TOLEDO, Ohio — A Toledo-based behavioral health agency must repay nearly $1.87 million to the state after a Medicaid audit found widespread billing and documentation violations – findings the agency’s CEO disputed, calling them clerical errors rather than evidence of overbilling.
The audit of Empowered for Excellence Behavioral Health of Ohio reviewed payments made between Jan. 1, 2021, and Dec. 31, 2023, and identified $1.75 million in improper claims, plus $115,000 in interest. The Ohio Auditor of State issued an adverse opinion, citing repeated noncompliance with Medicaid rules.
Among the issues cited:
- Claims submitted without supporting service documentation
- Missing or incomplete treatment plans authorizing services
- Duplicate or excessive billing on the same date of service
- Services exceeding daily limitations or billed without prior authorization
- Overbilled units not supported by documented duration
- Use of cloned notes instead of individualized clinical records
One of the largest overpayment categories involved Therapeutic Behavioral Services (TBS) per diem claims. The state sampled 60 services and found issues in 42 of them. That sample was used to project a broader overpayment estimate of $1.73 million in this category alone…