Medicaid provider must repay funds

A Portsmouth man may or may not be facing criminal charges, but according to the Ohio State Auditor, the man owes the state Medicaid system more than $139,000 related to what a state audit says are overpayments for healthcare services provided by the man and paid for by the state.

In a detailed report released by the auditor’s office, state officials claim that Joseph V. Poole of Portsmouth allegedly misrepresented his credentials — most specifically regarding first aid certification – in providing home healthcare services. The report alleges Poole was overpaid $127,901. The larger amount the state claims it is owed results from interest being added to the principle at least through early February.

The auditor’s report concludes, “if waste and abuse are suspected or apparent, [Ohio Department of Medicaid] and/or the office of the attorney general will take action to gain compliance and recoup inappropriate or excess payments in accordance with Administrative Code.”

The report does not make clear if Poole could face criminal charges as well as having to repay any funds the state says were inappropriately paid out. Asked for clarification of that issue, a spokeswoman for the auditor’s office did not return a phone call by press time. She also could not say what arrangements the state might allow Poole for repaying the sizable sum of money he allegedly owes.

The auditor’s report states the examination looked at Poole’s activities related to the provision of personal care aide and homemaker/personal care aide services provided between January 2013 and December 2015. The report claims Poole entered into a provider agreement with the Ohio Department of Medicaid (ODM) to provide services to Medicaid recipients, but also to adhere to the terms of the agreement, state statutes and rules along with federal statutes and rules, including the duty to maintain records supporting claims for reimbursements made by ODM.

“Our examination disclosed that the provider did not maintain first aid certification for the period of November 2013 through Dec. 12, 2014,” the report reads in part.

Additionally, the state claims Poole’s documentation of personal care aide services lacked required signatures from the recipients of his care.

“Also, the provider was reimbursed for activities that were not authorized on the individual service plan and were not consistent with the definition of personal care aide service,” the report continues.

In an appendix to the state report, Poole provided a two-page response. Among other arguments, Poole says he was not required to maintain first aid certification for the entire period claimed by the state. Poole claims he took the required first aid and CPR classes in December 2014. Poole further states that all documents relating to care provided were properly signed and that he was in compliance with any rules set out by Ohio Medicaid “and everyone else concerned.”

Some of the statement Poole gave to the auditor appears to be redacted in what was released to the public, the reason appearing to be that the full statement would have identified some of the people for which he provided care.

“What you have recommended would destroy my family’s financial security,” the conclusion of the statement reads in part. It also talks about destabilizing “the life and well-being” of presumably one of Poole’s patients, the name of which was redacted as previously noted.

The state did not provide contact information for Poole, and the Daily Times was unable to reach him personally for further comment.

Reach Tom Corrigan at 740-353-3101 ext. 1931.