Maryland Treatment Centers / Mountain Manor: Undocumented Attendance and Procedure Mismatches

In the Maryland Treatment Centers / Mountain Manor fraud case, Maryland Treatment Centers agreed to pay $500,000 to resolve allegations that it billed for mental health and substance-use services that were undocumented or not provided. The government alleged both missing evidence of treatment and Medicaid claims that contradicted the procedures recorded in patients’ charts. If you worked with attendance records, progress notes or billing, that gap between the care recorded and the care claimed is the heart of this case.

The settlement covered claims from January 1, 2009 through October 31, 2013. The Justice Department announced it on November 7, 2018, resolving a qui tam case brought by a whistleblower under the False Claims Act.

Missing Records and Mismatched Procedures

The government alleged that Maryland Treatment Centers knowingly failed to meet the Code of Maryland Regulations governing documentation of mental health and substance-use services.

Attendance and Daily Progress Notes

According to the Justice Department’s description of the settlement agreement, Maryland Treatment Centers allegedly submitted claims without documenting the services in any way. It also allegedly failed to write proper daily progress notes and place them in patients’ charts, and failed to document that patients attended, participated in or received the claimed services.

We see an absurd bargain in those allegations: taxpayers were allegedly asked to pay for treatment the provider had not even recorded. Children and adults came for care. Medicaid was asked to pay for that care, not an unsupported claim.

The Procedure in the Chart and the Procedure on the Claim

The government separately alleged that Maryland Treatment Centers documented procedures in patient progress notes that were inconsistent with the procedures it claimed for Medicaid reimbursement. Medicaid paid those claims, according to the announcement.

Here, the allegation concerns records that existed but told different stories. According to the government, the clinical account described one procedure while the reimbursement claim represented another. An insider familiar with the service can explain the difference between what the note describes and what the billing department submitted for payment.

Maryland Treatment Centers and Mountain Manor’s Services

Maryland Treatment Centers included its affiliate Mountain Manor Treatment Centers. At the time of the announcement, the Justice Department described a provider offering mental health and substance-use services to children and adults in outpatient and inpatient locations in Maryland, including Baltimore and Rockville. It submitted claims to health insurance plans, including Medicaid.

The Settlement Reached Beyond the Payment

The civil settlement resolved the whistleblower case and included an agreement with the Department of Health and Human Services’ Office of Inspector General to put procedures and reviews in place to prevent and promptly detect similar conduct.

The announcement credited the Inspector General and the Maryland Attorney General’s Office with the investigation.

What Evidence Is Needed to Prove Fraud?

We assess the attendance and billing records together, including what the people submitting claims knew. For allegations like these, we compare the service date, actual attendance, treatment record, rendering worker and paid claim. That connects what the provider represented to the payer with what happened in the treatment setting.

A clinician may understand what a progress note describes. Someone responsible for attendance may know whether a patient participated. A billing worker may understand the procedure represented on the submitted claim. The value of that knowledge is in connecting these accounts to the same patient and service date.

What a Psychotherapy Audit Found

A later Medicare psychotherapy audit shows how much payment can turn on treatment records. In its 2023 review of psychotherapy services, the Inspector General projected $579,667,510 in improper payments for March 2020 through February 2021. That was an audit estimate across Medicare psychotherapy, separate from this Maryland Medicaid settlement.

The audit examined 216 sampled enrollee-days and found 128 failed requirements. Missing time documentation was among the problems. For an insider, that puts the length of a billed session alongside the attendance and procedure questions raised here: what did the claim represent, and what did the treatment record support?

Behavioral health services can be paid by minutes, by a group session or through a program rate. Those payment units call for different comparisons. We bring the billing detail and the clinical account together so the case turns on the service the payer bought, rather than a general complaint about how a program runs.

When Billing Followed Authorization Instead of Care

A separate whistleblower complaint against CRC Health Corporation alleged that claims followed the care an insurer had authorized, even when the treatment delivered was different.

How Much of a Settlement Does a Whistleblower Get?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. In the Maryland Treatment Centers case, the Justice Department announced that the whistleblower would receive a share of the settlement.

You Know the Care Behind the Claim

If you saw Medicaid claims leave the billing department without the attendance or treatment records to support them, speak to one of our Whistleblower Experts about the claims you saw. We build the case around the care delivered, the claims paid and the decisions behind them, and bring in healthcare fraud whistleblower lawyers who understand treatment-center billing. We stay beside you from that first conversation through the pursuit of your case.