Mt. Gilead Group Home Closes Doors: So Many Questions Remain

Last week, a Montgomery County adult care home was forced to close down, causing dozens of adult, Medicaid recipients to be without health care or housing.

Owners Amy and Larry Patton had called the Department of Health and Human Services (DHHS) previously and informed DHHS that the slow Medicaid reimbursements were going to close down their facility.

There is very little information from the Pattons regarding the reasons the group home had to close, except for their complaints to DHHS regarding slow Medicaid reimbursements. It appears that they removed all valuable items from the Mt. Gilead, North Carolina group home, such as TVs and refrigerators, in the middle of the night. Employees came in the morning to find everything gone.

The residents and families of the residents in the adult care home are outraged, and rightly so. They should be outraged. But are they outraged at the correct people/companies?

As a Medicaid attorney, I see health care providers struggling every day to make payroll.  The health care providers depend heavily on Medicaid reimbursements (a) being provided, and (b) being timely. If these Medicaid payments fail to come or fail to come timely, the health care provider, like any other business, is forced to close.

I have no evidence that Pattons were not receiving their Medicaid payment except for the complaint they made to DHHS regarding timeliness.  There may have been more complaints.  We will probably never know.

But it is a fact that there are health care providers in North Carolina which are not receiving Medicaid payments.  In 2011, due to the Affordable Care Act (ACA) NC General Assembly passed Session Law 2011-399, which codified DHHS’ authority for pre-payment reviews.  A pre-payment review places the health care provider in a situation that few providers are capable of overcoming. Basically, the Agency stops the medicaid payments to the provider until the provider can prove in 3 consecutive months that the provider can document a 70% accuracy rate based on the Agency’s standards.

According to NC Gen. Stat. 108C-7, the prepayment review can only last up to 12 months, at which time the provider will, most likely, lose its ability to serve Medicaid recipients if it is unable to meet the documentation requirements.

But 12 months without Medicaid payments will wipe out a health care provider.

Surprisingly, NC Gen. Stat 108C-7 does not allow a health care provider to appeal. No due process.

Now I have no evidence that the Pattons were subject to a pre-payment review. I have no evidence that the Pattons were not receiving Medicaid payments.  But for a group care home to close its doors when the owners were not new to Medicaid (they also owned two other group homes in Guilford County), unexpectedly and without providing help to its Medicaid recipients is mysterious.

These were people trying to help Medicaid recipients.  They owned 3 group homes. I question whether the Pattons, like so many other health care providers, were subject to pre-payment review with no appeal rights.

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on January 28, 2013, in Affordable Care Act, DHHS, Group Homes, Health Care Providers and Services, Legislation, Medicaid, Medicaid Recipients, North Carolina and tagged , , , , , , , . Bookmark the permalink. Leave a comment.

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