Mental health firm discloses improper Medicaid billings

Grace Leong

Wednesday, Sept. 22, 1999 | 11:26 a.m.

The state said Summit Behavioral Partners-Nevada Inc. came forward and voluntarily disclosed improper claims and billings to the Nevada Medicaid Program in a bid to avoid criminal charges.

The Attorney General's office said Summit agreed to pay $156,702 as part of a settlement with the state.

Summit bought Hess & Associates, a Las Vegas mental health clinic, last January from Apogee Inc. and discovered problems there before closing the clinic in July.

"The business was submitting its bills to the Medicaid program under licenced psychologists' names when the work that was billed for was done by unlicensed people like interns and post-doctorate candidates," said Tim Terry, a state official.

"Given the fact that a criminal conviction automatically bars a health-care provider from participation in Medicaid, Medicare or other federally funded health-care program for at least five years, I would encourage providers who may have crossed the billing line to seriously consider this voluntary disclosure program," said Attorney General Frankie Sue Del Papa.

The state generally declines criminal prosecution of self-reporting providers if they make a full disclosure of all improper claims or billings including all internal audits, and if the state is granted complete access to inspect and copy the medical and financial records of all Medicaid patients treated by the providers.

The state also requires the provider to cooperate fully with any requests for other information, documentation or personal interviews to verify provider's disclosures, and that it hasn't destroyed, concealed or given false information.

Summit Behavioral Partner's chief executive, Pat Gotcher, could not be reached for comment.