The Medicaid program pays for opioid treatment program (OTP) services. Prior Office of Inspector General (OIG) audit reports have identified OTP services as vulnerable to fraud, waste, and abuse. OIG reviewed New Hampshire’s monitoring and oversight of the OTP providers (providers), including compliance with Federal and State requirements, to determine whether: (1) counseling hour and toxicology testing requirements were met, (2) initial treatment plans were prepared, (3) treatment plans were reviewed as required, and (4) the OTP service was provided.
New Hampshire claimed Medicaid reimbursement for OTP services that did not comply with Federal and State requirements. Of the 100 OTP services OIG sampled, 6 complied with Federal and State requirements, but 94 did not meet applicable Federal and State requirements. These deficiencies occurred because New Hampshire did not have the resources to oversee providers and enforce the OTP requirements. Providers said high personnel turnover, difficulty attracting and retaining personnel, and difficulty keeping patients engaged in counseling services contributed to the lack of adherence to State requirements. Furthermore, New Hampshire did not always provide guidance regarding State OTP requirements.
OIG estimates that New Hampshire improperly claimed at least $7.9 million in Federal Medicaid reimbursement for OTP services during the audit period. In light of this analysis, OIG recommended that New Hampshire’s Department of Health and Human Services take the following steps:
- Refund $7.9 million to the Federal Government,
- Take steps to ensure that providers comply with Federal and State requirements for providing and claiming Medicaid reimbursement for OTP services, and
- Improve communication with providers regarding the State requirements for opioid use disorder treatment and provide written confirmation about whether offsite counseling may be included as a required counseling service.
New Hampshire agreed with OIG’s recommendations and indicated that it will work with CMS to refund $7,943,271 to the Federal Government. It also stated that it continues to work with Medicare contractors on provider oversight of substance use disorder treatments. New Hampshire stated that it recently completed a training with all of the OTP providers that included information on the allowability of offsite counseling. Lastly, New Hampshire said that its Bureau of Drug and Alcohol Services will perform a clinical audit of the OTPs in July 2022.
Please click here to read the complete report from HHS’ OIG.