Arkansas Blog: Medicaid irregularities probed

The state has moved to terminate Medicaid payments to Gilead Family Resource Center, a provider of mental health services in McGehee, because of multiple irregularities, particularly in programs for kids. It is seeking repayment of $815,000. The center is appealing the state's order.

More details on the developing story are on the jump in an article reported and written by John Williams. It is worth remembering testimony from the 2007 legislative session at which legislators heard that Arkansas spends far more money than larger states on mental health services for kids. The lobby has grown stronger as the business has grown more lucrative.

Gov. Mike Beebe has made mental health a priority. Cleaning up wayward providers is one way to start.

State moves to terminate

The Department of Human Services has issued an order to terminate Gilead Family Resource Center, a mental-health-care provider based in McGehee, from the state Medicaid program. DHS also ordered that Gilead repay the state $815,807 for services it says the company improperly billed.

Gilead won an injunction in Pulaski County Circuit Court that allows it to continue billing Medicaid until the completion of its appeal to the state.

“This is very serious,” said DHS spokeswoman Julie Munsell. “The state considers termination to be a last resort.”

Findings of wrongdoing followed a joint audit by DHS’s Division of Medical Services, which conducts billing reviews, and by its Division of Behavioral Health, which checks for proper treatment. The audit report listed numerous irregularities in the company’s Medicaid billing. These included insufficient documentation, double billing, and misuse of billing codes to recoup excessive payments.

The audit also found that the company engaged in improper medical practices. Among these findings were that the company’s general practitioner prescribed psychotropic medication to preschoolers without consulting a psychiatrist. The report also states that children were diagnosed with mental illnesses by social workers and nurses unqualified to make such a diagnosis.

The audit covered the period from November 2006 to November 2007. Gilead’s current owner, Charles Gibson II, bought the company in August 2007. Gibson did some legal work for Gilead before becoming its owner. Lisa Moon, Gilead’s current vice-president, and Stephen Montgomery, its current treasurer, worked at the company for a few months previous to the ownership transition.

Gibson said he was aware of the audit before taking over the company. “In this business there are always audits,” he said. “It did make us think twice about it, but we had been through numerous audits before.”

Gilead’s previous owner was James Chambers, who Gibson said currently lives in Texas. Chambers could not be located for comment.

Gibson acknowledged that he controlled the company for a period covered by the audit, but he argued that his governance was not at fault for any of the wrongdoings found by DHS.

“The time that spilled over into our tenure was basically right when we took over and were not really aware of everything we needed to be aware of at the time,” Gibson said. “We made wholesale changes, but we weren’t really aware of any particular deficiencies.”

About 90 percent of the Gilead’s revenue comes from Medicaid. Gibson said that the company is working with DHS to make improvements needed to keep itself in business. “Honestly, most of the changes we need to make are already there,” he said. “They just don’t show up in the historical record before we took over.”

DHS spokeswoman Munsell confirmed that DHS is monitoring the company’s progress and helping it fix its problems. But she said DHS remains committed to the decision to terminate. “We still have concerns about the quality of care, but we also want the facility to have an opportunity to correct any issues,” Munsell said.

Gibson met with Governor Beebe to talk about the sanctions, though Beebe did not reverse the termination.

“The governor’s first priority is the health and welfare of those kids,” Beebe spokesman Matt DeCample said. “He’s 100 percent behind the DHS decision.”

However, Gibson said he was hopeful that Gilead will eventually be allowed to return to the Medicaid payroll once it makes necessary changes. “The Governor said that it’s his intent that everything is run right, and we said that’s our intent too.”

There is currently no date scheduled for a hearing in Gilead’s appeal.

-- John Williams

UPDATE: Gibson objects to the original headline's reference to the investigation as being one of potential Medicaid fraud. Double billings, if any, were bookkeeping mistakes, not fraud, he said. We believe the initial headline an accurate reflection of the potential scope of the probe and the state's decision to terminate a reflection of something more serious than simple bookkeeping errors. But to avoid misunderstanding, I"ve changed the original wording.

Comments

The report also states that children were diagnosed with mental illnesses by social workers and nurses unqualified to make such a diagnosi<<<

I know the UA cranks out a lot of MSW degrees. They gotta find work somewhere.

Posted by: eLwood | June 12, 2008 05:56 PM

Is that an U of A slight I'm catching here?

John McCain has a long way to go.

Posted by: johnpositions | June 12, 2008 06:55 PM

It is most gratiying to hear that one of the rudest most incompetant lipservices to the public good, lisa moon, is finally catching her due. Had this incosequental sewage any honor she would have drowned herself in the womb.

Posted by: Zarathustra | June 12, 2008 09:27 PM

Who is Lisa Moon?

Posted by: Meet John Doe | June 13, 2008 08:34 AM

Nurses are perfectly qualified to be hired to conduct therapeutic services--including diagnoses--if they have had previous experience in the mental health field prior to being hired to perform such duties.

...Sounds like the previous owner sold just in time! Perhaps he knew that his way of conducting the business was not exactly legit, and wanted to eliminate any association with the company before the innevitable happened. Isn't it convenient that he could not be reached for comment? I find it hard to believe that there was any intentional wrongdoing amongst the new owners. One sole owner could get away with being fraudulent, at least for a little while. But with three, there is more accountability, and surely one of them would've blown the whistle if they had the slightest incling that something was afoot.

Posted by: ND | June 13, 2008 10:09 AM

the people at gilead saved my life-why don't you look at the agencies that make people wait eight hours to see a doctor after waiting three months for the appointment. Seems to me that vindictive people are making horrible statements when they don't have the intelligence to know the truth about the situation. these people really help people why doesn't someone ask their clients about the services?

Posted by: lamar | June 13, 2008 03:56 PM

I personally think that there are vindictive forces against these people. We live in Southeast Arkansas where there are 4 mental health agencies for this widespread area. If you want to say they're providing poor services, look at the other 3 services
and ask them are they doing a better job. Just talk to some of the clients and ask them what they think. And then if you decide to close Gilead down, think where their clients will go. Think of themas clients who came from these other facilities who were providing what they thought were poor services or other problems they were having with them. Ask yourself- Is this really a good decision for the community?

Posted by: aw | June 13, 2008 04:21 PM

As a concerned citizen of McGehee I am highly disappointed in our government and Medicaid. The fact that they are "investigating" Gilead and not places such as Delta Counseling makes me sick. If there is a place that commits "fraud" it is Delta Counseling. Everyone in town knows that Gilead is the best mental health agency in town and every since they came to town people have been out to get them. Whether it has been false accusations or complaints it comes no doubtedly from disgruntled past employees or other mental health agencies that feel they are loosing business to this fine agency. I personally know people who have taken their children there or they themselves have been there. I also know for a fact that these people left other agencies such as Delta Counseling because of what medicaid is allegdging as poor client services. These people wanted a change and that's what they got. They moved from one agency to the other willingly. They have stayed with Gilead willingly. I have seen many good things come from this agency and for it to close would be a tragedy for this small community. If, and I mean IF there has been any wrongdoing on the part of this agency, it hasn't been done so knowingly. I do not believe for one minute that the current owners of this business would do such nor do I believe that any of the employees there would do such either. I believe when a business opens in town and starts doing well other businesses feel threatened by this and that is when things like this happen. I also believe that previous employees become disgruntled and they themselves have to resort to some type of "revenge" to feel the need to "get even." I ask the Governor himself to take a harder look at this case and ask Medicaid itself to put a stop to this action against this agency. This agency cares very deeply about the many clients it serves. It is not about making millions of dollars it is about helping people...that is what is different about this agency...it is what defines them and separates them from the other mental health agencies around. As for the allegations of "fraud" by this agency...it's hogwash! Can't medicaid find better things to do with it's time??? Go after the bigger agencies in town...the one's that really are committing fraud and demand repayment of the millions that they have taken in and look at the kind of care they are providing. Better yet, come and talk to any of Gilead's clients and see what they have to say about the type of care they are receiving...I dare you to find any that would say one bad word against them. As a taxpayer and citizen of this community where Gilead is located, I am THANKFUL, YES THANKFUL for such an agency that reaches out to families and children in times of crisis and need. I feel that without them this community would be a far worse place. And for anyone that would say such horrible things about Ms. Moon, it's obvious you didn't have anything more than a 2nd grade education, which in turn means Ms. Moon is far more qualified to work with children than you are any day of the week. Thank you Gilead for your hard work in this community...I can only pray that you will continue to have your doors open and that medicaid would have their eyes opened by what is obviously an all out attack by someone who has nothing more than evil in their heart for a place that has nothing but love in theirs. God bless Gilead and all those they serve!

Posted by: concerned | June 13, 2008 11:06 PM

Ahhhhh, now I understand, somebody's been caught intentionally out of compliance, or for lack of a softer term "outright stealing." The Govenor is aware of the facts of the case and has acted accordingly, the owners need to break out they're checkbooks and reimburse MY money, and maybe they won't be carted off to the pokey. Especially that CPA that did the books, then bought the place and continued business as usual, obviously an unsavory character.

Posted by: harley | July 3, 2008 01:33 AM

Arkansas Blog

Medicaid irregularities probed

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