An administrative law judge with the Arkansas Department of Human Services ordered on Friday that Medicaid payments to a Little Rock-based provider should continue to be suspended pending further investigation.
The state's office of the Medicaid inspector general suspended Step by Step Senior Home Care's Medicaid payments after the office determined there were credible allegations of fraud after a complaint by the mother of a beneficiary of the program, which provides basic health care to the needy and disabled.
Step by Step appealed the stoppage of payment, and an administrative hearing was held Oct. 24 and Monday on the case.
Administrative Law Judge Vicki Pickering ordered on Friday that "the facts and evidence introduced at the appeal hearing sufficiently established that the temporary suspension of Medicaid payments to the provider, Step by Step, should remain in effect."
"Obviously, we are pleased with the decision of Judge Pickering in supporting our decision to suspend this provider pending further action and investigation," Medicaid Inspector General Jay Shue said. "We look forward to working with all the authorities on this case as it moves through the legal process."
Calls to Step by Step Senior Home Care's office in Little Rock on Friday afternoon went unanswered. An office manager for the Little Rock attorney who represented Step by Step in the appeal hearing said attorney Simmons Smith was unavailable for comment.
Allegations of fraud against Step by Step, which is a provider in the Arkansas Medicaid Personal Care Program, surfaced after the mother of a beneficiary called the office of the Medicaid inspector general's hotline and reported that her son did not receive Medicaid services for which she was billed by Step by Step.
After the complaint, the Medicaid inspector general's program integrity audit team initiated an audit covering 101 beneficiaries of Step by Step on June 25.
According to the judge's order, the audit team confirmed the mother's allegations and determined that there were other issues of suspected Medicaid fraud, including billing a Medicaid beneficiary for services never received, altered documentation, "fabricated progress notes after a beneficiary's date of death and forgery of beneficiary's signature after reported date of death."
The inspector general's office notified Step by Step with a Sept. 19 letter that the office was suspending all payments for services performed.
Step by Step appealed whether the office was legally justified in suspending all Medicaid payments. During the hearing, Step by Step's owner, Breon Harmon, testified that in his opinion, "Step by Step was a victim and did not intentionally commit any fraud."
Step by Step representatives at the hearing also contended that there were other remedies available besides suspension of payment, such as education in proper Medicaid billing, and also noted that clients would be harmed if the suspension of Medicaid payments to Step by Step remained in effect.
After the two-day hearing, Friday's order stated that "Medicaid payments to Step by Step must be temporarily [suspended] pending the investigation by the Arkansas Attorney's General's Office."
Metro on 11/01/2014