Fifteen New Mexico behavioral health providers that were accused of fraud and shut down still haven’t been able to see the audits that lead to their downfall. The audits supposedly showed the companies over-billed the state for Medicaid reimbursements. Now, the company that performed the audit is having its track record questioned.
In 2012, Public Consulting Group (PCG) began performing audits on healthcare providers in North Carolina.
"I have found that most if not all of the PCG audits that I have defended were incorrect at the initial stage,” says Knicole Emanuel, a North Carolina lawyer who specializes in Medicaid. She’s started defending healthcare providers that are subjects of PCG audits.
“In some of the PCG audits that I have encountered, PCG has said that the Medicaid provider owes $700,000, $800,000, $1.5 million, these exorbitant amounts, and at the end of the day when they look at all the documents, it goes down to like $200 or $300,” Emanuel says.
The 15 behavioral health providers accused of fraud in New Mexico may have cost taxpayers around $36 million through Medicaid fraud. However, the difference between New Mexico and North Carolina is that providers in North Carolina are allowed to see their audit results in order to defend themselves.
In New Mexico, the audit in question is still under lock and key, and those providers are now being run by Arizona companies. In response to criticism of PCG's audit, a spokesman has said the company is "more than experienced and more than capable" of performing audit services for New Mexico.