North Carolina Department Of Health And Human Services Settles With Dominion Healthcare

Main Category: Litigation / Medical Malpractice
Also Included In: Mental Health;  Psychology / Psychiatry;  Medicare / Medicaid / SCHIP
Article Date: 06 Nov 2008 - 5:00 PST

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The North Carolina Department of Health and Human Services (DHHS) has settled litigation with a mental health services provider.

The agreement calls for Dominion Healthcare to pay DHHS more than $1.6 million in reimbursements for disputed Medicaid payments. It also requires that until certain high performance benchmarks are met by Dominion, all of Dominion's future claims will be manually reviewed for compliance with Medicaid requirements before Dominion receives any future payments from the Medicaid program. This assures that future payments to Dominion are for necessary medical services provided in accordance with the law.

The agreement provides that any of Dominion's various provider locations will be terminated from the Medicaid program unless within 90 days of the execution of the agreement the location is achieving at least a 75 percent payable claims rate based on the manual review of Dominion's claims. Manual claims review remains in effect for each remaining site until that site meets another benchmark of a 93 percent payable claims rate for 90 consecutive days. Dominion agreed it would not enroll to provide any additional Medicaid services until every one of its remaining provider sites reaches the 93 percent payable claims benchmark.

The agreement ends a dispute between DHHS and Dominion that began in February 2007, when the state investigated complaints relating to Dominion's billing of Medicaid for mental health services provided at several Dominion locations across the state. After a series of financial reviews and audits, DHHS determined that Dominion in many instances had either improperly provided services or improperly billed Medicaid. DHHS required repayment plus penalties and interest totaling $1.68 million.

The agreement, which was signed Oct. 21, calls for Dominion to pay that total in six monthly installments. With additional interest, the total will surpass $1.7 million.

North Carolina Department of Health and Human Services