Judge to hear appeal on New River Medicaid claim in May
Last modified: Jan. 24
BY KELLEN MOORE
A judge with the N.C. Office of Administrative Hearings will hear an appeal from the New River Service Authority in May regarding more than $600,000 in withheld Medicaid reimbursements.
Judge Julian Mann III is scheduled to hear the case the week of May 7 in Waynesville, paralegal Debra Gray said this week.
The Department of Medical Assistance halted Medicaid reimbursements effective Oct. 4, 2011, after receiving what it called a “credible allegation of fraud.”
The allegations included failure to produce documentation for services billed, failure to transition recipients to new care prior to closing agencies, failure to present qualified staff to deliver clinical services and failure to provide services to recipients, including medication management. The suspension was outlined in a Sept. 22 letter to CEO Pam Andrews, who later resigned.
In a lengthy response letter, Andrews explained the numerous processes in place to transition clients after the closure of New River Behavioral HealthCare offices in Caldwell, McDowell and Alexander counties.
“Because of the very significant burden of losing the primary source of funding for any provider organization … it is imperative that we be provided an opportunity to respond to these allegations without the simultaneous threat of having to close our doors through the loss of Medicaid reimbursements,” Andrews wrote.
The NRSA board requested a reconsideration review, which was conducted Oct. 19 by telephone and resulted in the continued suspension of funding.
The board then voted to file a petition with the Office of Administrative Hearings.
At stake is an estimated $626,977 in approved claims, according to a report from financial consulting firm Martin Starnes & Associates. That money could be used to put a dint into New River Behavioral HealthCare's massive list of debts, which Martin Starnes is now compiling.
Before the May hearing, both parties are required by the OAH to attempt settlement negotiations.
If those do not result in an agreement, the May hearing will commence in a fashion similar to a criminal trial but without a jury. Each side may present evidence, question witnesses and submit documentation. The hearing typically cannot last longer than five days, according to OAH policy.
Mann's decision will affirm, modify or set aside the original agency decision to suspend Medicaid reimbursements. He could issue a decision immediately after the hearing, but he has up to 45 days to decide.