Tuesday, May 21, 2019

Clinic Suspended for Alleged Medicaid Fraud


The Division of Medicaid suspended payments to NSCH Rural Health Clinic-Sunflower a little over a year ago.  NSCH pitched an appeal to Hinds County Chancery Court but struck out with Chancellor Dewayne Thomas.


The clinic provides comprehensive medical services to the Delta.  The facility is open to midnight during the week and no appointment is required.  It operates outreach programs to nursing homes and Head Start children.  The community outreach includes dental services.

The Division received a "credible" allegation that the clinic was submitting phony Medicaid claims for dental services.   An administrative hearing was held in December 2017.  The hearing officer suspended Medicaid payments in February 2018.

The Chancellor ruled that federal law required the Division to suspend payments "after the agency determines there is a credibel allegation of fraud for which an investigation is pending..." (42 CFR 455.23(a)(1)).  Judge Thomas said there were no exceptions that applied to the suspension as spelled out in the statute or regulations.

The order also states the fraud allegation was referred to the Attorney General for a criminal investigation:

the credibility of the allegation of fraud. Likewise, this Court cannot find that DOM's
determination that there was a credible allegation of fraud was unsupported by substantial
evidence. Instead, this Court finds that DOM referred the allegation of fraud to the
appropriate legal authorities and an ongoing criminal investigation has ensued. Therefore, DOM had
substantial evidence that the allegation was credible...
There is an exception if the clinic is the sole provider of health care in an area.  However, the Chancellor said there were "numerous" Medicaid providers offering the same services although the clinic offering more convenient hours.







9 comments:

Anonymous said...

tip of iceberg-

CPD21 said...

Dr. Truley didn't work there, did he? Asking cause a friend asked me.

Unknown said...

The only Judge in Hinds county that would follow the law.

Vladimir Putin said...

Jerry Tankersly DDS

Anonymous said...

Wonder if the dentist who was nailed in the prescription writing scam was part of this.

Anonymous said...

i just love the exception mentioned in the last paragraph of the article. i guess that means that a clinic has total immunity from medicaid fraud if they are the only one in town. remember , this is your money being stolen, not their money.

Anonymous said...

Tip of the iceberg is an understatement for what all happened with their screen team. just take my word. Young children and their parents were taken advantage of by the FNP's. Again, just something i know

Anonymous said...

Just one of the flies on the cow turd pile. You'd have to close a lot more if they were really investigated thoroughly.

Anonymous said...

So does this mean that this clinic is suspended from Medicaid payments indefinitely? Was this the final appeal? Anyone know? Who guided them to bill this way?

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