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DBH: two providers drove RSS billing spike; 11 decertifications, payment suspensions underway
Summary
DBH told the Committee on Health that a large Medicaid billing spike for Recovery Support Services (RSS) was driven by two providers; DBH has decertified 11 providers, suspended local payments for 8 providers, and is coordinating audits with DHCF and the Office of Inspector General.
Council members asked how DBH is preventing fraud and protecting patients after DBH and DHCF raised alarms about spiking claims. "When we saw the spike in RSS, we moved in on that one fairly quickly," Dr. Basron said, adding that one provider’s records showed fraud and was decertified while another was delivering services at high volume and is under audit.
Senior Deputy Atiyah Jackson told the committee DBH prioritized onsite reviews and joint audits with DHCF and said the department has decertified 11 providers and suspended local payments for eight while investigations continue. "Those investigations and audits are still in play," Jackson said. DBH said some decertifications are under administrative appeal before the Office of Administrative Hearings and noted appeals stay enforcement actions.
Committee members pressed DBH on the consumer notification process when payments are suspended or decertifications are initiated. DBH acknowledged inconsistent notification and pledged to improve communication with affected clients about their options, transfers, and appeal timelines. DBH said it will increase quarterly reporting for provider performance and publish more provider‑level metrics to improve transparency.
