Mental health agency passed up millions

Washington DC (Map, News) - D.C.'s mental health agency has failed to recover more than $30 million in denied Medicaid claims that have piled up over several years, maintains unreliable technology systems and software and may have violated local and federal spending laws, a new audit finds.

Of the roughly 1.4 million Medicaid claims submitted by the Department of Mental Health between 2002 and 2006, as many as 500,000 were rejected, the Office of the Inspector General found in an audit released Thursday. But a process for reworking and resubmitting those claims, which the D.C. government can do up to two years after their initial denial, is "nonexistent," the IG found.

Not even attempting to recover claims "poses a significant risk to the agency of incurring Anti-Deficiency Act violations, as local funds are used to pay the full share of costs to support Medicaid-eligible consumers," the IG wrote.

"DMH loses the opportunity to realize Medicaid funds each day denied claims are not aggressively addressed," the audit concluded.

In his written response to the report, Mental Health Director Stephen Baron claimed the $30 million figure was inflated by about $5 million. Baron acknowledged that his agency lacked the processes to resubmit claims prior to September 2006, but since then DMH "has corrected and resubmitted a total amount of $12.9 million, resulting in total reimbursement of $8 million."

The auditor also found that the agency's main application software, called eCura, "has significant weaknesses regarding reliability, integrity of information reported, and the effectiveness of provider claims processing." A "system design flaw" does not allow detailed monthly reports, the IG reported, while incorrect data built into the program led to a 2.5-month system in early 2006.

The IG recommended eventually replacing eCura "to improve DMH's business processes."

Baron responded that eCura "works as it was designed."

Yet another finding revealed a failure on DMH's part to stop its vendors from overspending their work orders. Those "unauthorized commitments" added up to $16.1 million in fiscal 2006 and may represent a violation of the District's Anti-Deficiency Act, which prohibits agency's from expending more than their budget allows.

mneibauer@dcexaminer.com

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