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D.C. clinic accused of fraud in reimbursement bid
Corners were cut, fired staffer says
A mental health clinic in Southeast Washington stands accused of defrauding Medicaid and the D.C. Department of Health Care Finance (DHCF) by counseling patients without first doing proper diagnostic examinations, cutting corners when it conducts the exams and manipulating requests for reimbursement, according to documents obtained by The Washington Times and interviews with current and former employees.
Family Preservation Services (FPS), a subsidiary of the Providence Service Corp. in Tucson, Ariz., has pressured employees to engage in such practices to recoup $500,000 in mental health service reimbursements that otherwise would have been denied, according to a former billing specialist, Patrice Lancaster, who recently was fired.
Officials with the parent company said they did not learn of Ms. Lancaster's allegations until after she was terminated, adding that when they pressed her for further details, she declined.
The allegations come at a challenging time for the D.C. Department of Mental Health (DMH), which less than two years ago complied with a mandate to cut staff and outsource services in the name of efficiency and better results, according to the office of D.C. Council member David A. Catania, at-large independent and chairman of the D.C. Council's Committee on Health.
On Tuesday, a spokesman for Mr. Catania acknowledged receipt of Ms. Lancaster's complaints and the importance of investigating any example of fraud, waste and abuse. The spokesman, Brendan Williams-Kief, said Mr. Catania's office directed Ms. Lancaster to contact senior officials at DMH, which has an office of accountability and oversight.
"In any contractor situation, there can be bad actors," said Mr. Williams-Kief. "Whether that is a function of too many providers or some providers being undercapitalized, the office of accountability is specifically tasked with looking into these kinds of complaints."
DMH spokeswoman Phyllis Jones said Tuesday that the department received an anonymous call to its ethics hotline in October that warned of a lack of valid treatment plans and failure to provide complete patient assessments at FPS. The call prompted an unannounced, focused audit of 52 client charts, she said, noting that the complaints could not be substantiated.
Seven additional complaints
Ms. Jones acknowledged the written complaint filed by Ms. Lancaster, which contains seven additional complaints, including failure to conduct 90-day follow-up visits with mental health patients and continuation of services billed to Medicaid where patients no longer needed services, but said they could not be substantiated. She declined to elaborate.
Officials at DHCF said the complaint does not fall under their jurisdiction.
Since 2004, FPS — one of many small mental health service providers that contract with the District — has received more than $17 million from the city, according to the Office of the Chief Financial Officer.
A performance oversight report reviewed by The Times also shows that DMH investigated complaints against the provider's clinical practice in 2010 that were found to be unsubstantiated.
Ms. Lancaster told The Times that she made several calls to corporate headquarters in June to complain of hostile work conditions at FPS, which is run by clinical director Roeathea Butler and district manager Rick Smith.
In October, shortly after she was fired, Ms. Lancaster told the corporate office that while still employed, she had sent three reports to Mr. Smith "showing the fraud, waste and potential loss of revenue that would occur if the bad practices weren't corrected." Her letter states that Ms. Butler angrily denied the allegations and fired Ms. Lancaster that same week.
Ms. Butler and Mr. Smith referred calls to the parent company.
Joyce Montes, assistant general counsel for the Providence Service, told The Times on Tuesday that she could not comment on the firing of Ms. Lancaster. In an email, she wrote: "We were not aware of Ms. Lancaster expressing any concerns about fraud until receipt of Ms. Lancaster's October 11, 2011, letter to [Chief Operating Officer] Craig Norris. During the company's investigation, Ms. Lancaster chose to withhold further information despite my requests for information related to her allegations of fraud. The investigation did not find evidence to support the claims that Ms. Lancaster made in her letter to Mr. Norris."
Numerous red flags
Ms. Lancaster's Oct. 11 letter also pointed to numerous "red flags," such as high employee turnover, FPS being understaffed and two compliance directors resigning within six months of each other. "They both communicated to me that they were not risking their licensure by remaining employed by FPS," she wrote.
Recently, Dr. Colleen Hawthorne, a psychiatrist and medical director at FPS, also resigned. Though Dr. Hawthorne declined to comment for this article, FPS staff who spoke to The Times on the condition that they not be identified said that she expressed similar concerns to them.
"All you'd have to do is visit to sense the looming fear that the place could be shut down at any time," said one current employee who corroborated Ms. Lancaster's claims, but who asked not to be named for fear of retaliation.
Those claims include pressure not to document incidents such as physical injuries and inappropriate contact between patients, and back-dating treatment plans.
"You don't know if you're being told to do something that is wrong, but you know when it doesn't feel right," said a former FPS employee who also corroborated Ms. Lancaster's complaints. "The place doesn't seem to operate from a place that says 'we care about the mentally ill.' It just doesn't have that vibe."
© Copyright 2013 The Washington Times, LLC. Click here for reprint permission.
About the Author
Jeffrey Anderson is an investigative reporter for The Washington Times. He can be reached at email@example.com.
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