Behavioral company to repay nearly $2M in improper Medicaid payments

(The Center Square) – Ohio state auditors uncovered nearly $2 million in improper Medicaid payments to a Toledo-area-based provider.

State Auditor Keith Faber recently announced he is recommending repayment of $1.96 million, including interest, from Caregiver Grove Behavioral Health LLC for programming for about 2.9 million low-income residents, older adults, people with disabilities, pregnant women, infants, and children.

The audit found $1.75 million in improper payments were made to Caregiving Grove, which has locations in Toledo and Cincinnati.

Faber said the company was paid about $6.2 million for mental health and substance use disorder services between Jan. 1, 2020 and Dec. 31, 2022.

The auditor has an agreement with the Ohio Department of Medicaid to audit Ohio’s Medicaid providers to ensure compliance with federal and state reimbursement requirements.

ODM, or the Ohio Attorney General’s Office, ultimately takes action to gain compliance and recoup any inappropriate or excessive payments.

Caregiving Grove’s report, according to Faber, showed a number of issues, including a lack of documentation to support services billed, service duration requirements that were not met, missing treatment plans and treatment plans that did not authorize the service billed for individual psychotherapy and group therapeutic behavioral services.

Auditors also found instances of billing for diagnostic psychiatric evaluations that exceeded Medicaid coverage limits and different counseling sessions that were billed for the same recipient on the same day.

Caregiver Grove acknowledged the findings and said it was committed to addressing the issues in the audit and remaining in compliance going forward.