Sunday, October 23, 2011

Did Smoky Mountain Center LME's Utilization Review Department Have a Role in the Downfall of New River Behavioral Health Care?

Hey, all I know is my own experience and I have outlined it here re: the comment I have made to Richard Craver's article pertaining to the $6.5 million black hole associated with New River Behavioral Health Care.

Here is Craver's article:

Here is my comment (and there are others at the article's URL):

"WHOA already. So, this appears to be what we 'know' at this point in time: (1) New River started experiencing money losses in 2010 of a significant degree (2) Medicaid 'fraud' accusations have been received from a 'credible source' according to NC DHHS.

I don't see how the two are necessarily related. WHY and what were the particulars of New River losing money in 2010? Was it because of some behavior on the part of the LME, specifically, Smoky Mountain Center LME? Was the director of New River 'misdirecting' money? Without the details which are pretty darn slow in coming forward, no one, except those on the inside, have any idea what has happened and why.

Who or what entity has made the Medicaid 'fraud' accusations? What are the accusations?

This is the question that I wonder about having worked with the Utilization Review Department (call that: 'tried to work with") of SMC LME: New River could not get paid for some reason. For me, it was merely a single client.

As regarding that case, for the life of me, regardless of what information I submitted about a very mentally ill client of mine who had been in the mental health care system since a child, I could not get dependable authorizations to see and be paid to see that state funded client. I threw in the towel re: working w/ SMC LME's state funded clients five years ago. Moreover, I won't take any state funded clients due to the paperwork re these clients. My worry, as a solo practitioner, has been that w/ the LME's taking over the management of Medicaid, that they will re-create paperwork equally onerous for Medicaid clients.

So, with the refusal of the SMC LME Utilization Review Department which provides the authorizations to work with the client (and thus get paid) and the overkill overviewing of what I submitted as 'the reasons' why the client needed therapy to the Clinical Director of SMC LME at that time----still the same people in place best I understand it from a recent review of their staff----I took the medical records of the client TO THE HOME of the Social Security adjudicator so that the client could at least be advanced to Medicaid----and that very well could have saved the client's life.

Given my experience with the Utilization Review Department of SMC LME 5 years ago, I have to wonder did SMC LME play any part in the non-payment/ non-authorization downfall of New River.

Details, please.


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