“Times Union: N.Y. Attorney General Settles with Whitney Young Health for Alleged Overbilling”
January 16, 2018
As published by The Albany Times Union, on January 12, 2018.
The state Attorney General has reached a $1.25 million settlement with Whitney Young Health over alleged overbilling of Medicaid by the health center’s Methadone Maintenance Treatment Program for patients with addictions to heroin and other opioids.
“As the opioid epidemic continues across the state, New Yorkers seeking help with addiction deserve to know they’re getting high-quality treatment,” Schneiderman said in a statement. “We will not tolerate Medicaid providers delivering substandard treatment, while New Yorkers foot the bill.”
The health center’s corporate compliance officer, Maureen Krone, countered that the issue had no bearing on Whitney Young’s ability to provide high-quality care.
“Whitney Young Health is on the front lines of combating the opioid crisis,” Krone said. “We understand the Attorney General’s concerns and are looking forward to putting this incident from several years ago behind us so we can continue to focus on our patients’ needs as they engage in treatment.”
It was not clear from the settlement whether treatment plans were incomplete because Whitney Young billed for services that were not provided, or because services that were provided were not documented properly. Krone said the problem was documentation, not failure to provide services.
Methadone is used to wean people, especially heavy drug users, off heroin and other powerful opioids. Many patients must stay on the medication for years, and some rely on it for decades.
Whitney Young Health, a federally qualified health center that treats about 20,000 patients regardless of their ability to pay, is one of the region’s primary providers of substance abuse services and until recent years had the only methadone program in the Capital Region. The health center operates its Methadone Maintenance Treatment Program on Dewitt Street in Albany as part of an integrated system that combines substance abuse treatment with primary care and mental health services.
Treatment plans lay out the approach that will be taken by a team of medical practitioners to address a patient’s addiction. As required by Medicaid, the plans must be customized to individual needs and include patient input on priorities to address.
Many treatment plans at Whitney Young appeared not to be individualized, according to the Attorney General Office’s review of about 200 patient files. The plans were not discussed, reviewed or signed by the patients as required by law, according to the office.
As part of the settlement agreement, Whitney Young has agreed to repay the $1.25 million it was not entitled to receive from Medicaid, within 60 days of the settlement date of Dec. 29. It is a sizable amount for the nonprofit organization, whose earnings in 2015 approached $1.2 million on revenues of $17 million, according to financial filings with the federal government.
Whitney Young Health must also employ an independent monitor for the next two years to ensure Medicaid rules and regulations are followed.