Overbilling found in Mental Health Program

Private mental health providers have overcharged the government about
$45 million for a basic, widely used service, a state official said
Thursday.
Until the companies pay the money back, the state is withholding 10 percent
of what they earn as they continue to treat patients.
The state discovered the overcharges when mental health officials reviewed
records of patients who were getting a service called community support.
The reviewers reported thousands of cases of misuse. More than a third of
the clients getting the service did not need it, and companies were spending
too much time on more than 80 percent of the people who needed help. The
state is trying to get money back from 185 providers. It withheld about
$900,000 from a recent round of payments.
Tara Larson, an assistant director in the state Medicaid office, told a
legislative commission Thursday that the overcharge figures were based on
"preliminary work," and that the final numbers aren't in.
Companies started offering community support to children and adults in March
2006. Company workers are supposed to teach skills such as anger control to
people who are mentally ill or are substance abusers, and find patients
other help they might need so they can live at home, stay in school, or find
and keep jobs.
The bills for community support started rolling in, to the tune of
$842 million last year -- hundreds of millions more than the state expected.
As costs ballooned, state officials and startled legislators tried to clamp
down on the companies. The legislature passed a law trying to regulate the
service, and the state Department of Health and Human Services recently
announced new controls.
Costs continue to rise. Over the past four months, the state spent $88
million more for community support than expected. The rate of spending would
exceed this year's $805 million budget for the service.
"This thing's out of control, and for the life of me, I don't see it getting
any better," said Sen. Martin Nesbitt, an Asheville Democrat who helps run a
legislative committee overseeing the mental health system.
Last week, the state said no new companies seeking to be paid with
government money would be allowed to sign up to offer the service.
While new sign-ups are on hold, state officials said they would tighten
rules for worker training and and company qualifications.
The state also wants to rewrite rules to make it easier to take away
permission for companies to bill the government.

From the News and Observer, Lynn Bonner, November 16, 2007

http://www.newsobserver.com/news/story/774722.html