Region 8 Mental Health Services: Preschool Day Treatment Claims and Unqualified Staff

In the Region 8 Mental Health Services fraud case, the provider agreed to pay the United States more than $6.93 million over allegations that Medicaid paid for preschool Day Treatment services that never happened or that unqualified staff provided. A former employee brought the case.

The Justice Department announced the settlement on December 14, 2017. Region 8, formally Madison-Simpson-Copiah Mental Health Commission Region 8, was a regional community health center serving Copiah, Lincoln, Madison, Rankin and Simpson Counties in Mississippi. The inspector general lists its location as Brandon. The allegations concerned claims submitted from 2004 through 2010.

Preschool Day Treatment Was Supposed to Deliver Behavioral Care

Preschool Day Treatment was a behavioral intervention program for children with serious emotional disturbances. Medicaid defined it as treatment in a therapeutic setting at the intensity needed to help children and adolescents live in the community. Region 8 operated the program for preschool children.

The settlement announcement cited the Mississippi Department of Mental Health: nearly 35,000 Mississippi children and adolescents had severe and persistent mental health issues. The alleged gap between funded care and actual care reached the children depending on the service as well as the taxpayers paying for it.

A child can be in the building while the claim tells a different story about the treatment delivered there.

Missing Services and Unqualified Staff Were Separate Allegations

The government alleged that many Region 8 claims concerned services that were either not provided or not provided by qualified individuals.

For an absent service, the question is what work the claim represented and whether that work happened. The treatment record, attendance, schedule and staff assignment put the billed service back into the day it supposedly occurred. A billing description can look complete while leaving the people who worked that day unable to recognize the service it describes.

For an unqualified worker, we look at who actually provided the service and whose qualification the claim represented. A job title alone leaves too much unanswered about work billed in that person’s name or through the organization.

What Evidence Is Needed to Prove Fraud?

For a Day Treatment case, the useful evidence connects a particular claim to the service actually delivered and the staff member who delivered it. We work with insiders to compare the payer, service date, billed activity and represented qualification with attendance, schedules, payroll, staff credentials and treatment notes.

Someone who knows how the program ran may understand why an activity on a schedule differs from the service named in a claim, or why the person shown as providing care differs from the person assigned to the children. Your account of how work became a bill helps us identify the discrepancy that needs investigation.

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 this case, the Justice Department said the former employee would receive more than $1 million from the recovery announced with the settlement.

Region 8’s case began with a former employee’s qui tam lawsuit under the False Claims Act. The Justice Department believed it was Mississippi’s largest False Claims Act health care settlement at the time. The Mississippi Division of Medicaid was also to receive a portion of the settlement proportional to its contribution to the Medicaid fund.

What Agency Investigates Healthcare Fraud?

Federal and state agencies investigated the Region 8 allegations: the United States Attorney’s Office for the Southern District of Mississippi, the Department of Health and Human Services Office of Inspector General, the FBI and the Mississippi Attorney General’s Medicaid Fraud Control Unit.

Oversight Focused on Staff and Medicaid Billing

Region 8 also entered a five-year corporate integrity agreement with HHS-OIG. The inspector general said it would monitor whether the organization provided intervention services through qualified staff and billed Medicaid properly. The settlement addressed the past claims, while the integrity agreement put future care and billing under oversight.

When a Child’s Day Becomes a Treatment Claim

Aspire Day Program offers a close comparison. In a separate children’s Day Treatment case, the government alleged that education, recreation and lunch were billed as covered behavioral treatment. It also alleged that lower-level or unqualified staff were represented as licensed professionals.

The Aspire allegations make the distinction visible. Children could attend, activities could take place and workers could be present, while the claim still misrepresented the service and the person delivering it. The billing account had to match more than the fact that a child spent the day there.

In a separate government complaint against Universal Health Services, the government alleged that five-minute hallway interactions at Keystone Marion Youth Center were recorded as thirty-minute individual therapy sessions.

Across these separate child-service cases, an insider’s knowledge of the actual activity gives the claim something concrete to be tested against.

You Know the Work Behind the Claims

If you worked in preschool Day Treatment and saw billing that did not match the care or the staff, talk with our whistleblower experts about what happened inside the program. We build the case with you, connect you with Medicaid behavioral health whistleblower lawyers and stay beside you as the case moves forward.