HANCOCK COUNTY, Ind. — An Indiana man is facing Medicaid fraud and counterfeiting charges after a six-year investigation into suspected fraudulent billing from his Greenfield based mental health service.
A probable cause affidavit states there was sufficient evidence that Timothy Adkins was submitting claims to Indiana Medicaid stating doctors were the rendering Health Service Provider in Psychology (HSPPs) when they were not.
It also stated that Adkins committed forgery in 67 instances where the signature of a doctor was signed on patient treatment plans.
In October of 2016, the Family and Social Services Administration (FSSA) contacted the Medicaid Fraud Control Unit (MFCU) and reported suspected fraudulent billing of in-home psychotherapy services by Behavior Source, LLC, the Greenfield based business owned by Adkins.
During the investigation, a doctor told officials he had worked for Behavior Source until July 2017. However, there was billing data with the doctor rendering HSPP through 2021.
In total, 12,472 claims were submitted to Indiana Medicaid totaling $475,116 where the doctor was listed as the rendering provider despite his statement he no longer worked for Behavior Source, the report states.
In March 2020, another doctor told investigators she was an HSPP for Behavior Source at two different times, for a few months in 2016 or 2017, then again starting in August 2019.
Officials noted there were treatment plans with her signature on them in 2018, but the doctor could not explain how her signature could be on the documents.
A random sample audit of 23,812 claims made between January 2017 and August 2021 submitted by the provider to Indiana Medicaid, showed a 60.30% error rate. Which meant the percentage of the reviewed claims and patient records did not meet the program requirements necessary for reimbursement from Indiana Medicaid.
The report stated that was because patient treatment plans were not signed by a physician or HSPP noting the HSPP signatures were forged, or the dates of review exceeded the regulatory requirements.
In all the fraudulent billing for non-compliant services added up to over-payment of $12,936.63 and an extrapolated value to the total claims of $947,837.03, the report states.
When interviewed in February, Adkins told investigators he was not surprised by the error rate and shared the concern of treatment plans not having HSPP signatures. He told officials depending on the date, faxes from one doctor did not always come in on a regular basis and that the ability of therapists to get documentation back to him with HSPP signatures was “spotty.”
Adkins said he knew it was “messed up,” the report said, but stopping meant more than 500 kids, 40 therapists and schools would have no services. Adkins said he set aside money to pay back Indiana Medicaid.
While Behavior Source provided mental health services, Adkins holds no psychology licenses or credentials.
Adkins was charged with three Medicaid fraud charges and one charge of counterfeiting from incidents in 2017 and 2018.