A Mansfield-based addiction treatment program owes almost $11 million to the state for services that were unsubstantiated or ineligible for reimbursement from the Ohio Department of Medicaid.
“Despite overwhelming circumstances, Ohio’s addiction treatment programs have helped lead the charge on the front lines of the state’s opioid crisis,” Auditor Yost said. “As their work continues, I urge these providers to hold fast to the safeguards that protect the state’s Medicaid resources and the citizens who depend on them.”
An examination of Medicaid claims submitted by the Mansfield Urban Minority Alcoholism and Drug Abuse Outreach Program found a number of violations that should have disqualified the company from earning $10 million of the $18.7 million it received from 2014 through 2015.
The overpayment is the largest amount reported in a Medicaid examination since Auditor of State Dave Yost took office in 2011. With interest, the company owes nearly $11 million.
Auditors found the company lacked records to support reimbursements for 41 percent of lab services, 26 percent of counseling services, 25 percent of intensive outpatient services and 12 percent of medication services.
Auditors also inspected the company’s personnel records for compliance with Medicaid requirements, flagging 129 services provided by unqualified staff. Disqualifying offenses included services provided by employees who lacked required licenses or certification from the Ohio Board of Nursing and Ohio State Medical Board.
The report cites additional problems with the company’s service authorization records, such as 262 services provided without required treatment plans. Another 15 services had treatment plans, but they did not authorize the services provided.
The examination also revealed that the company billed for services provided by two partner organizations located in Elyria and Dayton, but the company never reported those organizations to the Department of Medicaid.
The company responded to the report’s findings by attributing the violations to challenges posed by the state’s opioid crisis, as well as the company’s transition to an electronic system of recordkeeping.
Since 2011, Auditor Yost’s administration has identified improper payments of $50 million to Medicaid providers. A special report released in February highlights the costs and dangers citizens face when those providers disregard the regulations put in place to prevent fraud and inadequate care.
A full copy of the Mansfield UMADAOP report is available online.