Albany’s Whitney M. Young Methadone Clinic Billed Medicaid for Substance Abuse Treatment That Failed to Meet Required Standards

As Opioid Crisis Sweeps NY, Quality of Treatment is Critical; AG Schneiderman Continues Multi-Faceted Approach to Combating Epidemic

New York Attorney General Eric T. Schneiderman recently announced a $1.25 million settlement with the Whitney M. Young Health Center for improper billing by its Methadone Maintenance Treatment Program, which failed to properly document patient treatment plans necessary for the patients’ care.

“As the opioid epidemic continues across the state, New Yorkers seeking help with addiction deserve to know they’re getting highquality treatment. We will not tolerate Medicaid providers delivering substandard treatment, while New Yorkers foot the bill,” saidAttorney General Schneiderman. “My office will continue to hold Medicaid providers accountable and protect the integrity of the system.”

The Whitney M. Young Health Center’s Methadone Maintenance Treatment Program provides methadone and counseling for Medicaid recipients recovering from substance abuse addiction. The purpose of a treatment plan, as required by Medicaid, is to provide a tailored clinical plan for each patient devised by a multi-disciplinary team. The treatment plan must include patient input that prioritizes and addresses an individual’s needs so that he or she will have the tools to successfully progress through treatment. When these plans are properly created, implemented, and followed, they help those suffering from addiction complete treatment and change their behavior in positive ways that improve their lives. When treatment providers render substance abuse services that meet quality requirements, they provide crucial treatment to those in need. Given the opioid epidemic sweeping both the State and the country, the quality of treatment is critical.

The Attorney General’s office reviewed approximately two hundred patient files from the Whitney M. Young Methadone Maintenance Treatment Program. Many of the patient files had incomplete treatment plans. Many of the treatment plans were not discussed, reviewed or signed by the patients as required by law.

In the settlement agreement, Whitney Young agreed to repay the $1.25 million it was not entitled to receive from Medicaid, and to have an Independent Monitor in place to ensure that all Medicaid rules and regulations are followed. The Monitor will also ensure that treatment plans are properly created, maintained, and up-to-date.

Since taking office, Attorney General Schneiderman has launched a multi-levered strategy to tackle New York’s evolving opioid epidemic, including:

• Obtaining settlements with major domestic and global health insurers including Cigna, Anthem, and Empire BlueCross BlueShield (BCBS), which insure over 4 million New Yorkers, to remove barriers to life-saving treatment for opioid use disorder. The agreements put an end to the insurers’ policy of requiring prior authorization for medication-assisted treatment (“MAT”), which can lead to significant delays for patients seeking relief from addiction.
• Launching a multistate investigation – as part of a bipartisan coalition of 41 attorneys general - into whether opioid manufacturers and distributors engaged in any unlawful practices in the marketing and distribution of prescription opioids.
• Creating the Internet System for Tracking Over-Prescribing Act (“I-STOP"), a series of enhancements to New York’s prescription drug monitoring program that provide doctors with patient’s up-to-date controlled substance prescription history and established a safe disposal program providing a place for New Yorkers to get rid of expired and unneeded drugs—thus reducing the likelihood of stolen and forged prescriptions being used to obtain controlled substances from pharmacies. I-STOP reduced “doctor shopping,” a practice in which an individual attempts to obtain the same or similar prescriptions from multiple physicians, by 90% since 2014.
• Launching the Community Overdose Prevention (“COP”) program, a life-saving initiative that enabled state and local law-enforcement officers in the state of New York to carry naloxone, the extremely effective heroin antidote that can immediately reverse the effects of an opioid overdose. Since the program’s implementation in April 2014, more than 100 overdoses were reversed using kits provided by the COP program, which distributed over 27,000 kits across the state.
• Obtaining an agreement with Amphastar Pharmaceuticals, Inc. to cut and cap the price of naloxone for all agencies in New York State, reducing the price of naloxone by nearly 20 percent.
• Enforcing Mental Health Parity Laws to reach agreements with health insurance companies, requiring them to implement sweeping reforms in their administration of behavioral health benefits, in particular relating to medical management practices, coverage of residential treatment for substance abuse, and co-pays for outpatient treatment, and to submit regular compliance reports. The agreements ultimately provided over $2 million in restitution for members whose claims for were improperly denied.
• Successfully prosecuting more than ten licensed prescribers including operators of “pill mills” and other unlawful practices for crimes related to improper opioid prescriptions.
• Cracking down on drug trafficking networks that traffic opioids into communities around the state. The Attorney General’s Organized Crime Task Force (OCTF) has now taken down 25 large drug trafficking gangs, made more than 580 felony narcotics arrests, and seized more than $1.5 million and more than 2,000 pounds of illegal drugs since 2011. In the past several months alone, Attorney General Schneiderman’s SURGE (Suburban and Upstate Response to the Growing Epidemic) Initiative has resulted in 260 alleged traffickers and dealers taken off the streets.
• Urging health insurance companies to review their coverage and payment policies that contribute to the opioid epidemic, as well as sending letters to the country’s three largest pharmacy benefit managers requesting documents, data, and other information regarding how they are addressing the opioid crisis.

This case was investigated by MFCU Principal Auditor Investigator Sarah Finning, Auditor Investigator Alyssa Filkins, and Investigator Joseph Farrell, with assistance from Regional Chief Auditor Charles Norfleet and Supervising Investigator Dianne Hart.

The case was handled by MFCU Albany Regional Director Kathleen A. Boland. Catherine Wagner is MFCU’s Chief of Upstate Criminal Investigations. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul Mahoney. The Criminal Justice Division is led by Executive Deputy Attorney General Margaret Garnett.

Read the settlement agreement here.