Roundup Memorial Healthcare and Association Board of Directors Issued a Statement Regarding Billing Issues With Medicaid and Medicare
December 18, 2019
Roundup Memorial Healthcare (RMH) would like to update the community about their physical therapy program and recent events that have led to difficult decisions. The following statement was provided by the RMH Association Board of Directors this past Monday at Community Forums open to the public.
RMH recently completed a reassessment regarding whether or not it could bill for services provided by Mr. Criswell to Medicaid and Medicare. An individual brought this matter to Holly Wolff (CEO) and she brought it to the RMH Board of Directors. The Board instructed Holly to engage legal counsel to conduct a re-assessment of Mr. Criswell’s ability to bill Medicare and Medicaid.
Medicaid and Medicare have the authority to exclude individuals and entities from billing to Medicaid and Medicare. Mr. Criswell is excluded from Montana Medicaid. Services provided by an individual who is excluded from Medicaid cannot be billed to either Medicaid or Medicare. Regulations set by the Centers for Medicare and Medicaid Services are complex and unforgiving. It is not feasible for a critical access hospital like RMH to keep an employee who cannot bill to Medicare and Medicaid. 70% of all services provided by RMH are billed to Medicare and Medicaid.
RMH is informing our District Board of Directors that it will be reserving $660,000 to address repayment to Medicaid and Medicare for previously billed services provided by Mr. Criswell. This reserve does not account for any potential fines or penalties. A hospital that bills Medicaid and Medicare for services provided by an excluded individual may also be subject to penalties of over $10,000 per claim and up to three times the amount claimed. That hospital could also be excluded from participating in both Medicare and Medicaid programs as an entire organization.
The exclusion list prevents him from being able to provide any services that are billed to Medicaid or Medicare. RMH will be required to repay amounts previously collected for Mr. Criswell’s services. The repayment will be out of RMH’s operating budget. RMH has voluntarily submitted a disclosure to the Office of Inspector General (OIG) for these billing errors and has begun the communication process to work toward resolution.
“We built a new therapy facility around this important program and it is unfortunate that we had to make a change in staffing but we had to do what was required by Medicare and Medicaid regulations.” said John Pfister, President of the RMH Board of Directors. “This is very serious for our organization and we’d appreciate your support and understanding of the complexity of this matter. The Board members have a fiduciary responsibility for this organization so it can continue to serve the needs of the community.”
Last year Roundup Memorial opened the new Signal Peak Rehabilitation Center, making a significant investment into rehab services for the Roundup community. “We have heard great things about our contract physical therapists, along with our full time physical therapy assistant, who have been keeping the Rehab Center in full swing,” Mr. Pfister said. “We are fully committed to keeping these essential services in our local community for the patients we serve.”
More information on the effects of exclusion can be found at the following link: https://oig.hhs.gov/exclusions/files/sab-05092013.pdf