Vermont AG: no criminal misconduct in hospital’s billing

By LISA RATHKE
Associated Press
MONTPELIER, Vt. (AP) — The Vermont attorney general’s office found no criminal conduct in the billing practices of the Brattleboro Retreat psychiatric hospital but did discover several billing deficiencies that need to be fixed, the office announced Monday.

In 2015, former Attorney General William Sorrell said his office was conducting a criminal investigation into the private hospital after a whistleblower complained about alleged Medicaid fraud.

The office of Vermont Attorney General T.J. Donovan said Monday after completing the probe, the U.S. attorney general’s office and other investigating agencies also found no criminal misconduct. But the parties have acknowledged that from January 2015 until now some of the Retreat’s Medicaid claims and billing practices have imposed costs and inefficiencies on the Retreat’s business operations and the state.

To address the billing issues found, the Retreat has agreed to take steps to correct the problems, the attorney general’s office said.

“This agreement holds the Retreat accountable and is an example of problem solving for a good result of all parties,” said Donovan. “We look forward to work with the Retreat.”

The Brattleboro Retreat, founded in 1834, is a critical partner to the state in providing access to quality mental health and substance abuse services, current Attorney General T.J. Donovan said Monday.

The agreement calls for a third-party systems review of the hospital’s billing and claims practices and business operations related to claims, which will result in recommendations for best practices that the state and Retreat will adopt. The deal also requires the Retreat to file timely claims, within six months of the service provided, and to bill all other payers before a Medicaid claim is filed.

If the retreat fails to meet certain obligations, it will be notified in writing and allowed time to correct the defect. If it doesn’t fix the problem within the agreed upon time, or if a second breach is found, the state can declare it in default and have it placed into an enforcement agreement for three years to address the problems.

Retreat President and CEO Louis Josephson said he was pleased with the investigation’s outcome.

“In the last three years, the Retreat has launched a process to analyze and modernize its billing operations and related practices,” he said. “That work resulted in several upgrades that have measurably improved the hospital’s financial operations.”