Ethics of Medicaid Fraud? What’s the IMPACT of Medicaid Fraud?

Title: Ethics of Medicaid Fraud
Presenter: Dr. Jon Bailey, PhD., BCBA-D
Subject Matter Experts: Nicki Postma, BCBA, Karin Torsiello, BCBA, Ronit Molko, Ph.D., BCBA-D

Medicaid billing fraud – any billing fraud, for that matter – is a very serious matter which has the potential to not only affect every professional and agency that relies on Medicaid funding for ABA services, but most importantly, recipients of those services.

Recently, the behavior analytic community in Florida was rocked by events that has broad sweeping consequences. On May 2018, due to egregious, and perhaps pervasive, Medicaid billing fraud perpetuated by some agencies providing ABA services, AHCA (Agency for HealthCare Administration), the organization responsible for overseeing the $25.2 billion Medicaid programs serving 4.27 million people living in FL., imposed a 6-month moratorium on adding new ABA service providers.

Shortly thereafter, in July 2018, AHCA announced that it took action against 4 agencies that engaged in egregious billing fraud – DRA Behavior Health, MGM Behavioral, Harmony Mental Health and Behavioral Services and Meli Medical Center, Inc. Furthermore, AHCA also announced that they are conducting ongoing investigations, which will lead to further sanctions.

So, what are the consequences?

• Hundreds, perhaps thousands, of small to mid-sized ABA agencies, without sufficient capital to ride this out, are going out of business

• The reputation of ABA providers is being tarnished, perhaps irreparably – not just in FL, but across the country

• The legitimacy of the field of behavior analysis is coming under intense scrutiny

• But worst of all… tens of thousands of people receiving ABA services are not getting the services that they desperately need

Over the past 4 years, Special Learning has been conducting Live Ethics webinars with Dr. Jon Bailey, Ph.D., BCBA-D. During each of these webinars, we focused on analyzing the actions of individual ABA professionals credentialed by the Behavior Analyst Certification Board (BACB) – Board Certified Behavior Analysts (BCBA) and more recently, Registered Behavior Technicians (RBT) – as it pertains to violations of the BACB Ethics Code, which applies only to individual practitioners.

In reviewing ethics case scenarios submitted by practicing BCBAs over the same period of time, it became very clear that in many instances, actions taken by organizations caused the ethical dilemmas. This situation is certainly a case in point.

During our August 22, 2018 live webinar with Dr. Jon Bailey and our Subject Matter Experts, we will explore the topic of Medicaid fraud and its implications, both short term and long term, to the field of behavior analysis, professionals, and agencies that are part of the service delivery system. We will analyze the actions and possible motivations of the 5 agencies cited above, repercussions to BCBAs caught in the scandal, and possible reasons behind the breach of responsibility of BCBAs who were aware of the billing fraud, but failed to report this to the BACB and/or Medicaid fraud hotline.

Using the cases above as lessons learned, we will discuss proactive measures that individual BCBAs and RBTs can put in place to avoid being entangled in these situations, and how to avoid working for, or being associated with, organizations committing unethical acts.

We will also discuss organization wide systems and controls that agencies should have in place to become, and to be recognized, as an Ethical Organization in the field of health services.

Lastly, we will unveil the launch of the Ethics Standards Board for ABA Providers (ESBAP.)

Webinar Details

Title: Ethics of Medicaid Fraud
Date: Wednesday, Aug 22, 2018
Time: 9:00 am to 11:00 am Central
CEUs: 2 Ethics or Type II CEUs