Because of PCG Audit, New Mexico Freezes Mental Health Services!

Last week, I was busy working in my office when a woman named Shawn called me. The area code showing on my caller ID was definitely NOT from North Carolina. Turns out Shawn lives in New Mexico.

Pop Quiz: (For those of you who have been with me for a while): What is similar between New Mexico and North Carolina Medicaid? Answer: Public Consulting Group (PCG).

Remember my blog, “New Mexico and NC: Fraternal Twins?”

Seems that the bloopers surrounding PCG do not only lie within the state border of NC.

Oh, no! PCG is much more far-reaching than just NC.

Hence, Shawn calling me up to fly to New Mexico to speak to the New Mexico State legislature about PCG in NC. And, perhaps, how Medicaid providers can defend themselves (maybe without me since I do not have my NM law license, although I am sure I could pro hac in).

So what was I supposed to say to a bunch of state legislatures? Why would they even care what I have to say?

I ask Shawn this.

In July, New Mexico’s Human Services Department suspended Medicaid funding to 15 providers while conducting an investigation into allegations of fraud. An out-of-state consulting group released an audit in June accusing the mental health providers of overbilling the federal and state government by tens of millions of dollars.

New Mexico has frozen mental health services for Medicaid recipients?

Can you imagine? What has happened to the New Mexico Medicaid recipients who need mental health services?

 And this mental health services freeze is based on an audit conducted by Public Consulting Group? Are you kidding?  The same company that stated that my client owed $706,000+ Medicaid reimbursement overpayment, yet, after legal arguments, DHHS held that my client only owed $336????

THAT COMPANY????

So, here I am, flying to New Mexico… I am on a plane (obviously, coach) squished into a window seat, unable to straighten my legs, typing this, thinking that allowing me only one cup of water over a 3 hour trip constitutes cruel and unusual punishment, all to explain to NM legislators the ineptness of PCG.

Worth it?

Heck, yes, if my message does not all on deaf ears. I will keep you posted.

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on September 3, 2013, in Denials of Medicaid Services, DHHS, Extrapolations, Health Care Providers and Services, Legal Remedies for Medicaid Providers, Medicaid, Medicaid Appeals, Medicaid Audits, Medicaid Recipients, Medicaid Recipients Under 21, Medicaid Reimbursements, Medicaid Services, Mental Health, Mental Health Problems, Mental Illness, New Mexico, North Carolina, PCG, Prosecution, Public Consulting Group, RAC, RAC Audits, Regulatory Audits, Termination of Medicaid Contract and tagged , , , , , , , , , , , , , , , , . Bookmark the permalink. 7 Comments.

  1. You are amazing! Thank you for coming to New Mexico and speaking with our legislators.

  2. I hope so, too. As an advocate for people with disabilities it is disheartening to realize that we can become so powerless. Even to exonerate these providers may do little good if they have disappeared because of lack of funding. We are blessed that the legislature is taking this so seriously, and are doing it bipartisan. Again, so happy to have found your site & watched your testimony. N nombre de Nuevo México, muchas gracias!

  1. Pingback: NC General Assembly: Hold Contracted Companies Accountable in NC Medicaid! (If You Do Not, Who Will?) | medicaidlaw-nc

  2. Pingback: Traveling to New Mexico: Another Administrative Action with PCG | medicaidlaw-nc

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