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Behavioral Health Probe at Critical Juncture

Investigation: U.S. attorney's audit is looking into whether county agency's billing practices were intentionally deceptive.


A civil investigation by the U.S. attorney's office has reached a critical point in determining whether the county's Behavioral Health Department committed fraud in its federal billing practices.

"We're about to find out an important piece of information," Assistant U.S. Atty. Wendy Weiss said Wednesday. "We're in a touchy phase right now and it could go one way or another," Weiss said, declining to be more specific.

The inquiry, launched in January, stems from concerns raised by county doctors that their names and provider numbers were being used on Medicare claims for services provided by social workers. The investigation is separate from five other ongoing state and federal audits into the county's mental health system.

In a federal civil case, individuals as well as institutions can be cited for their actions, officials said. If found guilty of wrongdoing, defendants could face fines and restitution and could be barred from participating in some programs.

Several supervisors said Wednesday they believe that if the billing was faulty, it was unintentional.

"There is no indication of fraud at this point," Supervisor Frank Schillo said. "We welcome the audit and have been cooperating at every level. If it turns out anything has been fraudulent or illegal, I want to know about it."

Doctors began complaining about improper billing practices shortly after the county merged its Behavioral Health Department with the Public Social Services Agency in April 1998. Under the new organization, social workers replaced psychiatrists and psychologists as leaders of crisis teams who serve the mentally ill.

In many cases, a social worker, nurse or psychiatric technician would provide therapy or counseling to a client, but a doctor's name would appear on Medicare claims in order for the county to receive federal reimbursements for the services, doctors said.

"Billing under my [provider] number is probably not in compliance with [federal] guidelines," Dr. Timothy Tice wrote in a July 10 letter to then-Behavioral Health Department Director Stephan Kaplan. "Similar circumstances apply to several other physicians."

A month earlier, Dr. John Wong raised similar concerns. And as recently as March, Dr. Edward Arevalo, chief of the hospital's Department of Psychiatry, alleged numerous incidents of wrongdoing within the mental health department, including faulty billing practices.

Mike Powers, deputy director of the Health Care Agency, commented on the U.S. attorney's audit of the Behavioral Health Department.

"They're trying to determine our compliance of our Medicare billing practices," Powers said.

"We have fully cooperated with the U.S. attorney's office every step of the way."

The inquiry began shortly after supervisors voted in December to dismantle the 1,400-employee superagency, officials said.

The supervisors rescinded the merger after officials from the U.S. Health Care Financing Administration determined that the reorganization violated other federal billing rules and warned that the county stood to lose millions of dollars in Medicare and MediCal reimbursements.

Supervisor July Mikels, who along with Schillo voted against merging the agencies, said she was "relatively confident" that the U.S. attorney's inquiry would not result in large fines for the county.

"So far, they're saying there was no intention of fraud," Mikels said. "They're looking at it as faulty billing practices. . . . If there are fines, they won't be overly punitive. I don't believe they will be within the multimillion-dollar range."

Mikels said the investigation would most likely be concluded by July.

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