Even though it denies wrongdoing, Presbyterian Medical Services, a Santa Fe-based behavioral health provider that cares for 3,400 Medicaid patients across the New Mexico, is among two providers that have agreed to pay the state as a part of a settlement.
The Human Services Department announced that two mental health providers—PMS and Albuquerque-based Youth Development Inc.—will pay back roughly $4.2 million as part of an ongoing state investigation into alleged Medicaid overbilling and fraud.
PMS will pay the bulk of the amount, about $4 million, and in return get its Medicaid funding reinstated by the state after a nearly five-month freeze.
Still, PMS and Youth Development Inc., along with 13 other behavioral health providers in New Mexico, will remain under investigation by the state Attorney General's Office.
In a press release, PMS asserted that it was "choosing resolution instead of a long legal battle" because it's "unwilling to sacrifice services to so many New Mexicans."
"While we have never agreed with the state's contentions, allegations, or actions, PMS's primary motivation in settling was to preserve it's critical safety net behavioral health services and over 200 New Mexico behavioral health jobs," PMS President Steve Hansen said in a statement.
The state's Human Services Department froze Medicaid funding for 15 behavioral health providers in June after an audit found that they together overbilled the state $36 million over a three-year period. But HSD won't permit the public to inspect the full audit, conducted by Boston-based Public Consulting Group.
HSD initially referred the findings to the state Attorney General's Office, which is conducting an investigation. Both agencies have been heavily criticized for not releasing the audit, which the Las Cruces Sun-News, New Mexico in Depth and the Foundation for Open Government have all since asked for in lawsuits against the state.