Improper Medicaid Payments Totaling Nearly $1.3 Million Identified in Compliance Audit of CRN Healthcare in Montgomery County
State auditors identified nearly $1.3 million in improper Medicaid payments to a mental health and addiction services provider based in Montgomery County that received public funding, Auditor of State Keith Faber announced.
With added interest, the Auditor of State’s Office is recommending repayment of $1,427,776.38 from CRN Healthcare Inc. as part of a recently completed compliance audit covering activities from July 1, 2019, through June 30, 2021.
A copy of the full report is available online (ohioauditor.gov/auditsearch/search.asp)x.
The Ohio Department of Medicaid administers health care and related programming to about 2.9 million lower-income residents, older adults, individuals with disabilities, pregnant women, infants and children, and others. The Auditor of State, pursuant to an agreement with the Ohio Department of Medicaid, audits Ohio’s Medicaid providers to determine if those examined are in compliance with federal and state reimbursement requirements. The Department of Medicaid and/or the Ohio Attorney General’s Office ultimately take action to gain compliance and recoup any in appropriate or excess payments.
CRN Healthcare is an Ohio Department of Mental Health and Addiction Services certified provider that received $8.9 million in fiscal years 2020 and 2021 in managed care and feefor-service payments for 138,267 services.
Among other issues, state auditors found multiple instances in which:
The names of practitioners were not listed in documentation, and their eligibility to render services could not be verified.
No documentation was available to support of 44% of the tested payments.
Details, including the time of day, duration, or description of services, were not included in required documentation.
There were no treatment plans authorizing services that were provided.
Claims exceeded billing limitations.
As part of its official response, CRN “indicated it has purchased a new electronic medical records system that it believes will eliminate the vast majority of noncompliance,” according to the compliance audit report.
CRN also provided notice on March 1, 2023, that “it had closed all offices due to financial struggles and that another agency assumed the provision of services to its clients.” As of the close of the compliance audit, CRN maintained one office in Centerville, where one of the owners remained as the sole practitioner providing services to three middle schools.