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New Mexico fraud case is a blow against mental health

Posted on 06-29-16 in Advocacy, Mental Health, Treatment

New Mexico fraud case is a blow against mental health

In April, a long investigation by the New Mexico government into Medicaid fraud resulted in the exoneration of 15 nonprofit behavioral health providers in that state.

Citing “credible allegations of fraud,” the state’s Human Services Department (HSD) cut off Medicaid funding to the behavioral health providers in 2013, an action that has caused continuing disruption in New Mexico’s health care system. Apart from closures and staff layoffs, 3 of the 5 Arizona-based behavioral health providers New Mexico brought in to replace the nonprofits under investigation left the state earlier in 2016.

An audit conducted by the HSD in 2013 alleged $36 million in overbilling by the 15 providers under investigation. As of 2016, the state attorney general’s office found $1.16 million in overbilling, well under the alleged amount. In the wake of the investigation, several lawsuits have been filed against state contractors.

“It now 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 Mexicans receive their critical services,” wrote State Attorney General Hector Balderas in a press release.

Although striving for transparency and honesty in health care coverage is a laudable goal, the aftereffects of the investigation shed light on another problem: There are serious gaps in mental health coverage in the United States.

Costs, insurers often strong barriers to mental health treatment

According to Mental Health America (MHA), a nonprofit mental health advocacy group, 57 percent of adults with mental health disorders nationwide never receive treatment. Additionally, 18 percent of adults with mental illness were uninsured in 2012 and 2013. MHA also warns these gaps extend to adolescents, reporting 64 percent of youth with depressive disorders do not receive outpatient treatment.

Their findings echo those of the National Alliance on Mental Illness (NAMI). Their report “A Long Road Ahead: Achieving True Parity in Mental Health and Substance Use Care” found problems despite such advances as the Mental Health Parity Act of 2008, which requires mental health benefits in some employer-sponsored health care plans. Additionally, NAMI’s report also lists several barriers to mental health care, including:

  • Finding mental health providers in health insurance plans is very difficult
  • Insurers often deny authorization of care for mental health and substance abuse treatment
  • High out-of-pocket prescription costs in addition to high co-pays and deductibles
  • Difficulties in accessing psychiatric medications in health-care plans

An article published in the journal Health Affairs also found high costs acted as a powerful barrier to mental health treatment. The Affordable Care Act has also improved access to mental health, but there are coverage disparities between states. But sometimes money and access aren’t the only things keeping people from seeking treatment.

Accounting for stigma

There is a very real stigma around mental health and addiction issues, and studies have shown it plays a role in why people don’t receive treatment. Mayo Clinic offers several ways to deal with mental health stigma:

  • Patients shouldn’t equate themselves with their illness. For example, people aren’t schizophrenic; people have schizophrenia.
  • Avoid isolation. Family, friends, clergy and other community members can be sources of support – or know where sources can be found.
  • Don’t let stigma take over. Mental illness is a chronic illness like diabetes or heart disease. It’s not a sign of attention-getting, or moral weakness.
  • Join support groups. Mental illness can be isolating, but nobody should go through it alone. Support groups allow patients to share stories, experiences and strategies with those dealing with the same issues.

Mayo Clinic recommends seeking treatment as a good tool to fight stigma. Treatment is a relief, allowing a patient to finally identify their symptoms, recognize what’s wrong with them and develop a way to treat and move beyond their illness. It’s something Sovereign Health, a leading provider of mental health and substance abuse treatment, understands. Our staff crafts treatment plans tailored for each individual patient’s needs to ensure a lasting recovery. For more information on our programs, contact our 24/7 helpline.

About the author

Brian Moore is a staff writer and graphic designer for the Sovereign Health Group. A 20-year veteran of the newspaper industry, he writes articles and creates graphics across Sovereign’s portfolio of marketing and content products. Brian enjoys music, bicycling and playing the tuba, which’s he’s done with varying degrees of success for over 25 years. For more information and other inquiries about this media, contact the author and designer at