COLUMBUS ­ ­— State auditors identified $665,395 in improper Medicaid payments to a mental health and addiction services provider based in Hamilton County that received public funding, Auditor of State Keith Faber announced Tuesday.

With added interest, the Auditor of State’s Office is recommending repayment of $750,000 from Exclusive Services Inc., as part of a recently completed compliance audit covering Medicaid reimbursements from July 1, 2019, through Dec. 31, 2021.

A copy of the full report is available online via Search Audits (ohioauditor.gov/auditsearch/search.aspx).  

Ohio’s Medicaid Program provides health care and other services to about 3 million lower-income residents, older adults, individuals with disabilities, pregnant women, infants and children, and others.  

The Auditor of State, pursuant to an agreement with the Ohio Department of Medicaid, audits Ohio’s Medicaid providers to determine if those examined are in compliance with reimbursement requirements. 

The Department of Medicaid and/or the Ohio Attorney General’s Office ultimately take action to gain compliance and recoup any inappropriate or excess payments.

Exclusive Services Inc. is an Ohio Department of Mental Health and Addiction Services certified provider that received $1.2 million during the audit period in managed care and fee-for-service payments for 5,693 services.

Among other issues, auditors identified more than 300 instances in which there was no documentation to support the payment for all of the services billed, accounting for $644,803 of the total improper payments.

Auditors noted, “Exclusive Services indicated that the lack of documentation was due to staffing problems, coupled with its practice of billing from the schedule and productivity logs. During this compliance examination, Exclusive Services reported that it had implemented a hiring freeze, were re-training its employees and had contracted with a third-party biller.”

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The Auditor of State’s Office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,900 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.