The Line: Arizona Behavioral Health Provider Sues NM Company

March 11, 2016 – A lawsuit filed by Arizona-based La Frontera is raising new questions about what happened in 2013 when the state of New Mexico cut off Medicaid funding for 15 behavioral health providers that were accused of fraud. Almost all of the providers have since been cleared of the allegations.

La Frontera alleges in the lawsuit that OptumHealth New Mexico, which oversees payment for Medicaid services in New Mexico, owes the company money and misrepresented the situation in New Mexico when La Frontera took over services.

Where do we go from here? Host Gene Grant leads a discussion on this evolving situation with this week’s Line opinion panelists.

Janice Arnold-Jones, former state representative
Inez Russell Gomez, Santa Fe New Mexican
Laura Sanchez-Rivét, attorney at Cuddy & McCarthy, LLP
Stephen Spitz, host of New Mexico People, Places and Ideas on KUNM


1 thought on “The Line: Arizona Behavioral Health Provider Sues NM Company

  1. Fraud is difficult to prove in court. There are 5 elements of fraud that must be proved, the most difficult of which is intent. The state Auditor identified many “irregular” payments and expenses but did not feel intent could be proved. Typically an audit does not look at all transactions, which would involve re-accomplishing a company’s books. They look at procedures and a sample of transactions. In the present cases the samples examined indicated fraudulent activity which by Federal law requires pay to cease. The State hires an outside company like Optium because it does not have in-house ability (expertise nor manpower) to execute management of the behavioral health benefit.

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