Tuesday, February 27, 2018
By JUSTIN WIER
When the Ohio Auditor’s office approached Angel Carriers LLC of Youngstown for documents related to Medicaid services, managers claimed a fire had destroyed the records.
Auditors returned after learning the fire occurred in the building’s garage, and managers claimed the records were left in the building during its demolition.
The records surfaced when auditors issued a draft report labeling the entire amount reimbursed through Medicaid an overpayment.
“They said, ‘Oh, you mean these records?” Auditor Dave Yost said.
Yost recounted the story at a news conference Tuesday for the release of a report documenting noncompliance in Ohio’s Medicaid program.
The report documents $33.3 million in overpayments to 121 providers over a seven-year period including $458,083 to Angel Carriers from 2011 to 2014 — nearly 98 percent of the amount paid to the provider.
Atty. J. Michael Thompson, who represents Angel Carriers, said the claims reflect record-keeping issues following the fire, not the quality of services his client provides.
“This report raises significant doubts as to whether Angel Carriers will receive due process or a fair hearing,” he said in a statement. “No business should be condemned publicly like this while a case is still pending, as guilty until proven innocent.”
The auditor also found three other Mahoning County providers received $98,024 in overpayments.
Sebring psychologist David W. DeLong received $82,746 in reimbursements the auditor’s office deemed improper from 2008 through 2010.
The reasons included services where the activity documented did not match the service billed, services with no supporting documentation and services where the documentation did not support the time billed.
The Vindicator could not contact Dr. DeLong.
Summit Academy Youngstown received $14,663 in improper reimbursements from 2011 to 2013, according to auditor’s reports.
The charter school billed for services for students who were absent or not enrolled on the dates of service.
At the time, Summit’s interim CEO told The Vindicator the overpayments resulted from clerical errors and the company intended to refund the payments.
Finally, Homecare with Heart LLC of Boardman received $614 in improper payments between 2009 and 2011, according to the report.
Those resulted from services in which a physician did not sign the plan of care and others where documentation did not support the paid service.
Vicki Lee, who manages compliance for the company, said the organization is very diligent about meeting requirements, but there are a lot of moving parts.
“We corrected [the error], and now we continue to try to do better,” she said.
Home health care providers and transportation providers accounted for 86 percent of improper payments, Yost said, despite making up 30 percent of Medicaid providers.
The majority arise from failure to maintain complete documentation, services provided by unqualified employees and a lack of service authorization from a physician.
The auditor said 60 providers have paid only $1.9 million of $19 million in findings against them and advocated for legislation to help mitigate that problem.
Senate Bill 218, introduced by Peggy Lehner of Kettering, R-6th, would require Medicaid providers to obtain a surety bond. It would also require providers to complete certification before they receive payments.
“The idea that you can catch up on your certifications and we’ll pay you in the meantime is a profoundly stupid idea,” Yost said. “This bill would fix that bass ackwards approach.”