Review of Medicaid Payments Made by the New Mexico Human Services Department for Members Enrolled in the State's Medicaid Managed Care Program Entitled

SALUD!',"

This report provides the results of our review of Medicaid payments made by the New Mexico Human Services Department (NMHSD) for members enrolled in the state's Medicaid managed care program entitled, 'SALUD!'.  The objectives of our review were to determine whether managed care payments made under SALUD! were correct and for eligible members; and whether Medicaid payments made under the fee-for-service (FFS) program were for services already covered under SALUD!.  Our review disclosed that NMHSD made incorrect managed care and FFS payments totaling about $3.6 million.  We recommended that NMHSD refund the federal share totaling about $2.6 million related to the overpayments; maintain accurate and complete eligibility information; and consider revising its contracts with managed care organizations (MCOs) to allow for recovery of overpayments beyond the 24-month limitation and regardless of whether the MCOs provided services.  The NMHSD agreed with our findings and are in the process of determining the overpayments and taking corrective action.