Authored by Sylvia Xu via The Epoch Times(emphasis ours),
Colorado’s Medicaid program made an estimated $77.8 million in improper payments and another $207.4 million in potentially improper payments for autism therapy,according to a February report from the Inspector General for the Department of Health and Human Services.
Auditors investigated $289.5 million in Medicaid payments from 2022 to 2023 that paid for more than 1 million claims for Applied Behavior Analysis—a therapy used to treat autism and developmental disabilities.
Each of the 100 claims reviewed contained at least one improper or potentially improper payment, suggesting a 100 percent failure rate.
Improper payments are not necessarily fraudulent. Payments are considered improper when the claim does not meet federal or state requirements. Payments are potentially improper when the submitted claim is so poor or unreliable that auditors cannot verify that the services were provided correctly.
In 93 of 100 claims examined,the billing providers either did not provide notes verifying that the therapy took place, didn’t provide the required signatures, or billed for more time than the notes indicated.
In 18 cases, the therapy that was supposed to be performed by a specialist—such as a Board Certified Behavior Analyst—was performed by staff without those qualifications.
In seven cases, the children receiving therapy lacked a current doctor’s diagnosis or referral on file.
In 88 cases, facilities billed for recreational activities that are not considered medical therapy, such as academic tutoring, day care, or custodial care. In one case, a facility billed for children swimming and playing on water slides.
In 76 cases, facilities billed for a full eight-hour day without subtracting time for naps, meals, or breaks.
Source: ZeroHedge News
