Governmental Wand Waving and Late Apologies
In one of the most audacious acts of governmental power, in 2013, New Mexico accused 15 behavioral health care provider agencies of credible allegations of fraud and immediately suspended all Medicaid reimbursements to these agencies. These behavioral health care agencies comprised 87.5% of all New Mexico’s behavioral health care. Hundreds of thousands Medicaid recipients were adversely affected; all of a sudden, their mental health care provider was gone. Most of the companies were devastated. (One company was allowed to stay open because it paid millions to the state). See blog for more. See documentary.
Now, over 2 1/2 years later, three days ago (February 8, 2016), the NM Attorney General cleared 10 of the 15 companies. Oops, sorry, there was never any fraud. Sorry about the devastation of your company.
Imagine losing your job, your reputation, all your money, getting accused of a crime…then let two years pass. You walk into the grocery store (and everywhere else you go) and people stare at you, thinking that you are guilty of the crime for which you are accused. (Ever read “The Count of Monte Cristo?”)
Then you are exonerated. Are you happy or angry?
Here’s the issue: The government has a lot of power. Legally, the government has the authority to accuse you of a crime, seize your home, seize your property, take away your children, to put you in jail, to put you to death, etc.; the only barrier between the government carrying out these drastic measures and you is due process.
So, readers, if you are understanding my logic thus far, you understand the importance of due process.
However, for you who accept Medicare and Medicaid, due process is nonexistent. Since the inception of the Affordable Care Act (ACA), when it comes to accusations of fraud, due process has been suspended.
Hence the situation in New Mexico. Without substantial evidence supporting its decision (remember the Public Consulting Group (PCG) audit in this case actually found no credible allegations of fraud), the State of New Mexico accused 15 companies of fraud, suspended all their reimbursements, and put most of the companies out of business.
With a mere waving of the wand.
And an apology too little too late.
Posted on February 9, 2016, in Access to Care, Administrative Remedies, Affordable Care Act, Alleged Overpayment, Appeal Rights, Audits, Behavioral health, Credible Allegations of Fraud, Due process, Extrapolations, Fraud, Knicole Emanuel, Lawsuit, Legal Analysis, Legal Remedies for Medicaid Providers, Medicaid, Medicaid Attorney, Medicaid Audits, Medicaid Providers, Medicaid Reimbursements, Medicaid Services, Mental Health, Mental Health Problems, Mental Illness, New Mexico, North Carolina, PCG, Public Consulting Group, Public Consulting Group, RAC, RAC Audits and tagged Attorney general, Behavioral health, Behavioral Health Care Providers, Credible Allegations of Fraud, Due process, Health care provider, Medicaid, Medicaid Audits, Medicaid recipients, Medicaid Reimbursments, Medicaid Services, New Mexico, New Mexico Behavioral Health Providers, North Carolina, PCG, Public Consulting Group, Suspension of Medicaid Payments. Bookmark the permalink. 2 Comments.