June 30, 2022
Thought this was an interesting article… it indicates the importance of understanding supervision and oversight regulations for service providers/staff whom an eligible professional submits claims on behalf of. Additionally, if the supervision requirements are not met, those charges are subject to False Claims violations.
“Molina is managed health services company that provides health care plans to various state and federal health care programs…” The government contends that Molina (and Pathways…a company owned & operated by Molina) “submitted claims for reimbursement …while failing to properly license and supervise mental health center staff, including social workers and psychological associates, and failing to provide and timely document the provision of adequate clinical supervision to clinicians requiring supervision.”
This was a whistleblower case.