Columbus – Auditor of State Keith Faber’s Office released the 2018 Medicaid compliance examination of the Urban Minority Alcoholism and Drug Abuse Outreach Program of Lucas County, Inc. The examination found inaccurate billing totaling $414,414 and an $81,649 overpayment during a six month period.
The auditors found that there was no supporting documentation for the sample of Withdrawal Management with Extended on-site Monitoring Services, an addiction service, selected for the examination. Further, the auditors confirmed that the Provider had no documentation for any payments for the withdrawal management service. The Provider indicated it billed Sober Home Room and Board as withdrawal management services but did not provide withdrawal management services and the Provider had continued with this practice until it became aware that room and board is not a covered service as a result of this examination.
Accordingly, auditors identified the entire paid amount for this procedure code during the examination period, $414,414, as an improper payment. In addition, the office recommended that the Provider work with the Ohio Department of Medicaid to identify payments for withdrawal management with extended on site monitoring services billed with dates of service after our audit period and arrange for repayment of these services.
During planning for the examination, auditors noted that 42 percent of the intensive outpatient services were billed for same recipient on the same date even though this service is paid on a daily rate. Auditors examined a sample of 152 of the intensive outpatient services billed with two units per day and confirmed that in 76 instances the Provider billed two intensive outpatient services in error.
The auditors then examined the 76 services that were not duplicate billings and found the following errors:
- 52 instances where the provider billed with an incorrect modifier which resulted in an overpayment;
- 23 services with no treatment plan to cover the date of service;
- 5 instances there was no documentation to support the service billed.
In total auditors identified a total of 156 errors in 136 of the 152 services examined and the improper payment was projected to the Provider’s population intensive outpatient services billed with two units on the same date resulting in a projected overpayment of $81,649.
A full copy of this report is available online.