New Mexico Human Services Department Behavioral Health Provider Audits, Executive Summary

June 24, 2013
The New Mexico Human Services Department (HSD) contracted with Public Consulting Group (PCG) to audit certain behavioral health provider organizations. The scope of the audit included Medicaid services, non-Medicaid services, and an enterprise audit for claims submitted from July 2009 through December 2012. The summary avoids mentioning the names of the specific provider organizations, but does highlight examples of the findings. The 15 organizations receive 85% of state dollars; they provide treatment to more than 30,000 individuals. Each of the 15 organizations failed to meet Medicaid compliance standards. About 57% of the case files reviewed . . .