Fraud claim made against Rogers doctor
Medical board chairman suspended from Medicaid
The chairman of the Arkansas State Medical Board has been suspended from participation in the state Medicaid program in response to a “credible allegation of fraud,” according to a letter from the state’s Office of Medicaid Inspector General.
All payments for Medicaid services to Dr. Brian Hyatt, a Rogers psychiatrist, have been suspended by the office, according to the Friday letter acquired by the Northwest Arkansas Democrat-Gazette under the state Freedom of Information Act.
The office determined there was a “credible allegation of fraud” against Hyatt, according to the letter.
According to an affidavit for a warrant to search Hyatt’s phone records, the state attorney general’s office was contacted in April 2022 by a whistleblower from the behavioral health unit of Northwest Medical Center in Springdale.
Hyatt had been the medical director of the unit since January 2018. His contract with the hospital was “abruptly terminated” in May of last year, the affidavit states.
Investigators with the attorney general’s office watched hundreds of hours of surveillance video from the behavioral unit and did not see Hyatt enter a patient’s room or make direct contact with a patient, the affidavit states.
According to the affidavit, “red flags” were identified during an analysis of Hyatt’s Medicaid claims and use of evaluation and management coding, which is used to bill for medical services.
“Subsequent hospital care” codes like 99231, 99232 and 99233 are the most commonly billed codes, each paying a progressively higher rate, according to the affidavit. More complicated cases with patients who are unstable or are developing a new problem are indicated by a 99233 code, the affidavit states.
Between January 2019 and June 30, 2022, Hyatt billed more Medicaid patients at the 99233 code than any other doctor billed for all of their Medicaid patients, the affidavit states.
During that time period, “99.5% of the continuing hospital care claims for Medicaid recipients/patients were billed to Medicaid under 99233,” the affidavit states. “According to the claims submitted by Dr. Hyatt and the non-physician providers
working under his supervision, no patient being treated in the behavioral health unit located at Northwest Medical Center ever got better, at least not before the day of the patient’s release.”
Data shows about 20% of all “subsequent hospital care” codes billed nationally – and about 39% billed by Arkansas psychiatrists – are the 99233 code, according to the affidavit.
“Dr. Hyatt is a clear outlier, and his claims are so high they skew the averages on certain codes for the entire Medicaid program in Arkansas,” the affidavit states.
Billing patients at a higher rate than is appropriate is a kind of Medicaid fraud, the affidavit states. In Arkansas, Medicaid fraud resulting in an overpayment over $2,500 is a felony.
A Pulaski County circuit judge granted the request for the search warrant on Jan. 17.
Hyatt has not been charged with a crime. He has 30 days to appeal his suspension from the Medicaid program.
The attorney general’s office is also investigating “possible Medicare fraud” as well as “other overpayments and irregularities,” according to the affidavit.
Christina Bull, spokeswoman for Northwest Medical Center, said the hospital “continues to cooperate with the Attorney General’s Office during their investigation concerning Dr. Hyatt.”
“We take very seriously our responsibility to provide a safe environment of care for our patients and for our team members,” she said.
Hyatt owns and operates Pinnacle Premier Psychiatry in Rogers. He was appointed to the Medical Board in January 2019 by then-Gov. Asa Hutchinson and later elected chairman. His current term on the board expires Dec. 31, 2024.
The Medical Board is holding a special meeting at noon today in Little Rock. A discussion of the board’s leadership is the only item that appears on the meeting agenda.