For Immediate Release:                                                      

June 29, 2021                                                             

Modern Psychiatry and Wellness LLC Owes Ohio Medicaid for Non-Compliance with Requirements

Columbus – Auditor of State Keith Faber’s Office released the Medicaid compliance report for Modern Psychiatry and Wellness LLC, an Ohio Department of Mental Health and Addiction Services licensed treatment program with multiple locations in Butler and Warren Counties.

The audit found Modern Psychiatry and Wellness was not complying with Medicaid requirements for the services examined including group counseling, withdrawal management, and intensive outpatient program (IOP) for the period of January 1, 2018 through June 30, 2018. The report identified improper Medicaid payments totaling $29,835.24. With interest, $32,489.15 is due to the Ohio Department of Medicaid.

Auditors tested 250 IOP services and confirmed that there were 125 duplicate billings. After accounting for the duplicates, auditors found additional errors for lack of supporting documentation, and various billing errors that resulted in overpayments. In examining records for this test, auditors noted 20 instances in which Modern Psychiatry and Wellness submitted two documents for the same recipient, date, and time of day but contained conflicting information. These notes indicated different practitioners rendered the IOP service and that the topic and contents of the session along with the recipient’s response was different.

Auditors also examined withdrawal management services that were billed on both an hourly and per-diem basis.  In addition to errors related to lack of documentation to support the payment and overbilling units, auditors raised concerns with the appropriateness of billing the daily rate for these services. The agency indicated withdrawal management services include: daily medication to ensure safety and ease of withdrawal, nursing staff monitoring throughout the day; individual and group counseling; and case management services. However, the documentation submitted often only reflected a brief assessment/intervention with the recipient which averaged 30 minutes in duration. Other errors were due to non-compliance with treatment plans, either there was no treatment plan or the treatment plan did not authorize the service billed.

The report contains recommendations for the Provider to improve its internal controls to ensure compliance with Medicaid requirements. Additionally, a recommendation was made for the agency to seek technical assistance to ensure it is billing the daily rate for withdrawal management correctly and that the Ohio Department of Medicaid should monitor the agency’s billing to ensure that this issue is fully addressed.

The agency indicated that billing for more than one IOP service per day was an error caused by employees that did not fully understand the billing process and that it now contracts with a vendor to perform billing.

A full copy of this report is available online.

NOTE: Modern Psychiatry and Wellness has three fictitious names: Genesis Health & Life, Genesis Life and Wellness, and Genesis Health. The agency also operates a sober home under the name of Genesis.

###

The Auditor of State’s office, one of five independently elected statewide offices in Ohio is responsible for auditing more than 6,000 state and local government agencies. Under the direction of Auditor Keith Faber, the office also provides financial services to local governments, investigates and prevents fraud in public agencies, and promotes transparency in government.