By Jeff Balke
By Aaron Reiss
By Angelica Leicht
By Dianna Wray
By Aaron Reiss
By Camilo Smith
By Craig Malisow
By Jeff Balke
With help from Steve Tapscott, owner of the Texas Treatment Center methadone clinic, to which many HMC patients were transferred after TCADA's HMC shutdown, Sprague alerted Medicare to the apparent fraud. As of February 22, 2000, Medicare provider TrailBlazer Health Enterprises of Dallas had investigated and informed Sprague that "Medical records were secured from the provider and reviewed by our medical staff. It was determined that the services were not properly documented. We have, therefore, taken the necessary steps to recover the overpayment made to this provider."
Nothing above surprises Patrick Nolan, an HMC counselor who worked at the clinic less than five months before TCADA shut it down. Nolan has since gone to work for Tapscott's Texas Treatment Center.
Nolan never could understand the system by which HMC billed its methadone clients. TCADA provided reimbursement of up to $56 per week for HMC's treatment of methadone patients, some of whom qualified for free treatment or co-payments on a sliding scale, generally $1 to $3 per treatment.
"The clinic was still charging $21 a week extra. We determine eligibility as counselors, to see whether these clients can afford nothing, 50 cents a week, $5 a week. No matter what we determined, the computer would always say $21 a week, and it would keep racking up that bill for them, and racking it up and racking it up."
Nolan says clients were never forced to pay the bill before being treated, a practice known with an ugly lack of euphemism as "administrative detox," but that the bills caused a lot of arguments and confusion at the clinic. "Every morning, every day, every week, it was, 'Why do I owe so much when you told me I only owed a dollar a day?'
"I don't know if they somehow could get reimbursed for that. I really don't know that angle of keeping that in the computer. I'd say, 'It's not right,' and they'd say, 'You don't understand how we bill.' You could tell it was money-oriented because that's all we ever talked about. It was always, 'Where's the money, let's talk about the money, we need more money.' And I can tell you for a fact: I happened to get a glance of the payroll one time, for the Ozumbas, and it was shocking. They're literally [taking home] around $300,000 a year for both of them."
A current employee claiming knowledge of the payroll, who doesn't want his name used, confirms, after a long pause, the $300,000 figure as "close enough."
Regulatory agencies were not unaware of Houston Maintenance Clinic's idiosyncrasies. The Texas Department of Health, in response to a Freedom of Information Act request filed by the Press, provided copies of its own inspection reports for 1997, 1998 and 1999. TDH found that in HMC's first year of operation, a random review of 23 patient files found 21 that were incomplete or inaccurate. In 1998, 18 files were reviewed at random, and 15 were deficient. In 1999, 16 out of 19 patient files contained various irregularities.
TCADA also long had reason to be suspicious. The agency had, by its own account, weathered the entire course of HMC's contract without an acceptable accounting of the clinic's finances. A November 1998 TCADA audit reads like an encyclopedia of mismanagement. "Significant programmatic and financial weaknesses previously identified by the Commission in September 1997 remain uncorrected," the auditors wrote. "The clinic does not have policies and procedures for the following areas: Recording and reporting of program income." The commission found, contrary to Patrick Nolan's belief that no administrative detox was practiced at HMC, that 10 percent of examined client records "indicated that inability to pay would result in 'no dose' or administrative detoxification." Of the examined client records, 52 percent "contained no financial assessment, an incomplete assessment, or an assessment showing inability to pay," wrote the auditors. "However, progress notes discuss repeatedly 'client fees' and 'need to make payment' as an ongoing issue."
"A review of client records at Houston Maintenance Clinic indicates that treatment services are not adequately planned and delivered."
"Based on a review of general ledger accounts, it is evident that the Clinic charges the commission for costs that are unallowable such as bank charges, donations made, employee meals, property taxes, and penalties & fines."
TCADA identified "questioned costs" totaling $23,299.
HMC management provided replies and corrections to the commission's findings, but a post-audit letter from TCADA to HMC board chairman Dr. Youmay U. Ogboso stated that while "Management's responses do indicate corrective action planned they did not adequately address all of the recommendations in the report." One year later, in November 1999, the commission wrote to Amos Ozumba, rejecting HMC's request for "more time" to submit "an acceptable single audit covering the fiscal year 1997 and fiscal year 1998 periods." Later the same month TCADA wrote Ozumba that HMC's failure to submit the audits had resulted in suspension of the TCADA contract. Ten days later TCADA wrote Ozumba again, "abating" the suspension because Ozumba had "indicated that cash flow problems may impact [HMC's] ability to continue contractual obligations to TCADA clients."
Finally, on February 16 of this year, TCADA terminated HMC's contract. Final audits, and possibly a final payout of state money to cover recent documented and acceptable expenses, are still to come. TCADA's Goodman also confirms that the commission is investigating "a complaint" against the clinic, but she is not authorized to say more than that.