Our Grand Inquisitor says you can’t have treatment

Are states using targeted auditing to disrupt mental health services?

New Mexico used a recent audit to completely de-fund 15 mental health providers serving the bulk of the state’s publicly funded mental health care. Some 30,000 individuals have had their care interrupted. A number of for-profit and nonprofit providers are closing because they cannot maintain operations while fighting the proposed findings.

Although the state’s actions are authorized by law, they were not mandatory.

There’s no public access to the allegations within the audits. The audit findings are secret.

Similar events are playing out in North Carolina. According to newspaper reports, a 2012 Public Consulting Group audit that cost North Carolina $3.2 million found that North Carolina had overpaid behavioral health providers by $38.5 million, but the state found that less than 10% of the amount in question could be recovered.

Some coverage of this trend:

Administration at odds with state auditor over mental health fraud claims http://www.kob.com/article/stories/s3106244.shtml

Fraud probe update: CMS defends New Mexico's defunding amid questions about audit findings http://www.behavioral.net/article/fraud-probe-update-cms-defends-new-mexicos-defunding-amid-questions-about-audit-findings

NC Medicaid: Are New Mexico and NC Medicaid Providers Fraternal Twins? At Least, When It Comes to PCG! http://medicaidlawnc.wordpress.com/2013/07/18/nc-medicaid-are-new-mexico-and-nc-medicaid-providers-fraternal-twins-at-least-when-it-comes-to-pcg/

Even New Mexico Identifies PCG Audits as “Unreliable!” http://medicaidlawnc.wordpress.com/2013/07/15/even-new-mexico-identifies-pcg-audits-as-unreliable/

Big names in health care audit released http://www.abqjournal.com/214653/news/big-names-in-health-care-audit-released.html

Posted in: audit,fraud,medicaid,mental health