Ohio uncovers more alleged Medicaid fraud payments

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(The Center Square) – A northeast Ohio behavioral health agency received $1.2 million in improper Medicaid payments, Ohio’s auditor said.

The state wants $1.4 million in repayment, adding interest, from New Destiny Treatment Center in Summit County, Auditor Keith Faber said.

New Destiny was paid $11.5 million from Jan. 1, 2021, through Dec. 31, 2023, for substance abuse disorder, mental health and other services, Faber said.

“Issues identified in Tuesday’s compliance audit included missing documentation to support reimbursements and instances where treatment plans did not match services that were provided, among other issues,” the auditor said.

Medicaid is the joint-state federal health insurance program for low-income residents.

State law requires prior authorization for before a patient can be admitted for treatment.

“The 425 payments examined contained 45 instances in which prior authorization was not obtained after 30 consecutive days of admission through day 50 of admission,” the audit states. “New Destiny should ensure that prior authorization is obtained when required. New Destiny should address the identified issues to ensure compliance with Medicaid rules and avoid future findings.”

The audit also examined patient treatment plans “to confirm if the treatment plan indicated the service was authorized and that the treatment plan was signed by the recording practitioner,” the audit said. “The 78 payments examined contained 60 instances in which the treatment plan authorized a higher level of care than what was provided and four instances in which there was no treatment plan.”

These 64 errors are included in the projected improper payment amount of $1.1 million, the audit said.

Nationally, there has been a crackdown on Medicaid fraud this year.

Last month, the state of Minnesota filed criminal charges against two people for $1.5 million in alleged Medicaid Fraud, the state’s attorney general said, including one who was reportedly honored by the state as an “outstanding refugee.”