Health service provider disputes finding, calls action from state office unprecedented.
CANTON The state auditor said Tuesday that CommQuest Services owes the Ohio Department of Medicaid more than $910,000 for overpayments and interest.
CommQuest, a major provider of addiction and mental health treatment in Stark County, acknowledged some record-keeping problems but said the auditor’s finding of overpayment was unprecedented.
“We plan to engage Medicaid, explain our side and take whatever necessary steps we have to to protect the agency and the services that we provide,” CommQuest President and CEO Keith Hochadel said.
The auditor’s Medicaid review team looked at CommQuest’s records from Jan. 1, 2013, to Dec. 31, 2015.
During that time, Ohio’s Medicaid program paid CommQuest and its predecessor, Quest Recovery and Prevention Services, $12 million for 265,000 services associated with drug and alcohol addiction.
Based on a sampling of those services, the auditor calculated CommQuest, a not-for-profit organization, received nearly $840,00 in improper payments.
The review focused on 387 urine drug test services and 385 intensive outpatient services.
The review found 71 intensive outpatient services with errors. The errors included 30 instances where documentation was missing to support the service, 44 services that lacked a treatment plan to cover the service date and 11 instances where a qualified professional or a client failed to sign a treatment plan.
Based on that sampling, the auditor calculated those errors caused Medicaid to overpay CommQuest by $777,000.
The review also found 31 urine drug test services with errors, including 11 instances of no supporting documentation and 25 instances without a standing order for the service. The auditor calculated Medicaid overpaid CommQuest $62,000 because of those errors.
The auditor also calculated CommQuest owed almost $71,000 in interest and recommended CommQuest ensure its documentation is accurate and complies with Ohio Medicaid rules before submitting bills.
The auditor’s report will be sent to the Ohio Department of Medicaid, the Ohio Attorney General’s Office and the U.S. Health and Human Services Office of the Inspector General for review.
Ohio Medicaid spokeswoman Melissa Ayers said the department was reviewing the report and documentation before determining the appropriate next steps.
CommQuest response
CommQuest and its attorneys at the law firm of Vorys, Sater, Seymour and Pease have challenged the auditor’s report.
They argue the problems the auditor found historically been been corrected by Ohio Mental Health and Addiction Services through a regulatory process and not by a finding of overpayment by the auditor.
“As we’ve gone through this, I believe that there’s a misunderstanding of the behavioral health system in general,” Hochadel said.
There were close to 1 million pieces of paper in the sampled files, and while some files lacked complete documentation, “all services were medically necessary and all of them were high quality,” Hochadel said.
Last year, CommQuest started using electronic records that are easier to track.
CommQuest treats approximately 20,000 clients a year and operates with annual revenue of about $22.5 million.
The agency plays an important role in responding to the opioid epidemic in Stark, where the rate of Medicaid recipients with opioid-related diagnoses rose from 4.1 per 1,000 residents to 19.7 per 1,000 in 2016, according to a different auditor’s report released last week. Ohio expanded Medicaid coverage in 2014.
If CommQuest is ordered to repay Ohio Medicaid, it could affect how it serves clients.
“We put a lot of emphasis on access to care and treatment on demand, and some of that might get delayed,” Hochadel said.
Ongoing review
Auditor’s spokesman Benjamin Marrison said the review team selected CommQuest as part of its ongoing review of Medicaid claims and not because of any whistleblower or outside complaint.
In the past seven years, the auditor has identified $33.3 million in overpayments to 121 Medicaid providers and calculated $2.4 million in interest owed.
Most of those findings have come against transportation and home health providers.
Reach Shane at 330-580-8338 or shane.hoover@cantonrep.com
On Twitter: @shooverREP