Ohio's state auditors have uncovered a substantial discrepancy in Medicaid payments made to Lucas County-based behavioral health services provider Caregiver Grove Behavioral Health LLC. An announced report by Auditor of State Keith Faber indicates that improper Medicaid payments amounting to $1.75 million were made to the provider over two years. The state recommends that Caregiver Grove repay approximately $1.96 million, including the accrued interest on the improper payments and the Ohio Auditor of State's website details.
The audit stemmed from a compliance examination in an agreement between the Ohio Department of Medicaid (ODM) and the Auditor of State's Office. ODM delivers health care to approximately 2.9 million residents, including lower-income families, older adults, and people with disabilities. Within this context, the imperative is to safeguard these funds so they effectively reach those in need.
From January 1, 2020, to December 31, 2022, Caregiver Grove received about $6.2 million for mental health and substance use disorder services. However, the recent report has flagged several inconsistencies. There was an apparent lack of supporting documentation for the billed services. Furthermore, treatment plans were either missing or did not sanction the billed services for individual and group therapy sessions, among other billing infractions.
The audit findings included instances where Caregiver Grove billed for psychiatric evaluations and counseling sessions that surpassed Medicaid's coverage limits. Significantly, the provider also charged Medicaid for different counseling sessions for the same patient on the same day – a clear breach of protocol. Following the audit's revelations, Caregiver Grove expressed its commitment to remedy the discrepancies and to ensure future compliance, stating in its response within the audit report in a statement obtained by the Ohio Auditor of State Office, "to addressing the issues raised in this audit and ensuring compliance moving forward."
The Auditor of State’s Office, under Keith Faber's direction, not only audits over 5,900 state and local government entities but also offers financial services to local governments and addresses fraud in public agencies. This incident iterates the office's role in promoting financial diligence and accountability, especially in sectors that deal with public health and welfare resources. As the Ohio Attorney General’s Office moves to ensure compliance and recover the funds, the community watches, hoping that such vigilance will prevent future misuse and direct necessary resources to where they are most critically needed. According to the Ohio Auditor of State Office.
