Audio Ethics of Medicaid Fraud with Jon Bailey, PhD, BCBA-D

LEVEL: Advanced

CEU ELIGIBILITY:

2 BACB Learning or Ethics CEU

2 QABA Ethics or General

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Medicaid billing fraud - any billing fraud, for that matter - is a very serious matter which has the potential to not only affect every professional and agency that relies on Medicaid funding for ABA services, but most importantly, recipients of those services.

Recently, the behavior analytic community in Florida was rocked by events that have broad sweeping consequences. In May 2018, due to egregious, and perhaps pervasive, Medicaid billing fraud perpetrated by some agencies providing ABA services, AHCA (Agency for Healthcare Administration), the organization responsible for overseeing the $25.2 billion Medicaid programs serving 4.27 million people living in FL., imposed a 6-month moratorium on adding new ABA service providers.

Shortly thereafter, in July 2018, AHCA announced that it took action against 4 agencies that engaged in egregious billing fraud - DRA Behavior Health, MGM Behavioral, Harmony Mental Health and Behavioral Services, and Meli Medical Center, Inc. Furthermore, AHCA also announced that they are conducting ongoing investigations, which will lead to further sanctions.

So, what are the consequences?

Hundreds, perhaps thousands, of small to mid-sized ABA agencies, without sufficient capital to ride this out, are going out of business
The reputation of ABA providers is being tarnished, perhaps irreparably – not just in FL, but across the country
The legitimacy of the field of behavior analysis is coming under intense scrutiny
But worst of all... tens of thousands of people receiving ABA services are not getting the services that they desperately need

In reviewing ethics case scenarios submitted by practicing BCBAs® over the same period of time, it became very clear that in many instances, actions taken by organizations caused ethical dilemmas. This situation is certainly a case in point.

During our webinar with Dr. Jon Bailey and our Subject Matter Experts, we explored the topic of Medicaid fraud and its implications, both short-term and long-term, to the field of behavior analysis, professionals, and agencies that are part of the service delivery system. We analyzed the actions and possible motivations of the 5 agencies cited above, repercussions to BCBAs® caught in the scandal, and possible reasons behind the breach of responsibility of BCBAs® who were aware of the billing fraud, but failed to report this to the BACB and/or Medicaid fraud hotline.

Using the cases above as lessons learned, we discussed proactive measures that individual BCBAs® and RBTs® can put in place to avoid being entangled in these situations, and how to avoid working for, or being associated with, organizations committing unethical acts.

We also discussed organization-wide systems and controls that agencies should have in place to become, and be recognized, as an Ethical Organizations in the field of health services.

Lastly, we unveiled the launch of the Ethics Standards Board for ABA Providers (ESBAP.)

Presenter: Dr. Jon Bailey, PhD., BCBA-D
Subject Matter Experts: Nicki Postma, BCBA, Karin Torsiello, BCBA, Ronit Molko, Ph.D., BCBA-D

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