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A setting in the Community Health Automated Medicaid Processing System led to the reimbursement of thousands of improperly billed claims.
Michigan health officials are looking to recoup hundreds of thousands of dollars in home health services, inappropriately billed following a staff error that went unnoticed for six years.
The error was made in 2011, when a Michigan Department of Health and Human Services staffer changed the settings of a new payment processing system to allow for the automatic reimbursement of some home health claims. By the time the mistake was was resolved in 2017, providers had submitted 5,400 improper billings and received a total $278,000 in reimbursements, MDHHS says.
The issue was brought to light last week by whistleblower Everett Stern, who obtained emails between MDHHS staff and posted them to his website, Tactical Rabbit.
Emails show the setting change was intended to “ease the burden on claims processing staff,” after an early glitch in the Community Health Automated Medicaid Processing System (CHAMPS) was setting payments on incorrect procedures. The glitch was fixed, but the automatic payment setting was never turned off.
The setting relied on providers to self-police. MDHHS spokeswoman Lynn Sutfin says when providers submitted a bill, they were reminded their claims must conform to policy and warned that any improper payments would be recovered by the department. At the time, policy prohibited Medicaid reimbursement for home health aide services unless physical therapy and/or nursing services were also being provided to the beneficiary.
About 80 percent of the improper claims came from West Bloomfield-based M&Y Home Care, Sutfin says. Officials with M&Y did not immediately respond to a phone call for comment. The provider has appealed efforts by MDHHS to recoup the funds.
