State Medicaid agency reviewing potential fraud by providers

State Medicaid agency reviewing potential fraud by providers

COLUMBIA, SC (AP) - South Carolina's Medicaid agency is reviewing dozens of providers for possible fraud after payments for certain behavioral health services skyrocketed.

According to the agency, seven cases so far have been referred to the attorney general's office for potential prosecution. A review of records suggests providers over-billed on hours and billed for services not given.

The problem stems from the elimination last summer of the requirement that patients first get approval from another agency before receiving treatment or counseling for issues ranging from mental illness to drug abuse.

Director Christian Soura says his predecessor made the change to ensure patients got the help they needed.

Since Soura came aboard last November, the agency has terminated 49 providers' ability to bill Medicaid and resumed prior authorizations, though they're handled differently.

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