Four South Carolina doctors--all psychiatrists--repay more than $344K to Medicaid

May 17, 2012

Four Charleston area doctors were among 31 South Carolina health providers who erroneously billed the Medicaid agency nearly $2 million since 1999, according to state data released Tuesday.

The providers, three from Charleston County and one from Berkeley County, have repaid more than $344,000 to the state stemming from the charges, according to the S.C. Department of Health and Human Services. The local doctors face no sanctions stemming from the over-billing.

The practices of Dr. Sondra Keller and Dr. Ricardo Fermo, both listed as psychiatrists of MUSC’s University Medical Associates, together had billed the state more than $141,000 for clients that already were covered by grant funding, according to the S.C. Medicaid agency.

The office of Dr. James McKinney, a psychiatrist who practices in Mount Pleasant and Summerville, billed the state more than $115,000 although he “had little support documentation” for his charges, according to the agency. McKinney’s billing “did not meet policy guidelines,” the state said.

The practice of Dr. Scott Christie, a psychiatrist who sees patients at Oasis Christian Counseling in Moncks Corner, erroneously charged the state nearly $88,000 due to billing discrepancies, the Medicaid agency said.

Christie and McKinney could not be reached for comment.

Fermo, who no longer is affiliated with University Medical Associates and no longer accepts Medicaid patients, said he was unaware of the billing errors and repayment.

“I didn’t even know about this,” Fermo said. University Medical Associates primarily handled his billing, he said.

Problems might have arisen from technical difficulties with electronic health records, Fermo said. Issues also might have stemmed from improper documentation, he said.

“The guidelines are too strict,” said Fermo, who said he dropped his Medicaid patients in part because collecting state payment for their treatment was too difficult.

A spokeswoman for the Medical University of South Carolina did not return a request for comment. Keller also could not be reached.

In all, the state sought about $1.9 million health providers statewide have erroneously billed. So far, it has collected more than $1.7 million, according to state figures.

The state said many cases “were overpayments, duplicate billing and billing errors that did not involve fraud or abuse.” Other cases did involve abuse.

Dr. Jed Graham of Greenwood Family Practice is involved in an open fraud case with the S.C. Attorney General’s Office, according to the state. The state said it is examining Graham’s medical claim and prescription drug charges, including billing for Suboxone, an opioid, and “many drug tests.”

Another open fraud case involves possible false claims submitted by FaithWorks Pediatric Innervations, a Florence speech therapy provider. The management of that business kept “no documentation or patient records to support services billed,” according to state data.

Neither Graham nor FaithWorks could be reached.

The state’s review — summarized in a February report — was prompted by a nationwide investigation by U.S. Sen. Charles Grassley, R-Iowa. Grassley sought 2008 and 2009 data from each state about doctors who have the highest rates of prescribing commonly abused prescription drugs to people enrolled in Medicaid, the government-funded health insurance program for the poor and disabled.

Beyond the senator’s request, the state “conducts ongoing data mining to identify fraud and abuse in the Medicaid program that takes into account many factors besides the number of prescriptions written by an individual physician,” S.C. Medicaid Director Tony Keck said in a February letter to Grassley.

Source: Renee Dudley, "Doctors erroneously billed Medicaid," The (Charleston) Post and Courier, April 10, 2012.