The South Carolina Medicaid agency this week acknowledged problems with data it submitted in February to a U.S. senator as part of a national investigation of drug-prescribing habits.
Three Charleston-area psychiatrists mistakenly were linked to billing errors at practices that had overcharged Medicaid.
In addition, one of the practices was said to have repaid the state double the actual amount reimbursed in connection with the errors.
“There was no intent to misinform,” Kathleen Snider, bureau chief of compliance and performance review for the S.C. Department of Health and Human Services, said Tuesday.
In a Feb. 10 letter to U.S. Sen. Charles Grassley, an Iowa Republican investigating Medicaid abuse nationally, the state said it had identified “abuse and/or overpayment” in 31 cases it had probed in “Program Integrity investigations.” Medicaid is the government health insurance program for the poor and disabled.
Grassley had asked the state what actions it had taken against doctors cited as “top prescribers” of certain painkillers and anti-psychotics. Snider said the nature of Grassley’s request put pressure on the state to force links between doctors and corrective action.
“We were not trying to inflate what we’re doing in any way, shape or form,” Snider said. “In trying to respond to him and respond to those questions in his letter — you can’t really tell a U.S. senator he’s asking the wrong questions.”
The Post and Courier in March requested the names of the 31 providers in the Grassley report, using the data for an April 11 article.
The data linked Dr. Scott Christie, a psychiatrist who sees patients at Oasis Christian Counseling in Moncks Corner, to billing discrepancies resulting in $88,000 of erroneous charges to the state. But Christie was not associated with Oasis Christian Counseling at the time the charges occurred.
On April 13, the state wrote to Christie, acknowledging the error.
“Unfortunately, when I originally did the research for our response to Senator Grassley, Dr. Christie’s name was inadvertently linked to the Oasis Program Integrity review because he now works there,” Snider wrote.
Snider said in the letter that data limitations were among the factors that “contributed to the inadvertent linking of Dr. Christie to the Oasis review.”
On Tuesday, Snider said the “case-management system” used to compile the report is outdated.
“In retrospect, I wish I’d gone through the case record to better characterize (the findings) to Sen. Grassley,” she said.
The state data also linked Dr. Sondra Keller and Dr. Ricardo Fermo, both once associated with MUSC’s University Medical Associates, to billing errors. The state connected the two doctors to more than $141,000 in charges for clients who already were covered by grants.
In fact, neither doctor was involved with the infraction, said Heather Woolwine, spokeswoman for the Medical University of South Carolina. Fermo was not associated with MUSC in 2001 when the billing issues occurred, Woolwine said in an email Tuesday.
“MUSC is unable to determine how or why these individuals’ names were submitted to SC Medicaid, as individual names were not reported to Medicaid by MUSC, or how their names were attached to this data,” Woolwine wrote.
Woolwine also pointed out that MUSC self-reported the billing error. Sometime between 2001 and 2003, the hospital system’s compliance staff determined MUSC erroneously had charged Medicaid for patients already covered by three grants. MUSC staff then notified state and federal officials, ultimately repaying about $70,000 to Medicaid — half the amount the state indicated in its data.
“At this point, those involved in compliance for MUSC, as well as the financial stewards of these physicians’ department, have triple-checked the data and are confident that neither Drs. Fermo or Keller were involved in the 2001 Medicaid self-report and subsequent payment,” Woolwine said.
Fermo, who no longer is affiliated with University Medical Associates, told the newspaper last week he was unaware of the billing errors and repayment. Keller declined to comment.
Snider called the MUSC billing issue “an old case.”
“Again, what’s in our system at this point is very scanty,” she said.
The state requested $350,000 to update its case-management system in the upcoming budget year, Medicaid spokesman Jeff Stensland said.
As part of the nationwide investigation, Grassley sought data from each state about doctors who have the highest rates of prescribing commonly abused drugs to people enrolled in Medicaid.
Snider said she would correct the report on file with Grassley.
Jill Gerber, a spokeswoman for Grassley, said in an e-mail early Tuesday the senator’s staff awaits clarification.
“My colleague has a message in with the South Carolina folks — we haven’t heard back,” Gerber said in the email. “We’re eager to get to the bottom of this, so we hope to hear back soon.”
Reach Renee Dudley at 937-5550 or on Twitter @renee_dudley.