They come to your home. They come to your schools — claiming to be licensed behavioral health care providers.
They say they’ll help your kids and it won’t coast you a penny. Everybody assumes proper vetting has been done and entrust their kids to these so-called professionals.
Trouble is once the Louisiana Department of Health dropped a credentialing requirement from its handbook, the scammers came out in droves.
“What our agency is tasked to do,” said Louisiana Deputy Attorney General Bill Stiles, “is investigate Medicaid fraud by providers.”
There are active fraud investigations underway in Northwest Louisiana. And because the probe is ongoing, Stiles could not provide details.
But the bloated billing and questionable healthcare practices here and across the state had state Rep. Dodie Horton of Bossier Parrish fighting back.
“I have concern and outrage about the Louisiana Department of Health in closing the hole; in permitting a lot of this fraud from happening with the behavioral health program," Horton said.
Here’s what she’s talking about: people claiming to be mental health professionals working with students, and apparently providing no real help at all.
“There’s no real credentialing and verifying being done,” Horton said.
Meaning, anybody can claim to be a licensed behavioral health professional.
“When the DOH removed the credentialing, verifying and background portion of the requirement out of their book then the floodgates opened to fraud," Horton said.
These numbers were compiled by Louisiana’s Legislative Auditor in October 2017:
- 45 percent of 3,400 listed mental health providers did not meet requirements.
- 319 clinical social workers were not licensed.
- 714 professional counselors were not licensed.
- 113 marriage and family therapists were not licensed.
“You have people out there who are unlicensed,” Stiles said.
“People assume this is all being vetted, but it isn’t," Horton said.
Follow the money; here’s a taste:
- One provider paid more than $12,000 for 245 service hours on Christmas Day.
- Another received $9,000 for 179 service hours on New Year’s Day.
- Another got $35,000 for 729 hours in a single day.
“It’s impossible. I’m sure taxpayers are saying how is this even possible?”
“I can’t live with the fact that millions of dollars are going out; children improperly diagnosed,” Horton said, “that is going to stay with them the rest of their lives," Stiles said.
As far as closing the loophole at DOH, Horton says, “For two years there’s been no action.”
That’s why Horton carried HB211 proposing basic Medicaid reforms, requiring LDH to furnish complete claims for behavioral sciences and imposing a 12-hour/per day/per patient limit.
“There’s no accountability,” said Horton. "We need to bring back accountability in the behavioral health department.”
“How do you diagnose a two-year-old with PTSD?” asks Horton. "How do you diagnose a 4-year-old as bi-polar?”
“Roughly 10 percent of all Medicaid dollars are spent fraudulently. That’s $1.5 billion in Louisiana," said Stiles.
Added Horton: “It’s mind boggling this has been allowed to happen. I’m outraged, and I feel the public will be too.”