Insurance Fraud NEWS
Covington nonprofit billed Medicaid for $100K in unprovided services
April 22, 2019, Covington, LA
A Covington nonprofit billed the Louisiana Medicaid Program for more than $100,000 in behavioral health services that it either didn't provide or provided by using unqualified employees, according to the state Legislative Auditor's Office.
In some cases, the nonprofit Walk With Me billed for counseling services that licensed counselors said they never provided. In others, it billed for the work of staff members who weren't qualified to perform counseling and who said their duties actually involved helping with homework and supervising camp-type activities for children.
The investigative audit, made public Monday, was triggered by complaints from the Medicaid Fraud Control Unit of the state Attorney General's Office.
The audit recommends that the Louisiana Department of Health review appropriate legal action, including seeking the recovery of payments. In addition, the findings have been referred to several law enforcement agencies for potential prosecution.
In all, the nonprofit submitted claims totaling about $725,000 for Medicaid services between January 2015 and August 2018. The Department of Health suspended Walk With Me's license in August, citing "credible allegations of fraud."
The following month, all five managed-care organizations that operate the state's Medicaid program terminated provider agreements with Walk With Me, which is based in Stafford, Texas, but operates in Covington.
Latoyia Porter, who is listed as president of the nonprofit, said that a response to the audit is being prepared. If there are any discrepancies in billing, "we will do the honorable thing and recoup the money to Medicaid," she told The Advocate.
Porter said that Walk With Me is no longer providing services. The landlord at the strip mall where its offices were located said that it left several months ago.
Auditors, who conducted interviews and reviewed records, found that some staff members reported an unusually high quantity of services provided on a daily basis.
For instance, seven of them billed more than eight hours a day for individual "psychosocial rehabilitation" sessions. But a review of documentation for 11 clients showed the patients had received group rather than individual services. Because group services are paid at a lower rate, the error resulted in $18,541 in overpayments to the nonprofit, auditors said.
The Auditor's Office said the nonprofit may have violated state law and its Medicaid service provider agreements.
Walk With Me improperly billed Medicaid at least $34,376 for two staff members who did not perform any services and at least $72,627 for services provided by staff members who were not qualified to provide them, according to the report.
Two licensed professional counselors told auditors that they didn't provide the services for which Medicaid was billed.
The nonprofit billed nearly $26,000 for 543 hours of individual therapy sessions supposedly provided by Bahram Dehnadi and another $7,000 for group sessions, all between October 2016 and July 2017.
"However, Mr. Dehnadi told us he never provided PSR services to WWM clients and only provided group psychotherapy sessions two or three times at WWM's afterschool camp," the audit said.
The counselor said he had a contract from late 2016 to early 2017 to provide assessments and treatment plans for Walk With Me's clients. He estimated that he completed 50 to 75 of those assessments or plans and gave them to Porter.
Records also show that Walk With Me billed Medicaid $1,790 for services provided by licensed counselor Brook Capdeboscq from Jan. 1, 2018, to Feb. 8, 2019. But Capdeboscq said she didn't work for the nonprofit during that time.
It also billed Medicaid nearly $73,000 for services provided by four staff members described by the nonprofit as "servant leaders," even though the employees did not appear to have completed a basic clinical competency training program.
Tamira Polk, for example, told auditors that she worked off and on for the nonprofit from 2014 to 2017. She mainly helped children with homework at after-school camps and organized field trips and activities during the summer camp, she said.
The audit says that Polk was shown a schedule of billings that listed her as providing individual psychosocial rehabilitation services and community psychiatric support services. "Ms. Polk reviewed the schedule and stated that the client names listed were consistent with the clients in her group; however, she never provided counseling services to them," the auditors said.
Walk With Me was licensed by the Louisiana Department of Health to provide specialized behavioral services to children, adolescents, adults and families.
Its Facebook page says it provides social services, youth mentoring, crisis support and after-school and summer activities to low-income and at-risk women and children, particularly those affected by domestic violence.
Source: The New Orleans Advocate