Medicaid Payment Suspension Rule Creates Confusion in New Mexico

By | Published On: October 1, 2013

FTLF Partner Adam Falcone is quoted extensively in the article entitled, “Fraud in New Mexico: Credible? Incredible?”, published in the September/October 2013 issue of Behavioral Healthcare. The article describes fifteen providers, which comprise the majority of behavioral health providers in New Mexico’s Medicaid program, which had their payments suspended as a result of a “credible allegation of fraud”. Falcone disputes the State’s contention that it had to suspend payments to the providers under investigation.

“States risk losing their federal matching payments only if they have a situation where a good cause exception doesn’t apply,” he told Behavioral Healthcare. Falcone notes that there are six such good cause exceptions that could have been used by New Mexico to avoid suspending payments to the providers.  “If there’s a good reason not to suspend payments, there is a good cause exception to cover it.”

Read the entire article here. 

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