TWIN FALLS • Seasons of Hope laid off as many as 10 employees at its Twin Falls and Burley clinics earlier this month after losing its Medicaid provider status.
The Chubbuck-based mental health clinic and developmental disabilities agency has offices across the state.
In a 14-page letter of allegations dated March 28, the Idaho Department of Health and Welfaresaid Medicaid payments to Seasons of Hope were being suspended.
“The Department has determined there are credible allegations of fraud against Seasons of Hope and an active investigation is pending,” the letter said.
Seasons of Hope must repay nearly $440,000 in overpayments and pay a civil penalty totaling about $110,000, according to the letter.
The Idaho Department of Health and Welfare alleges Seasons of Hope 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’s website lists a variety of services they provide, including speech therapy, occupational therapy, developmental therapy, psychosocial rehabilitation, psychotherapy, psychological testing and adult daycare.
Seasons of Hope will file an appeal contesting department’s decision. The deadline is today.
Tom Shanahan, spokesman for the Idaho Department of Health and Welfare, said if an appeal is filed, a hearing will be scheduled within 30 days. A hearing officer will then make a decision about the case.
Magic Valley Presence
Heath Sommer, chief executive officer of Seasons of Hope, said the Twin Falls clinic was growing rapidly and the Burley clinic just opened a couple months ago.
Employees were being shared between the two offices, he said.
Seasons of Hope was planning to eventually open more offices in rural areas of the Magic Valley and Wood River Valley, including Oakley and Hailey, Sommer said.
Seasons of Hope employed about 100 people in Idaho and the company had to lay off “virtually everyone,” Sommer said.
A few people are still left doing administrative and legal work, he said. A couple of psychologists are still employed by the organization.
Sommer said there’s a Seasons of Hope psychologist who is still seeing non-Medicaid patients in Twin Falls.
How are patients affected?
In an April 8 statement, Sommer wrote that letters and emails went out to patients about Seasons of Hope.
“We made specific referrals to providers in your area we believe can appropriately assume your treatment needs,” he wrote.
A sign on the door of the Twin Falls office, located on Polk Street, says the clinic is only open by appointment.
Bibiana Nertney, spokeswoman for Community Partnerships of Idaho, Nertney said they’re open to talking with any former Seasons of Hope patients, but the agency doesn’t provide all the same services – such as psychosocial rehabilitation — as Seasons of Hope, she said.
Community Partnerships of Idaho – which has a Twin Falls office – provides services for children, teens and adults with developmental disabilities and mental illnesses.
“If families find themselves not knowing what to do, we’re here to help or point them in the right direction,” she said.
Idaho’s Medicaid providers
Idaho’s Medicaid program is a federal and state partnership. Most medical claims are paid with 70 percent federal funds and 30 percent state funds.
Shanahan said there are more than 30,000 Medicaid providers statewide.
Certified Medicaid providers go through an inspection once a year by the state’s Medicaid credentialing unit.
IDHW reviewed some of the mental health clinic, psychosocial rehabilitative and developmental disability services billed by Seasons of Hope from Jan. 1, 2010 to Jan. 31, 2013.
Shanahan said 27 patient records were randomly pulled at Seasons of Hope. Of those, 15 had missing, invalid or expired treatment plans.
Shanahan said the Medicaid credentialing unit notified fraud investigators about the findings in June 2012.
Fraud analysts sat down with Sommer in January to go over the allegations, Shanahan said, but a lot of practices continued at Seasons of Hope after that conversation.
Federal law required the Idaho Department of Health and Welfare to take immediate action at that point, he said.
Sommer said Seasons of Hope received a visit 18 months ago from the Idaho Department of Heath and Welfare.
He said representatives came back in January and asked questions, but didn’t say much about findings.
Sommer alleges that IDHW promised him Seasons of Hope would have time to respond to allegations before formal action was taken, but that didn’t happen.
“It has been devastating,” he said, adding that he believes it’s a violation of due process.
Sommer — who used to work for Idaho Department of Health and Welfare — said the agency has the right to investigate Seasons of Hope, but needed to provide time to respond to allegations.
He said there have never been formal findings of past impropriety against Seasons of Hope.