Minnesota psychiatrist billed state as if in two places at once

April 26, 2013

A highly paid psychiatrist working in state mental health hospitals engaged in a pattern of false billing claims while collecting more than $430,000 in payments beyond his base salary over three years, according to investigative documents obtained by the Star Tribune.

Dr. Robert B. Jones, who oversaw psychiatric care for hundreds of patients across Minnesota’s northern region, billed the state for services while he was actually working at his private medical practice and his family farm, according to findings documented in three investigators’ reports.

As a result, investigators concluded, patients under state care likely failed to receive the treatment they needed. In one instance, the state’s top psychiatrist, Dr. Alan Radke, failed to reach Jones because it was found that Jones “was in a tractor plowing his fields and didn’t hear the telephone ring.”

In an interview with the Star Trib­une, Jones denied any wrongdoing and said he didn’t know he was under investigation.

“I do know they paid me a lot of money to drive around,” he said.

Separately, during an inquiry last fall by the state Legislative Auditor, Jones charged that the state’s mental health system is chronically understaffed and barely capable of providing appropriate psychiatric care. Jones told an examiner from the Office of the Legislative Auditor that some of the state’s regional mental health hospitals went days without an on-site psychiatrist and that some patients received therapy by phone because there was no staff therapist available.

Jones, who was fired in February after 23 years working for the state, is now under investigation on a second front for Medicaid billings involving claims that could mount to hundreds of thousands of dollars.

Jones’ case is the latest sign of dysfunction in a state system that serves hundreds of psychiatric patients. The Minnesota Security Hospital in St. Peter was placed on conditional license in 2011 after reports surfaced of repeated patient abuses, and two doctors there were recently rebuked by a Hennepin County judge for misleading him about the care of a patient.

A confidential internal report written last August also indicates that top officials at the Minnesota Department of Human Services failed to crack down on Jones’ work practices despite knowing of his billing irregularities. The report shows that Radke knew Jones was claiming vast amounts of supplemental pay known as “callback” hours, but did not order Jones to stop the practice.

“We discussed this with Dr. Radke, and he said he had encouraged Dr. Jones to not claim callback during the workweek,” investigators wrote.

Radke declined to comment for this article.

In an interview last week, Deputy Human Services Commissioner Anne Barry described Jones’ actions as “incredible.” She said Jones put two groups of clients in jeopardy at the same time — those under state care and those in his private practice.

“When you are on-call, it means you have to immediately serve people with high needs, and that didn’t happen,” she said. “What Dr. Jones did under his billing would have been physically impossible to pull off.”

Barry also faulted Radke. “I’m a trust-but-verify person,” Barry said. “Dr. Radke trusted Jones would change his behavior. We have discovered Dr. Jones did things that even Dr. Radke didn’t know about. This shows we have to go beyond trust. We have to verify.”

‘Serious breach’

Altogether, Jones earned between $387,000 and $426,000 annually over the last three years, including base salary, on-call pay, callback pay and specialty differential pay.

In an interview with the newspaper, Jones said the reason he received more than $439,000 in on-call pay from 2009 through 2011 was that he was responsible for overall care at six of the state’s community behavioral hospitals, small regional mental health facilities with chronic staffing problems.

Yet investigators found that Jones was often working on state time at the for-profit Northern Pines Mental Health Center in Brainerd, a counseling center in Wadena, and for a small treatment team.

“On many occasions there is no indication that you reported to work for necessary callback duties,” Jones was told in his firing letter. “Your conduct is a serious breach of DHS ethical standards.”

While the investigation against Jones was in its latter stages, he met with an examiner from the Legislative Auditor and leveled his own charges at the state’s mental health system. He said he was forced to hire out-of-state doctors to cover staff shortages at six northern behavioral health hospitals and said patient care suffered as a result.

At one point, he showed the examiner a spreadsheet from his laptop computer: “ … in a few instances there had been no psychiatrists on site on some days … with coverage being provided by phone for part or all day,” the examiner concluded.

“Jones said that on-call psychiatrists are answering the phone, screening patients, ordering labs, prescribing medication and generally practicing medicine in a way that incurs liability and risk,” the summary states.

‘Last man standing’

Barry, who assumed direct oversight of the St. Peter hospital last year under direction from Human Services Commissioner Lucinda Jesson, has acknowledged difficulty in hiring qualified forensic psychiatrists for state facilities. But she also has said the system is improving, and said her agency is in negotiations with the University of Minnesota’s medical school to train and recruit new professionals for the system.

Jones said that when the innovative community behavioral hospital system was launched in 2006, the state did not plan adequately for medical staffing. Initially, each of the small regional facilities was supposed to have an advanced-practice nurse and two psychiatrists. In the rush to open the hospitals, he said “they just took whoever they could get.” For example, the hospital in Bemidji opened with one nurse on site and no psychiatrist, leaving Jones to describe himself as “the last man standing.”

Filling in at the St. Peter hospital, Jones told the Legislative Auditor’s examiner, he “came out feeling thoroughly exhausted and yet did not have any sense he had done anything helpful for the patients he had seen.”

Source: Paul McEnroe, "Billing puts psychiatrist in two places at once; Minnesota alleges false billing," Star Tribune, April 22, 2013.