HANCOCK COUNTY — A six-year investigation by officials with the Family and Social Services Administration (FSSA) concluded a local man committed medicaid fraud and counterfeiting, resulting in the misuse of thousands of state dollars.
The case is being prosecuted by officials from the Attorney General’s office. It was officially opened in Hancock County Circuit Court last week under the supervision of Judge Scott Sirk.
Timothy Dwain Adkins, 66, 300 block of Shadow Creek Pass, Greenfield, has been charged with three Level 5 felony medicaid fraud charges and one Level 6 felony charge of counterfeiting from incidents in 2017 and 2018. The most serious charge carries up to six years in prison.
According to a probable cause affidavit, there is sufficient reason to believe Adkins committed medicaid fraud when he submitted claims to Indiana Medicaid stating doctors were the rendering Health Service Provider in Psychology (HSPPs) when they were not. Additionally, officials believe Adkins committed forgery in 67 instances where the signature of a doctor was signed on patient treatment plans.
The report states FSSA contacted the Medicaid Fraud Control Units (MFCU) and reported suspected fraudulent billing of in-home psychotherapy services, Behavior Source, LLC. Behavior Source is a provider of mental health services, owned by Adkins, who holds no psychology licenses or credentials.
According to the Better Business Bureau, the business was opened in Indianapolis 2012 with Adkins named as the business manager and director of operations. Behavior Source employs HSPPs and provides billing and HSPP oversight services to businesses who provide outpatient psychotherapy, the report states.
A doctor told officials he worked for Behavior Source as an HSPP until July 23, 2017. The doctor stated he did not see any patients of Behavior Source after July of 2017, contrary to billing data showing the rendering HSPP through May 2019.
A subsequent pull of billing data indicated billing was submitted by Behavior Source with the doctor listed as the rendering HSPP through March 8, 2021. In total, 12,472 claims were submitted to Indiana Medicaid totaling $475,116 where the doctor was listed as the rendering provider despite his statement he no longer worked for Behavior Source, the report states.
In March 2020, an investigator interviewed another doctor who said she was an HSPP for Behavior Source during two different time periods: first in 2016 or 2017 for approximately three or four months, and then starting again on August 12, 2019. Officials noted there were treatment plans which had her signature on them in 2018, but the doctor could not explain how her signature could be on the documents.
In September 2021, the MFCU sent a subpoena to Behavior Source for patient records to conduct a random sample audit of 23,812 claims submitted to Indiana Medicaid by Behavior Source from Jan. 1, 2017 to Aug. 20, 2021.
The report states a review showed a 60.30% error rate — meaning the percentage of the reviewed claims and patient records did not meet the program requirements necessary for reimbursement from Indiana Medicaid — because patient treatment plans were not signed by a physician or HSPP noting the HSPP signatures were forged, or the dates of review exceeded the regulatory requirements.
The fraudulent billing for non-compliant services equates to an actual over-payment of $12,936.63 and an extrapolated value to the total claims of $947,837.03, the report states.
Adkins was interviewed by investigators in February. Adkins told officials he was not surprised by the error rate and said he shared the concern of treatment plans not having HSPP signatures, the report states.
Adkins said, depending on the date, faxes from one doctor did not always come in on a regular basis. Adkins said the ability of therapists to get documentation back to him with HSPP signatures was “spotty,” the report states.
Adkins told officials one of the doctors would not sign the vast majority of the treatment plans submitted to him by therapists because the doctor wanted more definition in specific areas of the treatment plan. Adkins said this put him into a considerable “panic” because Behavior Source had just signed contracts with additional school districts and had therapists depending on HSPP approval from Behavior Source, the report states.
Adkins said he knew it was “messed up,” the report said, but he didn’t want to stop services to over 500 kids, 40 therapists and schools who would have no services. Adkins said he set aside money to pay back Indiana Medicaid and said, “I’ll fall on the sword if need be,” the report states.
According to the report, Adkins agreed that he was not providing services at the level they were required to be provided by Medicaid, as he was not having proper HSPP oversight of mid-level providers.
When asked about one doctor’s signatures on 67 documents, from January 2017 through August 2019, Adkins told officials in the report there was never a time the doctor’s signature was on paperwork for Behavior Source when she did not work for Behavior Source.
Adkins admitted his normal procedure during the doctor’s employment was to electronically cut out a signature, paste it on the document and send the pre-signed document to the doctor.
Adkins stated he did this so he wouldn’t need to meet with doctor in person, the report states. When officials interviewed the doctor, the doctor said her process was to always sign documents in pen. When asked if the doctor had ever received pre-signed documents from Adkins for review, she emphatically denied that ever happened, the report said.
When analyzing the billing data submitted to Indiana Medicaid by Behavior Source from January 2018, to August 2019 officials say where some 4,679 claims, totaling $92,650, were submitted to Indiana Medicaid where the doctor was listed as the rendering provider despite her statement she did not work for Behavior Source during this period and did not sign or authorize any documents.
Adkins made his initial appearance in Circuit Court late Friday when he was officially arrested. No bond amount was listed, however he is not an inmate in the county jail. Adkins is slated to be back in court in late September for a pretrial conference.