Compliance Examination Identifies $1.75 Million in Improper Medicaid Payments to Lucas County-Based Provider

Press Release •Ohio Auditor of State

Tuesday, December 24, 2024

COLUMBUS - State auditors identified $1.75 million in improper Medicaid payments over a two-year period to Lucas County-based behavioral health services provider, Auditor of State Keith Faber announced.

With added interest, the Auditor of State's Office is recommending repayment of about $1.96 million from Caregiver Grove Behavioral Health LLC, according to a recently completed compliance examination.

The full report is available online at ohioauditor.gov/auditsearch/search.aspx.

The Ohio Department of Medicaid (ODM) administers health care and related programming to about 2.9 million lower-income residents, older adults, individuals with disabilities, pregnant women, infants and children, and others.

The Auditor of State, pursuant to an agreement with ODM, audits Ohio's Medicaid providers to ensure compliance with federal and state reimbursement requirements. ODM and/or the Ohio Attorney General's Office ultimately take action to gain compliance and recoup any inappropriate or excess payments.

Caregiver Grove Behavioral Health, with locations in Toledo and Cincinnati, was paid about $6.2 million for mental health and substance user disorder services provided between Jan. 1, 2020, and Dec. 31, 2022.

Tuesday's report identified a number of issues, including a lack of documentation to support services billed, service duration requirements that were not met, missing treatment plans, and treatment plans that did not authorize the service billed for individual psychotherapy and group therapeutic behavioral services.

Auditors also found instances of billing for diagnostic psychiatric evaluations that exceeded Medicaid coverage limits and different counseling sessions that were billed for the same recipient on the same day.

In its response to the audit findings, included in Tuesday's report, Caregiver Grove Behavioral Health acknowledged the findings and noted its commitment "to addressing the issues raised in this audit and ensuring compliance moving forward."

###

The Auditor of State's Office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,900 state and local government agencies. Under the direction of Auditor Keith Faber, the office also provides financial services to local governments, investigates and prevents fraud in public agencies, and promotes transparency in government.

Public Affairs
Contact: Marc Kovac
[email protected]