HARRISBURG - The state Superior Court has affirmed a trial court's ruling, denying an appeal from Community Care Behavioral Health Organization over alleged overpayment of Medicare funds in an audit of Berks Counseling Center.
Judge Joseph Seletyn ruled Nov. 7 to uphold the trial court's ruling. Community Care alleged that the trial court erred in denying a post-trial motion that awarded Berks Counseling Center a more than $80,000 cancellation of retractions.
Community Care is a nonprofit behavioral health managed care organization that "administers health care benefits to its members in Berks and Chester counties." According to the court, "The company contracts with behavioral health care professionals to provide care for its members with behavioral disabilities and pays for the care from Medicaid funds."
In an audit performed by Community Care, the company contends it discovered that Berks Counseling Center along with a satellite office, Chester Counseling Center, had what is known as a "retraction." Essentially, Community Care claims the counseling centers failed to repay $105,486.13 in Medicaid funds, court document state.
Berks Counseling filed action against Community Care stating that, "Retraction was not a proper remedy for the deficiencies identified in the audit." Instead, Berks Counseling argued that, “provider education,” a process in which Community Care assists the contractor in complying with contractual and regulatory requirements, was the proper remedy for most of the infractions, court papers say.
The court agreed with the ruling that since it was Chester Counseling's first audit by Community Care, Community Care should have provided education to remedy any issues according to the company's agreement with Berks Counseling.
After a bench trial it was determined that Berks Counseling was entitled to $81,704.47 in retractions.
Community Care had argued that neither Berks Counseling nor Chester Counseling should have been submitting for payment since under state law, "payment is conditioned on the supervisory physician’s review of and signing off on a patient’s “level of care assessment, psychosocial evaluation, treatment plan, and diagnosis.”
Berks Counseling conceded at trial that Medicaid regulations required a supervising physician sign off on treatment plans, court documents state.