One of the state’s largest managed care providers for Arkansans with disabilities is under investigation for Medicaid fraud, according to documents obtained by the Arkansas Democrat-Gazette.
Empower Healthcare Solutions LLC, which serves some 20,000 people in the state who need services for behavioral health disorders or developmental disabilities, received a notice of sanctions from the state Medicaid inspector general, notifying the entity that it is being investigated for fraud.
The letter, dated Wednesday, said the Office of Medicaid Inspector General “received complaints against Empower and performed an investigation regarding alleged fraudulent payments made by Empower to certain providers and vendors that resulted in unnecessary costs to the Medicaid program.”
The letter, addressed to Mitch Morris, the chief executive of Empower, said the Inspector General’s office referred the case to the Arkansas Attorney General’s Medicaid Fraud Control Unit. That unit “determined that credible evidence of fraud exists,” the document said.
Medicaid payments will be partly suspended to Empower, which is one of four Provider-led Arkansas Shared Savings Entities, or PASSEs, in the state. These entities funnel Medicaid benefits to a network of providers that are offering care to qualifying beneficiaries.
The inspector’s general office said it decided to not suspend all Medicaid payments for the time being.
“We have reached this determination due to the fact that Empower currently serves over 20,000 Medicaid beneficiaries who depend on Empower for continuity of care, and there are other available remedies that can more effectively protect Medicaid funds,” the letter from Elizabeth Smith, secretary of the Department of Inspector General, said.
Morris, the Empower CEO, denied wrongdoing.
"Empower is cooperating fully with the State's ongoing investigation but denies any allegations of fraud or any other misconduct," Morris said in an email.
In a letter sent Tuesday to state Medicaid regulators, Lloyd Warford, a deputy attorney general over the Medicaid Fraud Control Unit, said a full investigation was underway.
“The finding of credible evidence of fraud is based upon a careful and judicious review of all allegations, facts and evidence specific to this case,” Warford wrote. “It is important to note that a finding of credible evidence of fraud is the threshold necessary to open a formal investigation and not a final determination. It simply means that the allegations have been found sufficiently verified and credible to require a full investigation.”
Read tomorrow’s Arkansas Democrat-Gazette for more details.