paid about $36 million for fraudulent claims. The audit was prompted by concerns raised in December 2012 by OptumHealth New Mexico, the state’s Medicaid behavioral health managed care organization. In . . .