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State questions Health Department billings

December 09, 1998|By LAURA ERNDE

The Washington County Health Department's addictions unit was improperly billing insurance companies in a practice that may have constituted fraud, a state auditor said.

Of 43 cases reviewed, more than half had billing problems, said William T. Grossclose, chief of the Division of Internal Audits at the Maryland Department of Health and Mental Hygiene in Baltimore.

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In a Sept. 2 letter to health officials, Grossclose had not ruled out fraud.

Addictions counselors, who are not certified, were told to say their patients saw certified counselors even when they didn't, according to the letter.

Some were told to use Director of Outpatient Services Barbara Koelle's provider number for billing insurance claims in cases when the insurance company required certified counselors, Grossclose said.

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"It appears that in an effort to maximize program revenue, staff was directed to use the provider numbers of other personnel who possessed certain specific licenses," Grossclose wrote.

Grossclose recommended the matter be turned over to the Maryland Attorney General's Office, according to the letter, sent to Dr. Georges C. Benjamin , deputy secretary for public health services, and Dr. Robert Parker, Washington County health officer.

Parker defended the addictions unit's practices this week.

"I'm confident there was no wrongdoing and no intentional errors on the part of staff," he said.

Parker said state auditors have cleared the department of wrongdoing since Grossclose's Sept. 2 letter was written.

He refused to release paperwork to back up that claim but said he would release the auditor's final report when it is finished.

Both Parker and Grossclose said the addictions unit has changed its billing practices as a result of the audit.

"Procedures are put in place so it won't happen. We can avoid problems like this in the future," Parker said.

The addictions unit, at 13126 Pennsylvania Ave., employs 10 people who lead group counseling sessions and give individual counseling to adults with substance abuse problems.

Grossclose, in his September letter, said the faulty billing practice was verified by paperwork prepared by the addictions counselors.

It also was confirmed in the minutes of a Dec. 5, 1995, staff meeting for members of the health department's Substance Abuse Program, he said.

Grossclose interviewed the substance abuse program's chief, who told him she believed that insurance companies would not reimburse the health department unless the counseling was provided by a licensed person.

But when he interviewed insurance companies, they said that is generally not a requirement.

Most often, the companies required the service to take place in a licensed facility, Grossclose said.

In at least three cases, the insurer did require service be provided by a licensed clinical social worker. Even though an uncredentialed counselor was used, the health department billed the insurance companies, he said.

Of the 43 cases reviewed, Grossclose found:




- In 10 cases (23 percent), he could not determine whether billing errors were made.

- In three cases (7 percent) no billing was done.

- In three cases (7 percent), there were no billing errors.

- In 27 cases (63 percent), there were problems with overbilling, underbilling or using the identification number of a person other than the one who provided the service to the client.

He recommended that the addictions unit list each insurance company's requirements and train staff on proper billing procedure.

He also recommended the unit identify and correct other billing errors.

In a telephone interview, Grossclose said he could not estimate how much, if any, the billing errors cost insurance companies.

Koelle was contacted for this story, but referred questions to Parker, who said he wanted to speak for the Health Department.

Parker defended the actions of his employees.

Parker said no clients were shortchanged by seeing counselors with lower levels of training.




related story: Health Department worker claims reprisals for billing report

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