MM Curator summary
A MO behavioral health provider has successfully fought back $2M of services-not-provided allegations.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
WEBSTER GROVES — A highly publicized case that accused Great Circle of overbilling Medicaid for a lot of behavioral health services that may not have happened has taken an abrupt turn in the nonprofit’s favor. Instead of being on the hook for nearly $2 million, Great Circle must pay just $9,253.18, according to a recent settlement agreement that admits no wrongdoing.
“Great Circle’s policy is one of transparency — and that includes full cooperation with all reviews, audits and investigations,” Paula Fleming, Great Circle’s chief executive, said Tuesday in a news release. “We took this issue very seriously and, through collaboration, we were able to reach a conclusion both favorable to Great Circle and acceptable to the state.”
A January letter from the Missouri Medicaid Audit and Compliance Unit to Great Circle said $1,992,157 in “improper billing” had been identified. Great Circle, which has state contracts to provide an array of services for troubled youths across Missouri, many of whom have autism or are in foster care, appealed the audit findings to the Administrative Hearing Commission on Feb. 18, two weeks after a federal raid of its headquarters here.
According to records on file in the appeal, the audit was prompted by “data analysis that suggests possible over-utilization of therapy services.”
“The alleged overpayments are not based on any finding that the services for which (Great Circle) was paid were not actually provided, or any finding that they were not medically necessary,” Elizabeth Blackwell, an attorney for the nonprofit, argued in the original petition.
Clipped from: https://www.stltoday.com/news/local/metro/great-circle-accused-of-overbilling-medicaid-by-nearly-2-million-settles-case-for-less-than/article_9b1d75a8-550c-5fd8-aab8-2c4db3cf9e14.html