Independent Auditor’s Report On Compliance With Requirements Of The Medicaid Program
Learn how the AI-generated research projects were createdOverall Conclusion
In our opinion, except for the effects of the matters described in the Basis for Qualified Opinion paragraph, New Destiny has complied, in all material respects, with the select requirements of behavioral health services for the period of January 1, 2021 through December 31, 2023.
Audit Scope
Behavioral health services provided to Medicaid recipients by New Destiny Treatment Center, Inc. for January 1, 2021 through December 31, 2023, focusing on provider qualifications, service documentation, service authorization, and billing practices for selected services including those in the procedures table.
Key Findings Summary
Noncompliance related to services billed during potential inpatient hospital stays: 7 non-compliant services, 9 non-compliance errors, $1,232.86 improper payments.
More than one per diem service billed on a RDOS: 633 non-compliant services, 633 non-compliance errors, $113,038.22 improper payments.
UDS services exceeding limitations on an RDOS: 37 non-compliant services, 37 non-compliance errors, $535.76 improper payments.
View the Findings tab to see all 8 findings
AI-Assisted
AI Scope Summary
This audit demonstrates how to structure future Medicaid compliance reviews by concentrating on provider qualifications, accurate and complete service documentation, proper authorization and treatment planning, and the alignment of billing with Medicaid rule limitations, with an emphasis on RDOS controls, UDS limitations, and residential care integrations to avoid future improper payments.
AI-Generated Insight
The audit identifies pervasive documentation and billing controls weaknesses across multiple behavioral health service types (inpatient stay billing, per diem and UDS billing, and treatment planning). The resulting improper payments total over $1.22 million, with a conservative projection for intensive outpatient services indicating potential overpayments of about $1.10 million. Key remediation should focus on robust documentation, treatment plan approvals, and strict adherence to prior authorization and RDOS rules.
Audit Objectives
Assess New Destiny Treatment Center, Inc.’s compliance with Medicaid provider qualifications requirements for behavioral health services.
Assess compliance with Medicaid service documentation requirements, including documentation of date, time, and duration of service contact and adherence to minimum time requirements.
Assess compliance with service authorization requirements, including that treatment plans are authorized and signed, and prior authorization is obtained when required.
Assess compliance with Medicaid coverage rules and billing limitations, including limits on recipient-date-of-service aggregation, per diem services, and services included in residential treatment.
Identify and quantify improper Medicaid payments and provide recommendations to ensure ongoing compliance and reduce future findings.
Audit Findings (8)
Noncompliance related to services billed during potential inpatient hospital stays: 7 non-compliant services, 9 non-compliance errors, $1,232.86 improper payments.
More than one per diem service billed on a RDOS: 633 non-compliant services, 633 non-compliance errors, $113,038.22 improper payments.
UDS services exceeding limitations on an RDOS: 37 non-compliant services, 37 non-compliance errors, $535.76 improper payments.
UDS service billed on the same RDOS as a residential service: 12 non-compliant services, 12 non-compliance errors, $173.76 improper payments.
SUD group counseling on the same RDOS as a residential service: 4 non-compliant services, 4 non-compliance errors, $133.92 improper payments.
Residential services requiring prior authorization after 30 consecutive days of admission through day 50: 45 non-compliant instances, $8,699.55 improper payments.
Alcohol and/or other drug treatment program services sample: 2 non-compliant instances, $427.40 improper payments.
Intensive Outpatient Program (IOP) services: 66 non-compliant services, 82 non-compliance errors, $1,097,435.00 improper payments.
Recommendations (4)
Develop and implement procedures to ensure all service documentation and billing fully comply with Ohio Medicaid rules; establish a quality review process to verify documentation before claims submission.
Ensure treatment plans substantiate billed services, are updated as recipient needs change, and are signed by the recording practitioner; verify sufficient prior authorization where required.
Implement controls to ensure per diem services do not exceed limits, and that residential treatment services are not billed separately from residential care.
Address the identified issues to improve Medicaid rule compliance and prevent future findings.