Two years ago, an audit by the U.S. Department of Health and Human Services Office of Inspector General into Maine’s practices of seeking federal Medicaid reimbursements attracted headlines. Specifically, the Inspector General said the state claimed $138.9 million more in Medicaid money than it deserved for services rendered at schools statewide, and is seeking repayment of those misguided federal reimbursements.
When the statewide number was revealed in 2011 — resulting from an audit that covered 2006-2008 and was published in late 2010 — then newly elected Gov. Paul LePage was furious his administration was getting such a major financial monkey wrench thrown at it so early in his term without forewarning from the outgoing administration.
That episode was included in a string of bad news about the state of Maine DHHS finances, such as serious budget shortfalls, that plagued the department during that time period and after.
On the Medicaid overpayment front, things went pretty quiet for a while, though. Then just last month, the Office of the Inspector General released a new report detailing what role the Portland Public Schools played in the previously publicized $138 million in allegedly improper Medicaid claims statewide.
According to that report, Portland schools accounted for just less than $670,000 in Medicaid reimbursements that were later to be deemed invalid.
The story of the Medicaid overpayments is by now a bit old, but the new, more detailed report on Portland’s place in the larger scheme of things provides a bit of context to the types of practices the federal government bristled about paying for.
According to the Inspector General, the Portland Public Schools during the time period of the audit:
- Did not provide prescriptions signed by physicians or licensed practitioners for some physical or occupational therapy services provided to students.
- Sought federal reimbursements for services provided by what the Inspector General called “unqualified providers,” specifically that some speech services were not provided “by or under the supervision of a licensed speech language pathologist.”
- Received Medicaid money for rehabilitative services for a student three months after that student dropped out of school.
State DHHS spokesman John Martins confirmed yesterday that his department has agreed with the Inspector General’s analysis of the Portland Public Schools’ case in particular.
According to the report, Portland school officials don’t agree, however. I do have a call out to some Portland Public Schools officials, but in fairness, most of this alleged activity took place before the current top administrators were in place.
The school department countered in responses filed with the Inspector General that, in many of the disputed cases, the services were administered or overseen by a licensed clinical social worker, and on other occasions the district charged the Medicaid program a “reduced rate” for services by professionals “who did not meet the credentialing requirements.” The system also argued that, while “physicians or licensed practitioners” may not have prescribed some of the occupational or physical therapy services, occupational and physical therapists did.
The Portland schools officials also countered in their official commentary added to the report that, in the case of the student who’d allegedly dropped out, that student “was not absent on two dates of service.”
In some of those cases, the Office of the Inspector General stated in the report that in hindsight it agreed that oversight by a social worker was adequate. The Inspector General stated that it adjusted its findings accordingly.
The Inspector General on most occasions, however, stood its ground and said the “reduced rate” billing, occupational and physical therapist prescriptions and student attendance in question were not adequate by the federal office’s standards.
The office is seeking repayment by the state, which it faulted for not better vetting the Medicaid reimbursement requests coming in from local school districts. When asked if the state will seek repayments from the local school districts to offset the state repayments, John Martins of the state DHHS told me this:
As is the case in other settlements, the Centers for Medicare and Medicaid Services will submit a formal remittance notice at which time we will determine our payment options.
One lingering question I have after reading this report is, simply, why did the Office of the Inspector General release another report, three years after the statewide original and five years after the audit period, detailing what it saw as the shortcomings in Medicaid billing in Portland Public Schools in particular?
Will the office be issuing a new report for each school district included within that larger $138 million statewide Medicaid overpayment framework? Was Portland singled out because it’s the largest school district in the state, with 7,000 or so students and 3.2 million in total Medicaid reimbursements over the 2006-08 audit period?
I’ve reached out to the Office of the Inspector General to learn more about the motivation behind the second report. I’ll post here if I learn more about it.
In the meantime, here’s a copy of the report you can thumb through:
Update, June 3, 2013: I connected with a spokesperson for the Office of the Inspector General late Friday and was told the office did a separate report on Portland — out of all the school districts in Maine which may have contributed to the statewide overpayment problems — simply because it’s the largest school district of them all and represents the biggest portion of the disputed Medicaid claims. There are no plans to release individual reports on other districts in the state.