Wadena County Human Services was contacted in the fall of 2019 by South Country Health Alliance (SCHA) staff who were seeking to audit certain claims made by the county. This request was prompted by a discrepancy between claim amounts paid to Wadena County versus other similarly sized counties, Human Services director Jennifer Westrum explained during the county board meeting, Tuesday, June 23. The audit revealed “a pattern of multiple examples of inappropriate billing.”
Following that, SCHA sent a request to Human Services, Feb. 21, 2020, asking the county to conduct a review of the accuracy of the claims billed to SCHA in 2019 involving members who received four or more hours of service in any month during 2019. SCHA sought that the inaccuracies be “adjusted.”
Wadena County Home and Community Based Services supervisor Cheri Dodds completed the audit, which went beyond the original scope of those receiving four hours or more of service per month. The audit revealed billing discrepancies in a number of areas. Those claims included billing for travel time; billing for scanning/filing; lack of supporting documentation; and billing for an incorrect number of units of service.
The overpayment amount came to $18,727.80. That amount must be paid back, according to SCHA. Westrum recommended paying the amount back by taking that amount out of the return that Wadena County was expecting to receive later this year from SCHA. As Wadena County exited SCHA last year, the county expects to receive funds back from those that they paid into the county-based health plan.
County board members agreed with Westrum’s recommendation and unanimously approved offering that repayment, contingent on SCHA accepting that offer. As of Tuesday, such an offer had not been agreed upon by SCHA. If not, the payments will be refunded from the Human Services reserve funds.
Wadena County board chair Chuck Horsager asked what was being done to avoid the inaccurate billing in the future. Westrum said retraining of staff has taken place and staff have signed off on understanding accurate billing practices. Going ahead, self auditing will also take place to help avoid inaccuracies as billing practices can change from each insurance provider.