fbpx
Connect with us

Mississippi Today

Attorney General investigating provider fraud in Medicaid waiver

Published

on

Attorney General investigating provider fraud in Medicaid waiver

The Mississippi Attorney General's Office is investigating whether a behavioral therapist provider bilked Medicaid under a special program for people with intellectual and developmental disabilities.

Natalie Gunnells, the mother of a 23-year-old Medicaid recipient named Patrick, first noticed a billing discrepancy in early 2022 after requesting to see from the Mississippi Department of Mental .

The Department of Mental Health administers the program, called the Medicaid IDD waiver, but the Mississippi Division of Medicaid pays for it.

Advertisement

Under the waiver, Patrick is eligible to over 200 hours of services each month, but in the last several years, he's received just a handful of hours, if not zero.

READ MORE: ‘You're not in line': Family battles politics, indifference, and suspected fraud in federal health care program

That hasn't stopped Mississippi Behavioral Services, a clinic in Southaven owned by Vargas Clark, from billing Medicaid for thousands of dollars worth of therapy for Patrick, records obtained by Mississippi Today show.

Clark, who has not been charged with a crime, said he was unaware of the investigation and did not return several follow up calls and texts from Mississippi Today. Gunnells estimates Medicaid reimbursed the company for $42,000 worth of services that her son didn't receive from 2020 to 2022. She says disregard at the mental health and Medicaid agencies allowed this to continue unnoticed.

Advertisement

“We provide services as written for the service authorization,” Clark said. “Now there may be individuals that are authorized for, let's say, 30 hours. We may be providing 10. But we only bill services for services that are actually rendered.”

Mississippi spends about $125 million annually on the waiver program, an average reimbursement of about $45,000 worth of services for each person.

Several who spoke to Mississippi Today and voiced their concerns at a recent public hearing want to know where all that money is going. It's hard for them to believe that much care is being delivered, considering the worker shortage that has left them without any help for their adult children.

And they're worried that a lack of oversight in the program could mean taxpayer dollars are flying out the door of Medicaid while some of the state's most vulnerable go without services.

Advertisement

“There's no telling how much fraud is occurring,” Gunnells said.

One of those parents is Deb Giles, who has been unable to find a specialist to provide the speech therapy her son is qualified to receive. But at the hearing in February, Giles focused her concerns on the accountability within the program.

“My recommendation for the Department of Mental Health is to provide the recipients with reports on audits of the providers and to provide more audits,” Giles said. “I've into roadblocks, and not enough information as to how these providers are being audited. Some are not providing the services that they're being paid for, or reimbursed for, and I would like to see more information for Mississippi on how these providers are being audited. And also I'd like to be able to assess the audits, to read throughout the state of Mississippi what the providers are providing for the recipients.”

Giles told Mississippi Today she wasn't alleging a specific instance of fraud, but that the waiver program doesn't collect enough information from providers to ensure they're performing all the functions they're supposed to.

Advertisement

The Department of Mental Health's primary role in the IDD waiver is to provide clients with support coordinators from the agency's regional IDD centers. The support coordinator's job is to consult with the parent or guardian of an individual on the waiver to ensure they are receiving the services outlined in the support plan they create together. For years, Gunnells said her support coordinator did not review service reports with her. Several call logs Mississippi Today reviewed confirmed that this wasn't .

“It seems every standard put in place to ensure appropriate care for P (Patrick) was totally ignored from the Support Coordinator to all his superiors charged with ensuring the documents such as Quarterly Reports, Behavior Support Plan and required IDD service notes were submitted on time and accurate,” Gunnells wrote in a timeline of the alleged fraud. “They were so negligent that any agency billing Medicaid, that wanted to commit fraud, could without detection.”

Patrick Gunnells, 23, watches on his iPad in the living room at his Tupelo home on Mar. 9, 2023.

Department of Mental Health Director Wendy Bailey said the agency conducted its own internal investigation into the matter and referred it to Medicaid. She said DMH is providing additional to support coordinators and looking at ways to improve its site visit process at the regional centers. The central office reviews a sample of support coordination records monthly.

The state Medicaid agency is in the process of renewing its application to the federal for the waiver.

“While we don't have evidence to believe this type of provider fraud is widespread, we still have to be open to new ways of preventing fraud and be aggressive in rooting it out,” Medicaid spokesperson Matt Westerfield said in a statement to Mississippi Today. “This year, the Division plans to implement an electronic system for the ID/DD waiver that documents the time certain ID/DD services begin and end.”

Advertisement

The Medicaid statement also encouraged anybody who suspects Medicaid fraud to notify the agency here.

The Attorney General's Office, which began its investigation more than six months ago, did not respond to several requests for comment for this story.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Did you miss our previous article…
https://www.biloxinewsevents.com/on-this-day-in-1909/

Advertisement

Mississippi Today

On this day in 1917

Published

on

mississippitoday.org – Jerry Mitchell – 2024-05-05 07:00:00

May 5, 1917

Eugene Jacques Bullard, seen here in uniform in World War I, was the first African-American combat pilot. Credit: Wikipedia

Eugene Jacques Bullard became the first Black American combat pilot. 

After the near lynching of his father and hearing that Great Britain lacked such racism, the 12-year-old Georgia native stowed away on a ship headed for Scotland. From there, he moved to Liverpool, England, where he handled odd jobs before becoming a boxer, traveling across Europe before he settled in Paris. 

“It seems to me that the French democracy influenced the minds of both White and Black Americans there and helped us all to act like brothers as near as possible,” he said. “It convinced me, too, that God really did create all equal, and it was easy to that way.” 

Advertisement

When World War I began, he was too young to fight for his adopted country, so he and other American expatriates joined the French Foreign Legion. Through a series of battles, he was wounded, and doctors believed he would never walk again. 

No longer able to serve in the infantry, an American friend bet him $2,000 that he could not get into aviation. Taking on the , he earned his “wings” and began fighting for the French Aéronautique Militaire. 

He addressed racism with words on his plane, “All Blood Runs Red,” and he nicknamed himself, “The Black Swallow of .” 

On his flights, he reportedly took along a Rhesus monkey named “Jimmy.” He tried to join the U.S. Air Service, only to be turned away because he was Black. He became one of France's most decorated war heroes, earning the French Legion of Honor. 

Advertisement

After the war he bought a Paris nightclub, where Josephine Baker and Louis Armstrong performed and eventually helped French officials ferret out Nazi sympathizers. After World War II ended, he moved to Harlem, but his widespread fame never followed him back to the U.S. 

In 1960, when French President Charles de Gaulle visited, he told officials that he wanted to see his old friend, Bullard. No one in the government knew where Bullard was, and the FBI finally found him in an unexpected place — working as an elevator operator at the Rockefeller Center in New York

After de Gaulle's visit, he appeared on “The Show,” which was shot in the same building where he worked. 

Upon his death from cancer in 1961, he was buried with honors in the French War ' section of the Flushing Cemetery in Queens, New York. 

Advertisement

A sculpture of Bullard can be viewed in the Smithsonian National and Air in Washington, D.C., a statue of him can be found outside the Museum of Aviation, and an exhibit on him can be seen inside the National Museum of the U.S. Air Force, which posthumously gave him the rank of a second lieutenant. He is loosely portrayed in the 2006 film, “Flyboys.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Continue Reading

Mississippi Today

A seat at table for Democrats might have gotten Medicaid expansion across the finish line

Published

on

mississippitoday.org – Bobby Harrison – 2024-05-05 06:00:00

The Mississippi Capitol is 171,000 square feet, granted a massive structure, but when it comes to communication between the two legislative chambers that occupy the building, it might as well be as big as the cosmos.

Such was the case in recent days during the intense and often combustible process that eventually led to the of expansion and with that the loss of the opportunity to provide for 200,000 working poor with the federal paying the bulk of the cost.

Democrats in the House came under intense pressure and criticism for blocking a Medicaid expansion compromise reached by Republican House and Senate negotiators.

Advertisement

First of all, it would be disingenuous to argue that Democrats, who compose less than one-third of the membership of either chamber, blocked any proposal. Truth be known, Republicans should be able to pass anything they want without a solitary Democratic vote.

But on this particular issue, the Republican legislative leadership who finally decided that Medicaid expansion would be good for the state needed the votes of the minority party, which incidentally had been working for 10 years to pass Medicaid expansion. The reason their votes were needed is that many Republicans, despite the wishes of their , still oppose Medicaid expansion.

The breakdown in the process could be attributed to the decision of the two presiding , House Speaker Jason White and Lt. Gov. Delbert Hosemann in the Senate, not to appoint a single Democrat to the all-important conference committee.

Conference committees are formed of three senators and three House members who work out the differences between the two chambers on a bill. Considering that Democratic votes were needed in both chambers to pass Medicaid expansion, and considering Democrats had been working on the issue for a decade while Republicans blocked it, it would have made sense that they had a seat at the table in the final negotiations process.

Advertisement

One Democrat from each chamber on the conference committee could not have altered the outcome of the negotiations. But the two Democrats could have provided input on what their fellow legislative Democrats would accept and vote for.

In the eyes of the Democrats, the compromise reached without their voice being heard was unworkable and would not have resulted in Medicaid expansion.

The Republican compromise said Medicaid would not be expanded until the federal government provided a waiver mandating those on Medicaid expansion were working. Similar work requirement requests by other states have been denied. Under the compromise, if the work requirement was rejected by federal , Medicaid expansion would not occur in Mississippi.

After voicing strong objections to the work requirement, House Minority Leader Rep. Robert Johnson, recognizing the Senate would not budge from the work requirement, offered a compromise. The Johnson compromise to the compromise was to remove a provision mandating the state apply annually with federal officials for the work requirement.

Advertisement

Instead, under Johnson's proposal, state Medicaid officials would be mandated to apply just once for the work requirement. If it was rejected, Medicaid expansion would not occur, but hopefully that would compel the Legislature to take up the issue of the work requirement and perhaps remove it.

“We just want the Legislature to come back and have a conversation next year if the federal government doesn't approve the work requirement. It's as simple as that,” Johnson said.

Senate leaders agreed that Johnson's proposal was a simple ask and something they might consider.

But Lt. Gov. Delbert Hosemann, who presides over the Senate, said he never heard Johnson's proposal until late in the process — too late in the process, as it turned out.

Advertisement

Speaker Jason White, R-, also said he never heard the proposal, though Johnson said he repeatedly discussed it with House leaders. He certainly was relaying the information to the media during the final hectic days before Medicaid expansion died.

And perhaps if Johnson or one of his Democratic colleagues had been on the conference committee, that information would have been heard by the right legislative people and perhaps Medicaid expansion would not have died.

After all, a conference room or an office where negotiators are meeting to hammer out a compromise is much smaller than the massive state Capitol, where communications often get lost in the cosmos.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Advertisement
Continue Reading

Mississippi Today

On this day in 1884

Published

on

May 4, 1884

of Ida B. Wells, circa 1893 Credit: Courtesy of National Park Service

Crusading journalist Ida B. Wells, an African-American native of Holly Springs, Mississippi, was riding a train from Memphis to Woodstock, Tennessee, where she worked as a teacher, when a white railroad conductor ordered her to move to another car. She refused.

When the conductor grabbed her by the arm, “I fastened my teeth in the back of his hand,” she wrote.

The conductor got from others, who dragged her off the train.

In response, she sued the railroad, saying the company forced Black Americans to ride in “separate but unequal” coaches. A local judge agreed, awarding her $500 in damages.

But the Tennessee Supreme Court reversed that ruling three years later. The upended her belief in the court system.

Advertisement

“I have firmly believed all along that the was on our side and would, when we appealed it, give us justice,” she said. “I feel shorn of that belief and utterly discouraged, and just now, if it were possible, would gather my race in my arms and fly away with them.”

Wells knew about caring for others. At age 16, she raised her younger siblings after her and a brother died in a yellow fever epidemic. She became a teacher to her .

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Did you miss our previous article…
https://www.biloxinewsevents.com/?p=355325

Advertisement
Continue Reading

News from the South

Trending