Vermont Mental Health Agency Must Repay Medicare, Medicaid, and Tricare Payments Due to Background Check Lapse

A mental health services provider based in Springfield, Vermont, is required to pay $170,000 in restitution to the state and the federal government after nearly a decade of violating state and federal laws for Medicare, Medicaid, and Tricare billing. The news story highlights a lesser-known consequence of sub-standard employee background checks, particularly with regard to federal exclusion lists and how they can affect things like Medicare and Medicaid billing.

According to a report on the situation from the New England newspaper Valley News, the Springfield-based Health Care & Rehabilitation Services (HCRS) owes restitution because it mistakenly billed Medicare, Medicaid, and Tricare for the services of a social worker it had employed who was on an "exclusion list" kept by the Office of the Inspector General and the United States Department of Health and Human Services. From December 24, 2009, to May 15, 2019, HCRS billed the three federal insurance programs for its social worker's services, despite the fact that that person was not an eligible employee for those types of payments.

The Valley News article does not go into detail about the HCRS employee, whose status on the exclusion list was noticed by HCRS and disclosed to state and federal regulators in 2019. Though the Vermont Attorney General's office has released some documents about the case, they also did not name the HCRS employee. Valley News does note that, per a press release from HCRS, the employee in question "was excluded for reasons unrelated to employment at the community mental health agency," but does not provide further information about what the individual was placed on the exclusion list in the first place.

Regardless of the reasons for the employee's ineligibility, HCRS is required by state and federal False Claims Act laws to conduct employee background checks, and to make sure that it isn't employing individuals who feature on the exclusion list. HCRS, per its website, "provides mental health and substance abuse services to Vermont's Windsor and Windham counties." Vermont Attorney General TJ Donovan noted that, given the responsibility HCRS to provide "important care and services to some of the state's most vulnerable Vermonters…performing required background checks and complying with state and federal law is vital."

Because of the oversight, HCRS will now be required to pay back the money it billed to Medicare, Medicaid, and Tricare. According to Valley News, the agency has agreed to pay a sum of $170,000 to settle the matter; more than $100,000 is restitution to Vermont's Medicaid program.

In a press release, HCRS CEO George Karabakakis spoke on behalf of the agency, stating, "we regret our error and recognize the importance of ensuring all employment guidelines are followed." He continued by saying that, in the wake of realizing its mistake, HCRS has "strengthened our procedures to prevent a reoccurrence."

Especially in the healthcare sectors, employers often have a responsibility to satisfy not just their internal employment standards, but also those laid forth by state and federal regulations. This story serves as an important reminder about what those lofty standards can be, and why strong employee background checks are a must-have for healthcare employers.