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Audit: Provider overbilled government

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By Barry Massey
The Associated Press

SANTA FE — An audit commissioned by the state estimated the government overpaid a mental health provider $655,800 because of improper billings, but the organization’s top executive said Friday the auditors were wrong.

The Counseling Center was among 15 nonprofit providers of mental health services that had their Medicaid payments suspended last summer because of the audit that alleged fraud, mismanagement and billing problems over more than three years.

The Alamogordo-based provider has been cleared of fraud by investigators for Attorney General Gary King, but they identified overbillings in a sample of claims. It’s the responsibility of the Human Services Department to recover overpayments for mental health services provided to New Mexicans through Medicaid and other programs.

The attorney general continues to investigate allegations against other providers.

Human Services Department spokesman Matt Kennicott said the agency was

reviewing billings by The Counseling Center and expects to soon give the provider an amount the state will seek to recover. The amount of overbillings may not be the same as auditors projected, he said, but it will be hundreds of thousands of dollars.

Jim Kerlin, the nonprofit’s CEO, disputed the audit’s estimate of overpayments and complained of errors in the report, including that he had been paid $168,000 in 2011. His salary actually was $87,000, Kerlin said.

“They are wrong in what they say we did wrong,” Kerlin said in a telephone interview. “If we had any opportunity whatsoever to have questions and answers and the ability to know what they were looking for, we could have clearly demonstrated that we were doing nothing wrong.”

Providers have complained they were not given an opportunity to respond to the allegations against them before the department froze payments and referred the matter to the attorney general. The department contends that federal Medicaid rules require the state to halt payments once it concludes there are credible allegations of fraud.

The Counseling Center is out of business because of the dispute with the state. The department, after suspending payments, contracted with Arizona companies to take over providing services that had been done by the New Mexico nonprofits.

Behavioral health services can range from counseling for mental disorders to community support services in which workers help train mentally ill patients deal with tasks in daily life such as handling money and performing household chores.

King’s office released a redacted copy of its investigative report and portions of the audit involving The Counseling Center in response to public records requests by The Associated Press and others.

The report found improper billings for community support workers who called patients to remind them of appointments.