A nonprofit behavioral health provider in New Mexico submitted more than $4 million in overbillings, according to an audit conducted for New Mexico's Human Services Department, which included a case-by-case review of 150 reimbursement claims.
New Mexico Attorney General Gary Kings office released a portion of the audit of Santa Fe, N.M.-based Presbyterian Medical Services in response to a state district judges ruling earlier this month. The audit examined service claims submitted for Medicaid reimbursement over nearly four years - from mid-2009 through January 2013.
Presbyterian Medical in November 2013 agreed to repay the $4 million to the state and, as a result, had its Medicaid funding restored.
But Don Daniel, Presbyterian Medical Services vice president and general counsel, said Monday that the nonprofit had determined most of the claims in question actually were properly billed, with services provided, but it was faced with a decision to either repay the requested amount or embark on a potentially lengthy court battle.
Thus, Monday's release of the audit did little to resolve questions over the legitimacy of its findings. The audit has been turned over to the Attorney Generals office for investigation of possible criminal wrongdoing but no charges have been filed to date.
The audit included the following findings:
Of the 150 claims reviewed by the audit firm, 41 were found to have overbillings.
In several cases, the audit concluded that nonprofit staffers did not appear to have necessary qualifications for the work they were doing.
On some of the claims, the audit firm said it could not find documentation to confirm that reported drug tests and other types of billed services were actually conducted.
New Mexico Human Services Department spokesman Matt Kennicott defended the state agency's handling of the situation. In an email to the Albuquerque Journal, he pointed out that Presbyterian Medical agreed to reimburse the $4 million and submit to an intensive oversight and staff retraining. The nonprofit could have chosen to not accept the settlement, he added.
The provider operates clinics and runs other programs around the state, mostly in rural areas. The audit was conducted by Boston-based Public Consulting Group.