After I published my EXCLUSIVE report on Hennepin County’s Mental Health Center, which stands accused of ninety (90) licensing violations by the state Department of Human Services (DHS), whistleblowers reached out with more information about the County’s operations.
The Mental Health Center is licensed by the state under the substance use disorder treatment program. There are more than 400 such facilities licensed in Minnesota.
Included are some famous and respected names, such as the Hazelden Betty Ford clinic in St. Paul and the Mayo Clinic in Rochester.
Other names on the list include Evergreen Recovery, whose license was revoked and whose senior executive have been indicted in an alleged $30 million Medicaid fraud. Also on the list is NUWAY, who reached an $18,500,000 legal settlement with the U.S. Attorney over that clinic’s Medicaid billing practices.
Under our health care bureaucracy, substance use is located within the larger category of “behavioral health,” which also includes mental health and items such as gambling addiction.
And now we go down the rabbit hole. Behavioral health services are provided by entities called Certified Community Behavioral Health Clinics (CCBHC). DHS informs,
Certified Community Behavioral Health Clinics (CCBHC) was originally developed by SAMHSA (Substance Abuse and Mental Health Services Administration) and CMS (Centers for Medicare and Medicaid Services) and tested during a federal demonstration project from 2017 through 2019.
I was not able to extract any useful information out of that sentence. I am also convinced that the above subject and verb do not agree. But more importantly, payments to clinics are done through the prospective payment system (PPS).
Whistleblowers tell me that the problem lies in PPS. They describe the payment system as “high payments, low transparency.” Whistleblowers maintain that the PPS system ends up being far more generous than a standard fee for service model, perhaps inflating costs by tens of millions of dollars.
PPS is a cost-based reimbursement system, so providers have an incentive to inflate costs to capture more revenue. Auditing, true ups, adjustments to the reimbursement rates sit beyond the public view.
Hennepin County’s facility is just one of dozens of CCBHC’s licensed across the state, It’s unknown whether Hennepin County is a unique problem case, or representative of the type.
Developing…
