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New Mexico lawmakers want federal probe of suspension of Medicaid funds

ALBUQUERQUE – Democrats with the state’s congressional delegation are calling for a federal investigation into the withholding of Medicaid payments from 15 nonprofits that provided behavioral health services to needy New Mexicans.

In a letter sent Friday to U.S. Health and Human Services Secretary Sylvia Burwell, Sens. Tom Udall and Martin Heinrich were joined by Reps. Ben Ray Lujan and Michelle Lujan Grisham in saying the state’s actions disrupted care for the most vulnerable residents.

“As we have consistently conveyed via countless phone calls, letters and in-person meetings, an overwhelming body of evidence indicates that this disruption was unwarranted and reckless,” they wrote.

New Mexico’s behavioral health system was upended in 2013 when Republican Gov. Susana Martinez’s administration froze payments to the nonprofits after an audit raised questions about fraud and abuse. The audit had alleged $36 million in Medicaid funding was mishandled by the providers.

The attorney general’s office launched an investigation, but the state Human Services Department eventually replaced the nonprofits with companies from Arizona. The providers protested, saying their due-process rights were violated because they were denied hearings by the department.

Many of the nonprofits have since filed lawsuits against the department.

Ten providers were vindicated earlier this month when Attorney General Hector Balderas announced that an investigation turned up some regulatory violations but no pattern of fraud.

Three others had been cleared of previously. Investigations into two more are pending.

The senators and representatives said in their letter that Balderas’ findings confirmed their longstanding concern that irregularities surrounding the Human Services Department’s actions undermined the legitimacy of its auditing process.

They also voiced concerns about constituents losing access to care, doctors and nurses being laid off and clinics across the state having to close.

The Martinez administration did not immediately respond to requests for comment regarding the delegation’s push for a federal inquiry.

Earlier this month, the department said it would review Balderas’ findings on the regulatory violations. It also vowed to continue trying to recoup misspent and overbilled Medicaid funds from the providers.

The members of the delegation also renewed their request Friday for oversight by federal officials and called for a verification process to ensure any state investigation into allegations of fraud meet certain standards.



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