SORC LLC Medicaid Audit Finds Over $600,000 in Non-Compliance

For Immediate Release:                                                      

July 1, 2021                                                               

SORC LLC Medicaid Audit Finds Over $600,000 in Non-Compliance

Columbus – Auditor of State Keith Faber’s Office released the Medicaid compliance report for SORC LLC, an Ohio Department of Mental Health and Addiction Services licensed treatment program located in Lucas County. The audit identified incidents of non-compliance with Medicaid requirements totaling $677,976.

Auditors tested select substance use disorder services for compliance with Medicaid requirements including case management, ambulatory detoxification services, and alcohol/drug screen-lab analysis of specimens (lab) services during the period of July 1, 2017 through December 31, 2017. Auditors found that 272 of the 294 services tested (93 percent) did not meet requirements and identified improper Medicaid payments for these errors in the amount of $624,381. With interest, $677,976 is due to the Ohio Department of Medicaid.

Significant findings related to the following non-compliance:

• 216 of the 294 services (73 percent) had no documentation to support the payment;
• 38 lab services were duplicate billed;
• 90 percent of ambulatory detoxification services had no treatment plan to authorize the service; and
• 48 percent of case management services had no treatment plan to authorize the service.

Services are to be performed in accordance with a treatment plan as this is the document that contains the goals and objectives for the treatment along with the frequency, duration, and type of treatment to be provided. The plan should be maintained in the individual’s clinical record.

The report contains a recommendation for SORC to develop a record-keeping system that ensures compliance with the requirement to maintain all records necessary to fully disclose the extent of services provided. Additionally, it was recommended that SORC implement a quality review process to ensure that documentation is present, complete, and accurate prior to submitting claims for payment and seek technical assistance from the Ohio Department of Mental Health and Addiction Services to ensure that it maintains a complete and adequate individual client record.

While auditors requested documents over an eight-month period, SORC indicated that, as a result of maintaining paper records in multiple office locations, utilizing multiple electronic medical record systems, staffing shortages, limited resources, and other activities, it was unable to produce the requested documentation in this period of time.

A full copy of this report is available online.

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The Auditor of State’s office, one of five independently elected statewide offices in Ohio is responsible for auditing more than 6,000 state and local government agencies. Under the direction of Auditor Keith Faber, the office also provides financial services to local governments, investigates and prevents fraud in public agencies, and promotes transparency in government.