The state of Maine stopped MaineCare payments to two behavioral health service agencies pending investigation of fraud allegations and is helping approximately 500 affected clients find alternative providers while the investigation is on-going.
In late September, the state stopped MaineCare payments to Umbrella Mental Health Services and AngleZ Behavioral Health Services, both located in the central part of the state, after receiving a credible allegation of fraud for the agencies, says John A. Martins, director, Public and Employee Communications, Maine Department of Health and Human Services (DHHS). Martins could not specifically detail the allegations or how they were received, but says claims and audit data, or a hotline tip, are among ways an allegation can originate. If an allegation is deemed credible by an investigation agency – such as the Attorney General’s Office or the Department of Justice – the state is obligated by law to suspend payments pending an investigation, Martins says.
The agencies contacted DHHS to ask for an informal review, an interim step to a formal appeal and the department again looked at the findings, according to Martins. “The finding of the credible allegation was upheld, so (both agencies) have now submitted a formal appeal of the decision.” The agencies remained closed as of early November, pending the DHHS administrative hearing process.
Martins says the state notified by letter the clients who may have been affected, to let them know they may experience a disruption of services and to assist them in finding alternative care as needed. “We gave them an 800 number to call to help us help them find a new provider in the interim,” he says. “We’ve been working with folks since the beginning of this process to help them get access to services.”
Martins says the state determined that there is enough capacity in central Maine to handle the displaced clients. “There’s a wide gamut of what they provide for case management services in that geographic region of the state and there is capacity to handle these clients,” he says. “So the transition to services has begun for these clients and we have been there for a resource for them.”
Phone messages left at both Umbrella and AngleZ were not returned, so it is unclear how many employees may have been laid off pending the investigation. However, Martins says the state Department of Labor’s Rapid Response team held sessions at both agencies. Rapid Response is a program to assist workers facing job loss because of downsizing or closures. The program’s goal is to safeguard the economic stability of workers and the surrounding community. Staff members meet with affected workers and assist them in signing up for unemployment and accessing other job search or support services, says Julie D. Rabinowitz, director of communication, Maine Department of Labor. Rabinowitz said last month that it was her understanding that layoffs would likely be temporary.
By Pamela Berard