Wave of Medicaid audits continues, with more providers on the hook to repay millions

Mental health agencies around the state are looking over their shoulders as they grapple with an unprecedented spate of Medicaid audits launched by the state Office of Payment Accuracy and Recovery, the fiscal guardian of the government health insurance program for Oregon’s poorest residents. Out of 99 Medicaid audits being conducted by the office, a full 23 target providers of mental health and addictions treatment, ranging from private nonprofits, such as Cascadia Behavioral Healthcare, to individual therapists to county bureaucracies such as the Yamhill County Health and Human Services Division. “People are very concerned,” says Ed Blackburn, deputy director of Central City Concern, a Portland nonprofit that agreed to repay the government $1.4 million for inadvertently overbilling Medicaid in 2006. State investigators insist they aren’t putting mental health providers in their cross-hairs. “Whenever we have big audits in any area, they say it’s a crackdown,” says Trisha Baxter, OPAR administrator. “But we have always done audits, and we will always do audits, so it’s not that we’re targeting them.” Nonetheless, several of the state’s biggest mental health providers are facing demands for repayment from Medicaid auditors. Cascadia faces a bill of $2.7 million; Mid-Columbia Center for Living owes $500,000; and Lane County $939,000. Other audits are in a more preliminary stage and are not yet public record. The audit of Mid-Columbia, a consortium providing mental health services to residents of Hood River, Sherman, Wasco and Gilliam counties, is the first that its director, Sharon Guidera, can remember in her dozen years at the agency. Given that Medicaid is a major source of funding for mental health programs, however, she doesn’t think the scrutiny is unfair. “They’re working through the mental health system, then they’ll move to the next group,” she says. For some, the atmosphere of paranoia is likely to intensify later this year, when a new federal program known as the Payment Error Rate Measurement Project comes to Oregon and conducts a fresh round of Medicaid audits. “We expect that in the next year, everyone will get audited,” says Gina Nikkel, executive director of the Association of Oregon Community Mental Health Programs. The auditing frenzy is a side effect of the fantastically complex Medicaid program, which spends roughly $2.25 billion a year to provide health care for Oregon’s poorest residents. Providers submit bills to Medicaid on the honor system, but the government reserves the right to demand repayment if it finds anything fishy about the bills later. In some cases, providers are able to dig up supporting documentation from their files; in other cases, they have to bite the bullet and pay back the government. Either way, state officials emphasize that the amount that ultimately is repaid depends on documentation, discussion and lawyers. “There’s a lot of back and forth,” OPAR’s Baxter says. In Cascadia’s case, auditors reviewed 103 individual bills and identified numerous irregularities, including failure to furnish documentation that the billed therapy actually was provided, failure to record mental health assessments and treatment plans, and failure to submit progress notes, all of which are required for Medicaid clients. In their final report, issued in November, state auditors extrapolated that the total overpayments amounted to $2,724,400. Cascadia, however, has appealed the finding, so the final amount it must repay remains undetermined. Overall, many people in the mental health field suspect that the state auditors are scrambling to toughen up local providers for the impending federal probe that is slated to begin later this year, a hunch buttressed by the fact that roughly one-quarter of the state audits are focused on mental health and addiction treatment providers, even though such programs account for less than 10 percent of total Medicaid spending. But OPAR’s Baxter says the audits are simply part of its mission to protect the financial integrity of the Medicaid program. “We want to hold our providers accountable,” she says. This email address is being protected from spambots. You need JavaScript enabled to view it.

Go to top
Template by JoomlaShine