Medicaid fraud probe

John Williams

The state has moved to terminate Medicaid payments to Gilead Family Resource Center, a provider of mental health services in McGehee, because of multiple irregularities, particularly in programs for kids. It is seeking repayment of $815,000. The center is appealing the state's order.

More details on the developing story are on the jump in an article reported and written by John Williams. It is worth remembering testimony from the 2007 legislative session at which legislators heard that Arkansas spends far more money than larger states on mental health services for kids. The lobby has grown stronger as the business has grown more lucrative.

Gov. Mike Beebe has made mental health a priority. Cleaning up wayward providers is one way to start.

State moves to terminate

The Department of Human Services has issued an order to terminate Gilead Family Resource Center, a mental-health-care provider based in McGehee, from the state Medicaid program. DHS also ordered that Gilead repay the state $815,807 for services it says the company improperly billed.

Gilead won an injunction in Pulaski County Circuit Court that allows it to continue billing Medicaid until the completion of its appeal to the state.

“This is very serious,” said DHS spokeswoman Julie Munsell. “The state considers termination to be a last resort.”

Findings of wrongdoing followed a joint audit by DHS’s Division of Medical Services, which conducts billing reviews, and by its Division of Behavioral Health, which checks for proper treatment. The audit report listed numerous irregularities in the company’s Medicaid billing. These included insufficient documentation, double billing, and misuse of billing codes to recoup excessive payments.

The audit also found that the company engaged in improper medical practices. Among these findings were that the company’s general practitioner prescribed psychotropic medication to preschoolers without consulting a psychiatrist. The report also states that children were diagnosed with mental illnesses by social workers and nurses unqualified to make such a diagnosis.

The audit covered the period from November 2006 to November 2007. Gilead’s current owner, Charles Gibson II, bought the company in August 2007. Gibson did some legal work for Gilead before becoming its owner. Lisa Moon, Gilead’s current vice-president, and Stephen Montgomery, its current treasurer, worked at the company for a few months previous to the ownership transition.

Gibson said he was aware of the audit before taking over the company. “In this business there are always audits,” he said. “It did make us think twice about it, but we had been through numerous audits before.”

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