Hospitals owned by Universal Health Services have faced false claims scrutiny since February 2013, but criminal investigators have recently turned their attention to UHS corporate offices, located in King of Prussia, Pennsylvania, according to a Securities and Exchange Commission disclosure filed by the company last week.
The New Mexico attorney general has finally released the full 355-page behavioral health audit, 19 months after 15 providers were charged with credible allegations of fraud and had their Medicaid funding cut off. But the audit offers no real proof that overbilling or fraud legitimately exists and the whole situation shows there is a thin line between a fervent witch-hunt and well-balanced scrutiny.
In the summer of 2013, 15 behavioral health providers in New Mexico were suspected Medicaid fraud based on an audit by a Boston-based consulting group contracted by the state. The audit, which prompted state officials to suspend Medicaid funding to the providers, was finally unsealed last week after nearly two years of protests from the providers in question as well as public advocacy groups.
A portion of a 2013 audit investigating the billing practices of a New Mexico nonprofit behavioral health provider reveals more than $4 million in overbilling based in a case-by-case review of 150 claims, but questions remain regarding the legitimacy of these findings.
A pair of editorials last week took up the issue of Medicare and Medicaid fraud, waste and abuse, signifying these problems are becoming a greater focus of public attention and debate.