AG: No Fraud Found Among 15 Providers Audited

Attorney General Hector Balderas

From The Office Of The Attorney General

SANTA FE – In a letter sent to legislators this morning, Attorney General Hector Balderas cleared Pathways and TeamBuilders of fraud. They were the final two providers in the Behavioral Health Investigation.
 
Upon taking office in 2015, Balderas released the PCG audit in its entirety with minimal redactions, and made it a priority to complete the 12 pending behavioral health investigations to bring transparency and accountability to the process.
 
The PCG audit and the Human Services Department alleged there was $36 million in overbilling by the providers. In its separate investigation, based on the allegations of the PCG and OptumHealth audits, the Office of the Attorney General found there was approximately $1.16 million in overbilling and no evidence of fraud.
 

“Our thorough investigation of the providers concluded that there was not a pattern of fraud, despite the actions of the Human Services Department in finding credible allegations of fraud and freezing funding to 15 providers across New Mexico in 2013,” Balderas said. “Now it falls to the Human Services Department to take timely and appropriate administrative action to resolve this regrettable situation to ensure that tens of thousands of vulnerable New Mexican receive their critical services. The department must find a way to fight fraud that does not put services to the most vulnerable at risk or result in hundreds of New Mexicans losing their jobs.”

Click here to view the investigated reports related to this case.

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