Medicaid irregularities probed | Arkansas Blog

Medicaid irregularities probed



The state has moved to terminate Medicaid payments to Gilead Family Resource Center, a provider of mental health services in McGehee, because of multiple irregularities, particularly in programs for kids. It is seeking repayment of $815,000. The center is appealing the state's order.

More details on the developing story are on the jump in an article reported and written by John Williams. It is worth remembering testimony from the 2007 legislative session at which legislators heard that Arkansas spends far more money than larger states on mental health services for kids. The lobby has grown stronger as the business has grown more lucrative.

Gov. Mike Beebe has made mental health a priority. Cleaning up wayward providers is one way to start.

State moves to terminate
The Department of Human Services has issued an order to terminate Gilead Family Resource Center, a mental-health-care provider based in McGehee, from the state Medicaid program. DHS also ordered that Gilead repay the state $815,807 for services it says the company improperly billed.
Gilead won an injunction in Pulaski County Circuit Court that allows it to continue billing Medicaid until the completion of its appeal to the state.
“This is very serious,” said DHS spokeswoman Julie Munsell. “The state considers termination to be a last resort.”
Findings of wrongdoing followed a joint audit by DHS’s Division of Medical Services, which conducts billing reviews, and by its Division of Behavioral Health, which checks for proper treatment. The audit report listed numerous irregularities in the company’s Medicaid billing. These included insufficient documentation, double billing, and misuse of billing codes to recoup excessive payments.
The audit also found that the company engaged in improper medical practices. Among these findings were that the company’s general practitioner prescribed psychotropic medication to preschoolers without consulting a psychiatrist. The report also states that children were diagnosed with mental illnesses by social workers and nurses unqualified to make such a diagnosis.
The audit covered the period from November 2006 to November 2007. Gilead’s current owner, Charles Gibson II, bought the company in August 2007. Gibson did some legal work for Gilead before becoming its owner. Lisa Moon, Gilead’s current vice-president, and Stephen Montgomery, its current treasurer, worked at the company for a few months previous to the ownership transition.
Gibson said he was aware of the audit before taking over the company. “In this business there are always audits,” he said. “It did make us think twice about it, but we had been through numerous audits before.”
Gilead’s previous owner was James Chambers, who Gibson said currently lives in Texas. Chambers could not be located for comment.
Gibson acknowledged that he controlled the company for a period covered by the audit, but he argued that his governance was not at fault for any of the wrongdoings found by DHS.
“The time that spilled over into our tenure was basically right when we took over and were not really aware of everything we needed to be aware of at the time,” Gibson said. “We made wholesale changes, but we weren’t really aware of any particular deficiencies.”
About 90 percent of the Gilead’s revenue comes from Medicaid. Gibson said that the company is working with DHS to make improvements needed to keep itself in business. “Honestly, most of the changes we need to make are already there,” he said. “They just don’t show up in the historical record before we took over.”
DHS spokeswoman Munsell confirmed that DHS is monitoring the company’s progress and helping it fix its problems. But she said DHS remains committed to the decision to terminate. “We still have concerns about the quality of care, but we also want the facility to have an opportunity to correct any issues,” Munsell said.  
Gibson met with Governor Beebe to talk about the sanctions, though Beebe did not reverse the termination.  
“The governor’s first priority is the health and welfare of those kids,” Beebe spokesman Matt DeCample said. “He’s 100 percent behind the DHS decision.”
However, Gibson said he was hopeful that Gilead will eventually be allowed to return to the Medicaid payroll once it makes necessary changes. “The Governor said that it’s his intent that everything is run right, and we said that’s our intent too.”
There is currently no date scheduled for a hearing in Gilead’s appeal.
-- John Williams

UPDATE: Gibson objects to the original headline's reference to the investigation as being one of potential Medicaid fraud. Double billings, if any, were bookkeeping mistakes, not fraud, he said. We believe the initial headline an accurate reflection of the potential scope of the probe and the state's decision to terminate a reflection of something more serious than simple bookkeeping errors. But to avoid misunderstanding, I"ve changed the original wording.

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