AUGUSTA — A newly filed court appeal by an Augusta-based mental health care provider gives details about why it was cut off from MaineCare payments last September and why a judge should overturn that decision.
As a result of the payment cutoff, AngleZ Behavioral Health Services “was put out of business and it had to lay off 87 employees and stop serving its more than 300 clients,” AngleZ attorney Jay McCloskey wrote in the complaint filed in Kennebec County Superior Court against Department of Health & Human Services Commissioner Mary Mayhew.
He said the agency, owned by Annalee Morris, exhausted its departmental appeals, receiving notice May 5 of the state decision to uphold the payment suspension. Documents show the funding was pulled after allegations of “billing for inappropriate services.”
McCloskey said the decision by the DHHS, which licensed AngleZ to provide mental health services, was based on information from Susan Waddell, special agent in charge of the Office of Investigations of the Office of Inspector General, federal Department of Health and Human Services and Catherine Richard, special agent with the same department.
A declaration by Richard says, “I believe that AngleZ engaged in a scheme to defraud MaineCare, and that a payment suspension of MaineCare payments is appropriate and necessary to protect the integrity of the MaineCare program.”
The hearing record shows that Richard stated that “AngleZ may be recruiting staff and clients from a competing mental health agency and that AngleZ was owned by a former part owner of a mental health agency being investigating by the (investigations office).”
Morris was a co-owner of Umbrella Mental Health Services, leaving in October 2012 and starting AngleZ. The state suspended MaineCare payments to both agencies in September. In all, some 500 people in central Maine had to find MaineCare-paid coverage through other agencies after the state halted payment payments to both AngleZ and Umbrella. The agencies provide case management services and help people get access to medical, social, educational and mental health services and medication management.
Richards also listed a site visit by state licensing staff that “found lack of documentation” and other discrepancies: employment of a case worker who was also a case manager, billing for individuals more than 80 years old, four files with the same comprehensive assessment with only the date change, an assessment that might have been copied and “a patient file with a comprehensive assessment with identical information as a comprehensive assessment from eight months earlier.”
Richards also reported “an AngleZ client was sitting in front of a television with two AngleZ workers and they appeared to be playing something, and that another AngleZ client was present too.”
The state DHHS has until July 21 to file the case record with the court under a “final extension” granted by Justice Robert Mullen. The state is represented by Assistant Attorney General Thomas C. Bradley, who successfully sought the extension to file the record in the case and who represented the state at the administrative hearing level.
McCloskey says that in the intervening eight months since the suspension following “a credible allegation of fraud,” Morris, a registered nurse, has been “under a cloud” and “unable to attain employment under her nursing license.” She also offered to meet federal and state agents and answer any questions, but has received no response, the attorney said in the pleadings.
According to the state regulatory website, Morris’s license as a registered nurse is active through May 18, 2016, and no disciplinary action is recorded.
A spokesman for the department, John Martins, said previously that once the state has received “a credible allegation of fraud” and an investigation is pending, the state must halt payments.
AngleZ maintains that there was not enough information from Waddell and Richard to determine existence of a credible allegation of fraud, that it was denied due process and a right to a fair hearing because all AngleZ witnesses were excluded from testifying including Morris.
The appeal asks a judge to determine that the payment suspension was wrong, order MaineCare payments released for work already performed by AngleZ and allow AngleZ to resume proving MaineCare services.
Betty Adams — 621-5631
Twitter: @betadams
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