From the Winston Salem Journal of North Carolina
The state said yesterday that it will try to recoup payments from providers and examine possible fraud after a preliminary audit found misuse of a new service for mental-health and substance-abuse treatment paid for with Medicaid dollars.
The Department of Health and Human Services announced last month that it would audit private companies and nonprofit agencies that provide what's called "community support." The providers determine patients' needs and then give some basic aid such as helping clients work on social skills.
A review of the program led regulators to start visiting the 167 providers billing the highest amount of community-support services per person they served, the department said yesterday.
While the audits continue, "we now know that some providers aren't using the services as they were intended, or they aren't properly documenting their use," department secretary Carmen Hooker Odom said. "We need to act now to make sure that children and adults with mental illness and substance-abuse disorders get the services they need."
The department plans a three-tiered response to these providers that will include paying back claims that weren't documented fully or have 5 percent of Medicaid payments withheld until they demonstrate compliance.
Providers with a compliance score below 50 percent will have 25 percent of payments withheld and their actions referred to authorities for investigations into fraud and abuse.
The department is already working to recalculate the proper payment rate for the service, which federal Medicaid officials agreed to pay for last year.
No comments:
Post a Comment