This week, the Vermont Attorney General’s office announced that an investigation into allegations of improper Medicaid claims by the Brattleboro Retreat had been concluded. T.J. Donovan’s office says while there was no criminal misconduct, the facility needs to make corrections in its procedures.
In 2015 the Vermont Attorney General’s Medicaid Fraud and Residential Abuse Unit revealed that an investigation was being conducted into billing practices at the Brattleboro Retreat, a non-profit facility that provides mental health and substance abuse treatment.
Medicaid Fraud Unit Director Linda Purdy said the review was extremely complex. “To go back to October of 2015 we actually completed our first investigation that rose out of the Thomas Joseph lawsuit. We basically found instances of inaccurate entries both that were not in the financial benefit of the Retreat and that some were in the financial benefit of the Retreat but they all relatively minimal but were appropriate. We made a formal referral to the Department of Vermont Health Access and then they did a year-long investigation and they found new questions. So we opened another investigation.”
Purdy says that investigation found no criminal misconduct but did identify areas of billing deficiencies to be corrected. Purdy says the mistakes were found to be unintentional. "There were problems with the billing and sometimes it would it would be that there would be too long of a delay and so that would affect the accounting of what they were bringing in and what was going out. But there was never any identified intentional fraud or misbilling. And actually the Medicaid payments that were made were appropriate for the services that were provided and that’s why there was no criminal fraud.”
An MOU between the state and the facility acknowledges that from January 2015 until the present some of the Retreat’s Medicaid claims and billing practices have been “suboptimal.” It creates a third party review of operations and defines the state’s expectations and requirements including claims error rates and prioritizing billing claims. Purdy says a top to bottom review of the Retreat’s billing and accounting systems will be reported to the Department of Vermont Health Access and the Attorney General’s office. “The MOU requires everyone to meet on what the third party reviewer comes up with in terms of suggestions for improvement. It’s at the Retreat’s cost. It will benefit both the Retreat and certainly benefit the state of Vermont to ensure that they’re billing and accounting practices are improved to the point of being at an optimal best practices level.”
Brattleboro Retreat President and CEO Louis Josephson says they agree and are continuing to work on improvement of practices. “We did not wait certainly for this final announcement by the Attorney General or this MOU with the state to start improving things. So we’ve done a lot of work. We certainly had indications of areas that we needed to improve that are kind of basic functions and we’ve taken steps to do that. So I’m looking at the third party review as an opportunity to get some real expert eyes in the industry to look at our operation and make further suggestions and provide us with goals and metrics for us to meet. So it’s a good thing for us. It can only be helpful.”
The Vermont Attorney General’s office said other investigating agencies including the U.S. Attorney’s office reached the same conclusions.
The Brattleboro Retreat has been a WAMC underwriter.
