TOLEDO, OH (WOWO) A Toledo behavioral health agency has been ordered to repay nearly $1.87 million after a state audit found extensive billing errors, missing documentation and services rendered without proper authorization.
The audit, released by the Ohio Auditor of State, reviewed claims submitted by Empowered for Excellence Behavioral Health (EEBH) between January 2021 and December 2023. Investigators identified $1.75 million in improper Medicaid claims, plus more than $115,000 in interest, and issued an adverse opinion citing repeated noncompliance with state Medicaid rules.
Auditors said the violations were broad, including missing treatment plans, claims without clinical documentation, duplicate or excessive billing on the same dates, and services billed beyond daily limits. Some staff billed at higher clinical rates than their documentation justified, and one practitioner billed before receiving required certification according to WTOL Toledo 11.
One of the largest findings involved Therapeutic Behavioral Services per diem claims. In a sample of 60 services, auditors found errors in 42 of them. That sample was used to project a $1.73 million overpayment in that category alone. Auditors also reported instances of “cloned notes,” where identical clinical records were copied across patient files instead of individualized entries.
In its formal response, agency CEO Jonathan James disputed many of the findings, arguing the audit misinterpreted treatment plan language and that all services were delivered appropriately. James called the issues “clerical and procedural documentation errors” rather than evidence of overbilling.
He said the treatment plans in question did authorize group services under the Ohio Administrative Code and that billed services were properly documented in progress notes. However, state officials rejected that claim, saying the reviewed plans did not authorize TBS services or list required interventions.
Empowered for Excellence received nearly $15 million in Medicaid payments during the audit period for more than 114,000 mental health and substance use disorder services. The organization has been instructed to tighten internal controls and ensure documentation is complete before billing.
Repayment is required following adjudication by the Ohio Department of Medicaid.
According to its website, the organization is a nonprofit that provides mental health and addiction services, including outpatient therapy, intensive outpatient programs, psychiatric care and sober living support for adults and adolescents.
