ACA.supremecourt.070419

Records from a health center that's accused of misdiagnosing Iberville Parish students as having serious mental health disorders will follow those students for years, authorities say, but the full impact of the false reporting — part of an alleged scheme to maximize Medicaid payments — remains unknown.

Federal prosecutors allege that from 2011 to 2015, St. Gabriel Health Clinic Inc. officials gave schoolchildren bogus mental health diagnoses, without informing their parents, and offered group therapy sessions during classroom hours, all to collect Medicaid reimbursement.

Six charged in federal health care fraud schemes totaling nearly $250 million, U.S. attorney says

The clinic siphoned more than $1.8 million from the federal health care program "without regard to whether such diagnoses were accurate or had any basis in fact," according to an indictment filed in U.S. District Court in Baton Rouge.

Two of the clinic's top executives, Victor Clark Kirk, 70, and Marilyn Brown Antwine, 51, both of Baton Rouge, have been charged with fraud as part of a wider crackdown on alleged Medicaid misuse in Louisiana.

The nonprofit they ran had contracted with the Iberville Parish School Board since 1997, but the school ended its mental health contract with the group in 2015. Three years later the board signed on again with the clinic, but in a more limited fashion.

The U.S. Attorney's Office said the clinic's faulty diagnoses of students would remain on their healthcare records, but it’s unclear if any of those fraudulent reports found their way into official student records and if students suffered any adverse effects as a result.

Iberville Parish Schools Superintendent Arthur Joffrion said Wednesday the diagnoses wouldn't have harmed students’ education.

“It shouldn’t have had any impact on their quality of instruction that the students were receiving at the time," he said, adding that since he became superintendent in 2016, he hasn't received any complaints from parents or students connected with this issue.

The clinic falsely identified students as having serious mental disorders and billed the government for questionable services it performed in three parish schools, according to a federal indictment. The clinic offered educational programs as group psychotherapy, including the Character Counts! program, so the clinic could continue to earn reimbursement from the federal healthcare program, according to court records.

Amy Smith, a spokeswoman with Character Counts!, a nationally known character education program, said the organization does not track who uses the program or why. “Anybody can go onto the website to purchase resources,” she said.

She added that she’d never heard of anyone describing Character Counts! for group psychotherapy.

Jamie Tindle, executive director for the special needs advocacy group Families Helping Family of Greater Baton Rouge, said she doubts the bogus medical records got mixed in with student records. She said the false diagnoses would have likely triggered a flood of new individualized education plans, which require parental approval. Even so, she urged parents to check to make sure.

“I would be skeptical,” Tindle said. “I would want to go to the school and make sure none of that was in their record.”

Federal authorities said St. Gabriel Health Clinic sent parents consent forms allowing behavioral health professionals to treat students without notifying them when the clinic performed a service, which then allowed the clinic to bill insurance companies and Medicaid. Once the clinic diagnosed a student, its officials would ask for federal reimbursement for psychotherapy services that were neither actual group therapy sessions nor medically necessary, the federal complaint alleges.

The indictment describes the lengths Kirk and Antwine went to falsify documents, including firing an employee who refused to change a student's diagnosis code needed to secure reimbursement.

According to the nonprofit’s tax filings, Kirk made $100,006 in 2016, while CEO Shirley Wade made $134,000. The company listed making more than $2 million in 2015, with more than half coming through contributions and grants.

An attorney representing Kirk didn't return a message Wednesday seeking comment on the charges.

The Iberville School Board's decision to sever ties with St. Gabriel Health Center came amid complaints from parents about students being pulled from core classes by clinic nurses for medical exams, billing parents’ insurance companies without proper consent before treatment and attempting to treat students without parental consent forms on file. The bulk of the complaints were from the Math, Science and Arts Academy-East campus.

Neither Joffrion nor the U.S. Attorney's Office knew how many students received false diagnoses. Federal court records allege St. Gabriel Health filed for fraudulent reimbursements at least 100 times.

The school district enacted a handful of policies in 2018 to ensure parents are notified before their kids receive on-campus behavioral or mental health treatment. Joffrion said parents are often present during the intake process, the first step before students are diagnosed and given treatment options as well as plans for specialized education.

The school district began contracting with St. Gabriel Health Clinic last year for nursing services. Joffrion said the school board approved the contract after school officials were satisfied with the nonprofit's leadership change and that the clinic isn't providing mental health services.

The clinic didn't return a message Wednesday seeking comment.

Email Youssef Rddad at yrddad@theadvocate.com.