Clinic: Medicaid billing errors were unintended

Clinic that no longer gets Medicaid payments contends it accidently made billing mistakes

Associated Press

BOISE, Idaho (AP) -- An Eastern Idaho mental health clinic that was accused of fraud and suspended from getting Medicaid payments in March says in an appeal that it was acting in good faith when it billed for services incorrectly.

The Chubbuck-based Seasons of Hope clinic lost its payments earlier this year following an 18-month state investigation conducted by the state Department of Health and Welfare. The investigation found that the company billed for services that weren't covered, misrepresented services and billed for services not documented.

The company's appeal filed Wednesday contests Health and Welfare's decision to revoke its Medicaid provider status. The agency also asked the company to repay $439,000 in overpayments and pay a $110,000 civil penalty.

In the appeal, the company admits certain services were billed improperly and documentation of other services was lost. But the company contends those cases were simply mistakes, and the company was punished too harshly for its errors.

After the company lost its Medicaid funds, it was forced to lay off about 100 employees and close several of its clinics.

"Lost paperwork is a reality for any organization, and while the Department could have cited Seasons for paperwork storage violations and issued a warning or fine, the Department asserted fraud," the appeal states.

The appeal argues the clinic was already taking steps on its own to investigate inaccurate billing practices, and it sought advice from Medicaid officials on several occasions to make sure it was entering the correct information when it billed Medicaid and patients.

It also alleges Health and Welfare made several errors in examples of fraud it detailed in a March 28 letter to the clinic.

A hearing to decide whether the state's actions are justified is expected within 30 days.

State officials declined to comment, and Seasons of Hope's attorney could not immediately be reached for comment by The Associated Press on Friday.

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