Compliance audit identifies more than $1.4 million in improper Medicaid payments and interest to Scioto County provider
COLUMBUS — State auditors have identified more than $1.3 million in improper Medicaid payments over three years to a Scioto County mental health and addiction services provider, Auditor of State Keith Faber announced Tuesday.
With added interest, the Auditor of State’s Office is recommending repayment of $1,486,790.61 from Jay Hash LLC, which does business as HopeSource, as part of a recently completed Medicaid compliance examination.
The Ohio Department of Medicaid administers health care and related programming to about 2.9 million lower-income residents, older adults, individuals with disabilities, pregnant women, infants, and children, and others.
The Auditor of State, as allowed in law and under an agreement with the Ohio Department of Medicaid, audits Ohio’s Medicaid providers to determine if those examined are in compliance with federal and state reimbursement requirements.
The Ohio Department of Medicaid and/or the Ohio Attorney General’s Office ultimately take action to gain compliance and recoup any inappropriate or excess payments.
HopeSource is an Ohio Department of Mental Health and Addiction Service certified agency in Scioto County that was paid about $9.9 million for 102,000 substance use disorder services.
Auditors identified numerous issues with reimbursements paid to HopeSource, including service documentation and billing practices that did not fully comply with Medicaid requirements, services provided that were not authorized by treatment plans or for which prior authorization was not obtained, and unbillable activities included in documented services.
The full report is available online at ohioauditor.gov/auditsearch/search.aspx.
Auditors noted that HopeSource disputed the basis for the Auditor of State’s “determination that certain activities included in partial hospitalization services are not billable and the validity of the statistical sampling and extrapolation methodology. (Auditors) reviewed the criteria and our methodologies and maintain that our results and recommendations are valid.”