A spokeswoman for Faber’s office said the billing issues appeared to have been errors rather than intentional.
“If our office identified anything that was concerning of fraud or abuse, our special investigations unit would have been involved,” said Allie Dumski, Faber’s press secretary.
The psychiatry practice, which specializes in helping people with addictions to drugs and alcohol, particularly heroin and other opioids, was not complying with Medicaid requirements for the services examined including group counseling, withdrawal management, and intensive outpatient program (IOP), Faber’s office announced.
Auditors studied 250 IOP services and found 125 duplicate billings. Auditors found other errors for lack of supporting documentation, and other billing errors that resulted in overpayments. Auditors found 20 instances where Modern Psychiatry and Wellness submitted two documents for the same recipient, date, and time of day but contained conflicting information.
“These notes indicated different practitioners rendered the IOP service and that the topic and contents of the session along with the recipient’s response was different,” Faber’s office stated.
According to audit documents, Modern Psychiatry “indicated that billing for more than one IOP service per day was a billing error caused by employees that did not fully understand the billing process. In addition, the provider stated that it now contracts with a vendor to perform billing.”
Dr. Quinton Moss, the founder and CEO of Modern Psychiatry, told the Journal-News, “We had some quality concerns that we had to address, and we addressed those, and got a vendor who is managing our billing, so we think that we’re on the good standing right now.”
As for errors that may have happened since 2018, “We don’t anticipate having any other findings. We don’t anticipate that at all. Some of this occurred when there were significant changes with redesign and how services were billed by Medicaid,” he said.
Modern Psychiatry also operates Genesis Health & Life, Genesis Life and Wellness, and Genesis Health. It also operates a sober home under the name of Genesis.
Asked how prevalent the errors were, Dumski told the Journal-News: “For the time period tested, the agency received payment of $2,731,129 for 35,661 services. We examined a sample of 547 of these services and found that 199 of the 547 (36%) were not compliant.”
Why was the agency examining billing from 2018, this media outlet asked. Dumski answered: “We initiated the examination in November 2020 and selected the period prior to the services being moved to managed care to test services that were paid by the Ohio Department of Medicaid.”
She added: “Once our report is released, the Ohio Department of Medicaid will determine if it wants to pursue an administrative action to recoup any or all of the improper payment identified in our report. If the Department decides to take action, it will notify the agency separately.”
About the Author
