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Medicaid Billing Fraud?

Quote:In Pennsylvania, almost anyone can start their own psychiatric clinic, be they a doctor, an experienced hospital administrator, or even a former ward leader, like Carlos Matos.

Matos says he is the co-founder of the Juniata Community Mental Health Clinic (JCMHC), near Fifth and Huntingdon streets in Fairhill. He had been a Democratic ward leader until he pleaded guilty to a felony charge in 2007 for bribing three Atlantic City councilmen and was barred from political work.

Although Matos’ attorney says Matos no longer works at the clinic, a whistleblower lawsuit filed in the Court of Common Pleas last month alleges that he was the director of JCMHC in 2013. The suit also claims that he and another administrator fired an employee for reporting what she said were “fraudulent billing practices” at the clinic.


Quote:Matos, when reached Tuesday, said he had not heard of the lawsuit, and referred questions to his lawyer, Geoffrey Johnson, who said a formal response to the complaint was pending, and “absolutely denied” the allegations. Johnson said the termination was solely performance-based.

However, Yeadon resident Sheree Brown says she was just doing her job. She was hired as the deputy director of business operations at JCMHC in June 2013. Her primary duties "included analysis of rejected Medicaid billing and her recommendations as to what action to take to correct the billing," according to the lawsuit. It was an important position: The surrounding Fairhill neighborhood has one of the highest poverty rates in the city and 95 percent of patients received some form of subsidy, like Medicaid.

It’s a lot of paperwork to deal with, but the responsibility didn’t bother Brown, a six-year veteran of the city’s Department of Behavioral Health, which pays out money for patient costs through a city contract. What did start to trouble her, according to the legal complaint, were what she said were inexplicable medical charges and soaring bills for psychotherapist time that didn’t seem to mesh with reality.

Brown puts it bluntly.

“The billing process wasn’t being done according to state laws,” she said in a recent interview.

Brown noted what she said was a pattern of overbilling within her first month of work and says she immediately notified the clinic’s director, whom she names as Matos.
So, like... I can start my own asylum? I have psych patient experience. I see good things in Ten*K's future.

For the crazies... Not so much...
tolerance for failure meter... LOW

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