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DHCF flags sharp billing spikes in behavioral-health programs; 15 providers suspended
Summary
DHCF testified it has identified suspicious billing patterns in community support and recovery services, leading to targeted audits, provider payment suspensions (15 currently, behavioral health only) and law enforcement referrals. DHCF said the program integrity unit has grown and deployed new analytics to detect outliers.
During the DHCF briefing, Deputy Mayor Turnage and program integrity officials described pronounced, suspicious growth in some behavioral-health billing lines. Turnage said the agency is seeing "sharp and very suspicious, billing patterns" and that community support services (CSS) enrollment and cost growth far outpaced other program areas. DHCF described targeted audits, increased payment suspensions and partnerships with law enforcement and the Inspector General.
Kevin O'Donnell, director of DHCF's Division of Program Integrity, told the committee the 15 provider payment suspensions currently in effect relate only to behavioral-health providers, with five suspensions imposed since the start of FY25 and additional credible-allegation cases under review. He said DHCF also procured a new data-analytics fraud-detection tool and will use increased data granularity (including NPIs for rendering individuals) to detect anomalous utilization patterns earlier.
