Northeast Kingdom Human Services has agreed to pay Vermont $65,335 to settle a Medicaid fraud and neglect investigation launched by the Vermont Attorney General’s office. Under the settlement, announced Monday, the social service nonprofit has also promised to undergo reforms to better serve its clients who might pose a risk to themselves or others.
NKHS is one of Vermont’s designated agencies. The private nonprofits are contracted by the state to offer a slew of mental health, substance-use disorder and disability services on a regional basis. The Northeast Kingdom nonprofit serves Caledonia, Essex and Orleans counties.
According to the settlement, NKHS failed to safely supervise an adult with severe developmental disabilities entrusted to its care between 2022 and 2024. Despite their client’s “escalating aggressive and sexualized behavior,” the state says NKHS staff didn’t properly plan the vulnerable adult’s care and at times improperly transported and restrained him.
Among other reforms, the nonprofit has agreed to hire someone with relevant expertise to review behavioral support plans for clients who pose a risk to public safety.
Separately, the settlement says one of the nonprofit’s therapists incorrectly billed Medicaid for 149 one-hour sessions when shorter appointments had actually been provided. This pattern of medical billing fraud known as upcoding resulted in overpayments totaling a little over $8,000.
NKHS did not dispute the state’s allegations, although the settlement emphasized that the nonprofit caught the upcoding problems internally and reported them to the state.
“Vermont’s Medicaid providers must engage in robust compliance monitoring and promptly self-report errors,” Vermont Attorney General Charity Clark said in a statement. “These actions help us protect the integrity of the Vermont Medicaid Program, which thousands of vulnerable Vermonters rely on.”
This isn’t the only venue in which NKHS has recently been accused of improperly upcoding Medicaid.
A former employee, Tesla Hubbard, has taken NKHS to court, arguing she was retaliated against and fired for raising concerns about the nonprofit’s billing practices. Hubbard claims the nonprofit was routinely double-billing for its mobile crisis services, and that she was let go for raising the issue internally and to the state.
Hubbard’s claims concern a different set of Medicaid-funded services than those dealt with in Monday’s settlement. It’s unknown if the attorney general is investigating Hubbard’s claims, although Hubbard’s attorney, Alexander Dean, said the state was at one point looking into them. He said Monday he doesn’t know the status of that investigation.
Hubbard’s lawsuit, which was filed in March in federal court, is ongoing. In legal filings, NKHS has denied Hubbard’s allegations.
