Sarah M. Hall and Chloe T. Hillard, attorneys in the Health Care & Life Sciences practice, co-authored an article in Healthcare Business Today titled “Medicaid Behavioral Health Investigations and Payment Suspensions in D.C. are Increasing – How Providers Can Limit Risk.”
Attorney Clifford E. Barnes of Clifford E. Barnes, Esq. & Associates, LLC contributed to this article.
Following is an excerpt:
Behavioral health providers in the District of Columbia are operating in an environment of heightened government scrutiny. In recent months, federal and District authorities have signaled an intensified focus on Medicaid fraud in the behavioral health space, combining criminal prosecutions by the U.S. Attorney’s Office with aggressive program integrity actions by the D.C. Department of Health Care Finance (“DHCF”). These efforts have included criminal and civil investigations into alleged billing irregularities and, at an increasing rate, the suspension of Medicaid payments to providers based on suspected fraud. Such suspensions are implemented in almost all cases, as permitted by regulations, before any final determination on the merits. These developments raise significant legal, financial, and operational risks for behavioral health providers in D.C.
