Former employees of Mind Springs, a behavioral health service provider based in Grand Junction, Colo., say the center falsified patient assessments to make its treatment programs seem more effective and to secure funding for at least nine years, The Denver Post reported May 15.
The whistleblowers, who had no clinical licenses or experience with behavioral healthcare, claim they were told by supervisors to make up diagnoses for patients to justify treatment; diagnose certain patients with disorders they didn't have to qualify them for costly, Medicaid-funded treatment they did not need; and falsify patient progress among all patients they were assigned to assess — including those whose symptoms had not actually improved — because state funding for the center was partly dependant on the success of treatment.
The whistleblowers say that rather than focus on adequate treatment for patients, the center was focused on patient turnaround and inflated patient progress.
From 2017 to 2018, the center was at risk of losing up to $257,000 in state funding if it failed to show that its patients' depression symptoms became less severe in the first six months of treatment, and that symptom severity had decreased by 50 percent within a year. The falsified forms recorded patient progress to meet these requirements, according to The Denver Post.
Beyond falsifying records for funding, former case manager Amy Jensen, who took part in at least 1,000 patient assessments between 2014 and 2018, says two of her supervisors instructed her to diagnose clients serving parole with substance use disorders, regardless of a history of substance misuse. This diagnosis would ensure that each parolee would qualify for Medicaid-funded outpatient programs that generated revenue for the center.
Soon after the whistleblowers came forward, three state departments conducted audits of the center.
The Colorado Department of Public Health & Environment found "zero deficiencies," its records show, according to The Denver Post.
The Department of Human Services found Mind Springs failed to report 40 percent of "critical incidents" such as botched prescriptions, violence, injuries, patient escapes and staff wrongdoing within the required 24 hours, and to provide patients being released from its hospital with the proper paperwork for continued treatment. It also reported data submission errors, but did not cite the instances of falsified evaluation among those errors.
The Department of Health Care Policy and Financing said it found that the center had been using certain methods of auditing and statistics that enabled it to maximize government funding without expanding services.
No one conducting the audit reached out to any of the 29 current and former employee whistleblowers, according to The Denver Post.
The Department of Health Care Policy and Financing began its own internal review, and the Human Services Department also announced an investigation into the evaluation forms.
However, Ms. Jensen told The Denver Post that she worries these announcements are "a disingenuous PR move" due to her belief that previous audits were not conducted thoroughly or seriously.
Becker's Healthcare reached out to Mind Springs for comment but received no response.