Audit finds treatment center owes Medicaid $11M

A addiction-treatment program in Mansfield owes nearly $11 million to Ohio's tax-funded Medicaid program for services that it failed to substantiate or that were not eligible for reimbursement, a state audit found.

A review 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 treatment program from receiving $10 million of the $18.7 million it was paid in 2014 and 2015.

Auditor Dave Yost said the overpayment was the largest amount reported in a Medicaid review since he took office in 2011. With interest, the not-for-profit treatment program owes the state nearly $11 million.

“Despite overwhelming circumstances, Ohio’s addiction-treatment programs have helped lead the charge on the front lines of the state’s opioid crisis,” 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.”

The $25 billion Medicaid program provides health coverage to 3 million poor and disabled Ohioans.

In response to the audit, the treatment center's attorney, Timothy G. Pepper, stressed that there was no "fraud, waste or abuse" and all services questioned were provided to patients. He attributed the problems to an increase in patients as a result of the state's 2014 expansion of Medicaid and the program's transition to an electronic record-keeping system.

Auditors found that the company lacked records to support reimbursements for 41 percent of lab services, 26 percent of counseling services, 25 percent of outpatient services and 12 percent of medication services.

An inspection of the company’s personnel records found 29 services provided by unqualified staff members because they failed to meet Medicaid requirements. For instance, employees lacked required licenses or certification from the Ohio Board of Nursing and Ohio State Medical Board.

The audit also uncovered 262 services provided without required patienttreatment plans authorizing the services. An additional 15 services had patienttreatment plans, but they did not authorize the services provided.

The Mansfield center also billed Medicaid or services provided by partner organizations in Elyria and Dayton without reporting them to the Department of Medicaid as required, auditors found.

Since 2011, Yost's office has uncovered $50 million in improper payments to Medicaid providers.