A nonprofit health care organization working on a state contract to provide public health and family support services in Mills and Pottawattamie Counties improperly billed Medicaid for more than $20,000, according to a report from the Iowa state auditor.
According to the report, FAMILY, Inc. was hired by Promise Partners, since rebranded as Thriving Families Alliance, to fulfill a contract Promise Partners had with the Iowa Department of Public Health to provide services for the Maternal, Infant, Early Childhood Home Visitation and Early Childhood Iowa programs.
According to the FAMILY, Inc. website, these services include home visits “to assist parents in their role as their child’s first and most influential teacher.”
The home visitor assesses parenting skill development, conducts home safety checks, makes sure the child is participating in age-appropriate activities and checks on their health, according to the website.
People are also reading…
At the end of each visit, the home visitor fills out an Ages and Stages Questionnaire to chart the child’s progress, and these ASQ surveys are at the heart of the dispute between the state and FAMILY, Inc.
According to the report, conducting the ASQs was part of the contract between Promise Partners and FAMILY, Inc., and was something FAMILY, Inc. was reimbursed for by Promise Partners, along with all the other services provided.
FAMILY, Inc. contends that the ASQs were not explicitly part of the contract, which is why the organization billed Medicaid for reimbursement.
FAMILY, Inc. billed Medicaid for 328 ASQ surveys conducted between July 1, 2017 and May 31, 2021, for a total of $20,016.66.
“The nonprofit says, ‘Well, what we were required to do was provide these services,’” Iowa State Auditor Rob Sand said in an interview with the Daily Nonpareil. “And the contract, in passive voice, also said that surveys must be conducted of the recipients of the services. Now, if that’s in the contract, most people would read that contract with the understanding that that’s part of what they’re getting paid to do. The nonprofit here instead said, ‘Okay, well, surveys also have to be conducted, but it’s not in this part of the contract, then we can use that to separately bill Medicaid directly for conducting those surveys.’”
Sand compared it to signing a contract to buy a car, and the contract said that the car will be delivered by a certain date.
“I would expect that they’re not going to come back to me and say, ‘Well, the contract didn’t say that we were going to deliver the car. You’re going to need to pay extra for that,’” Sand said. “The contract is for a car, technically, but it says it’s going to be delivered. The commonsense reading of that contract means the person who has the car right now will do the delivery.”
As a state contractor, FAMILY, Inc. has participated in multiple reviews and audits over the years, and not once did anyone ever say that the organization should not be billing Medicaid for the ASQs, FAMILY, Inc. Executive Director Kimberly Kolakowski said.
“We’ve participated in whatever has been asked of us, none of which raised concerns regarding our billing practices,” Kolakowski said. “From our perspective, there was no clear language in our contracts or through any of the reviews, audits, technical assistance that we have participated in — and there have been many — that would have indicated to us that this was a problematic practice.”
As a subcontractor, FAMILY, Inc. submits monthly claims to the contractor that hired them — Promise Partners — and is reimbursed for the services it provided, including salaries, benefits, cost of supplies and mileage.
According to Kolakowski, FAMILY, Inc. never billed Promise Partners for administering the ASQ surveys, and she has the documents to prove it.
“Every month we have to submit to them billing claims and provide documentation, we have to maintain and provide at any time the documentation to substantiate the claims that we are making,” Kolakowski said. “We did not submit claims for the administration of these ASQ screeners and then also turn around and bill it to Medicaid. We did not do that.”
The state auditor’s report recommends that IDPH strengthen “internal controls and operations, such as periodic comparison of surveys completed to billings submitted to Medicaid.”
The report also recommends that the state seeks reimbursement of the amount paid to FAMILY, Inc.
Copies of the report were sent to the Polk County Attorney’s Office, the state Attorney General’s Office and the Division of Criminal Investigation.
DCI currently has no plans to investigate the case and would require a request from either the county attorney or attorney general’s offices to do so.
“FAMILY, Inc. is very much committed to working together with the entities involved to reach an amicable resolution,” Kolakowski said. “But outside of providing any information that was requested of us, we have been excluded from the process of figuring this out.”
The process has been so opaque that the state didn’t notify Kolakowski when the report was issued, she said.
“A couple of weeks ago we received a call from the state auditor’s office where, as noted in the report, they conducted an interview with our organization and we again shared the same information that we have been sharing and provided our written response,” Kolakowski said. “And that’s where it’s been. In fact, I became aware that the report was issued through other channels.”
When asked for comment, IDPH spokesperson Sarah Ekstrand wrote:
“The Iowa Department of Public Health and Iowa Medicaid are working collaboratively to establish internal controls to compare services paid for with IDPH funds services billed to Medicaid to identify duplicate payments. We will also work together to establish and implement a process for corrective action should duplicative payments be discovered and to recoup the ~$20K paid to FAMILY Inc. as the result of Medicaid billings.”