Idaho Department of Health Appeals Seasons of Hope Fraud Ruling

2013-07-04T02:00:00Z Idaho Department of Health Appeals Seasons of Hope Fraud RulingBy Julie Wootton - Twin Falls Times-News

TWIN FALLS • The Idaho Department of Health and Welfare is appealing a hearing officer’s decision to dismiss fraud allegations and restore Medicaid provider status for Seasons of Hope.

An appeal was filed Tuesday.

IDHW spokesman Tom Shanahan said the bottom line is the agency is contesting the amount of money Seasons of Hope will have to pay in penalties.

A hearing officer decided the Chubbuck-based mental health agency will have to pay $94,161.40 in recoupment, $9,986.84 in civil monetary penalties and $8,145.12 in fines.

“We think Seasons of Hope owes taxpayers much more than that,” Shanahan said.

Heath Sommer, chief executive officer of Seasons of Hope, wrote in a statement Tuesday that government agencies have the right to investigate, not destroy.

“Idaho is too special of a place to become yet another headline of government scandal, and yet it is happening before our eyes in this case,” he writes. “To any rational citizen, the thought that the Department (of Health and Welfare), not liking the decision of a former chief district court judge, could simply send the case back to themselves for review, is just plain wrong.”

In March, Health and Welfare completed an 18-month investigation based on allegations of fraud and suspended Medicaid payments to Seasons of Hope.

The agency alleged the company altered records, billed for services that weren’t covered, misrepresented services, billed for services not documented or provided, and billed for medically unnecessary services.

Seasons of Hope appealed, admitting that paperwork and billing errors were made but denied any fraud.

In April, the company laid off almost all of its 100 employees and closed seven clinics around the state.

Ten employees at the Twin Falls and Burley clinics lost their jobs.

Last month, hearing officer Peter McDermott dismissed allegations of fraud against Seasons of Hope and restored the company’s Medicaid provider status.

“Making errors is not fraud,” he wrote in a decision. “Fraud requires an intentional act. There is no proof that Seasons of Hope committed fraud.”

Health and Welfare’s appeal filed Tuesday states the agency suspended Medicaid payments to Seasons of Hope as required by federal law when there are “credible allegations of fraud.”

“DHW never alleged that fraud occurred in this case; DHW merely suspended payments based on credible allegations made by others,” according to the appeal.

The document claims there isn’t a rule under the Idaho Administrative Procedures Act allowing a hearing officer to lift the suspension of Medicaid payments.

After a mid-September deadline for filing briefs, the director of the Idaho Department of Health and Welfare will have 56 days to make a ruling.

If Seasons of Hope appeals once a decision is made, Shanahan said he believes the case would go to district court.

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