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Northeast Ohio Medicaid Providers Owe More than $1 Million
Columbus – Examinations of four northeast Ohio Medicaid providers identified more than $1 million in overpayments this week, according to reports released by Auditor of State Dave Yost.
Auditors uncovered much of that amount at G.S. Burton Development, LLP in Summit County, where they calculated $895,617 in overpayments stemming from 860 service errors that occurred from 2012 through 2014.
During that time, the provider received nearly $1.3 million in reimbursements from the Ohio Department of Medicaid (ODM) for 22,357 services, mostly non-medical transportation and homemaker/personal care aide services.
Auditors determined 283 services were provided by 11 employees who were ineligible during the entire period and 17 employees who were temporarily ineligible. Reasons for those determinations included a lack of criminal background checks and drug tests, missing personnel files, no first aid and/or CPR certification, and failure to complete required annual training hours.
“These requirements are pure commonsense,” Auditor Yost said. “It’s disturbing to know that some Ohioans risk being in the care of individuals who lack basic but essential medical training and who haven’t even been properly vetted for the job.”
Additionally, two drivers went periods of time without having a valid driver’s license, one temporarily had a suspended license and another driver had a driving record with six points.
“These standards are in place to protect people and are not optional,” Yost said.
Auditors discovered 297 errors in the provider’s service documentation, including 177 instances where the units billed exceeded those documented and 86 services with no supporting documentation. With the current amount of interest, the provider owes ODM $951,525.
In Cuyahoga County, auditors determined a provider named Sharon Mason was overpaid $49,530 from 2012 through 2014 due to 166 errors in service documentation. Mason received $175,230 from ODM during the period for 1,269 personal care aide services.
The examination identified 74 services for which Mason submitted only typed documentation based on a template that auditors determined was unreliable. Auditors also found 51 instances where Mason billed for two separate shifts despite documentation showing single, continuous shifts. The billing practice resulted in increased reimbursements. Other errors included 19 services where units billed exceeded documentation and 18 services lacking documentation. Including $2,386 in interest, Mason owes ODM $51,916.
“A Medicaid provider’s first priority is the care of its patients. It’s second is accountability to taxpayers,” Yost said. “That involves maintaining complete, accurate records to verify public funds are spent in accordance with the law.”
Auditors conducted two reviews of intermediate care facilities, resident treatment facilities for individuals with intellectual disabilities.
At Madison Village Manor, Inc. in Lake County, auditors found $57,061 in overpayments. The provider received reimbursements for 241 dates of service in 2014 after the recipient of the service was already discharged. Auditors learned the provider was aware of the error and made efforts to correct the recipient’s status.
Also in Lake County, auditors identified $24,230 in overpayments to the Broadfield Care Center, where records showed the provider was reimbursed for 86 unauthorized bed hold days. Authorization is required for beds to be held for more than 30 days when patients are temporarily absent.
Full copies of these reports are available online.
The Auditor of State’s office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,900 state and local government agencies. Under the direction of Auditor Dave Yost, the office also provides financial services to local governments, investigates and prevents fraud in public agencies and promotes transparency in government.