Eye On Boise

State appeals dismissal of Medicaid provider fraud case

Here's a news item from the Associated Press: POCATELLO, Idaho (AP) — The Idaho Department of Health and Welfare is appealing a decision by an administrative judge to dismiss fraud charges and restore the Medicaid provider status of a southern Idaho mental health provider. Agency officials announced an appeal this week in the case involving Seasons of Hope. Last month, a hearing judge cleared the clinic of fraud alleged by the agency after an 18-month investigation. State lawyers accused the Chubbuck-based provider of inappropriate billing and also sought to recoup more than $439,000 in overpayments. The judge, however, did order Seasons of Hope to repay more than $94,000 in payments and fines, saying there was evidence of billing mistakes, but not fraud. But agency spokesman Tom Shanahan says agency attorneys believe the clinic owes taxpayers more than that amount.

Click below for a full report from the AP.

State files appeal in Medicaid fraud case

POCATELLO, Idaho (AP) — The Idaho Department of Health and Welfare is appealing a decision by an administrative judge to dismiss fraud charges and restore the Medicaid provider status of a mental health provider operating in southern and eastern Idaho.

Agency officials announced an appeal this week in the case involving Seasons of Hope. Last month, a hearing judge cleared the clinic of fraud alleged by the agency after an 18-month investigation.

State lawyers alleged the Chubbuck-based provider if inappropriate billing and also sought to recoup more than $439,000 in overpayments and another $18,000 in fines and penalties.

Former state judge Peter McDermott, however, did order Seasons of Hope to repay more than $94,000 in Medicaid payments. In their appeal, agency lawyers are seeking a bigger repayment sum.

"We think Seasons of Hope owes taxpayers much more than that," spokesman Tom Shanahan said.

The Chubbuck-based provider lost its Medicaid payments earlier this year when investigators accused the company of billing for services not covered, misrepresenting services and billing for services that were not documented, leading the agency to revoke its Medicaid provider status.

Seasons of Hope appealed the revocation and fines, but was forced to lay off about 100 employees.

McDermott sided with the clinic, finding that administrators and staff made mistakes with billing but did not intentionally try to defraud the state and the Medicaid program.

This week, Heath Sommer, chief executive officer of Seasons of Hope, questioned the agency's decision to appeal McDermott's findings.

"To any rational citizen, the thought that the Department (of Health and Welfare), not liking the decision of a former chief district court judge, could simply send the case back to themselves for review, is just plain wrong."

The appeal will be reviewed by the agency director Richard Armstrong.




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Betsy Z. Russell
Betsy Russell covers Idaho news from the state capitol in Boise and writes the Eye on Boise blog.

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