Failure to Oversee Contracted Behavioral Health Documentation and Interventions
Penalty
Summary
The governing body failed to oversee services performed by a contracted behavioral health vendor, including the accuracy of behavior documentation for two residents enrolled in the Medicaid Behaviorally Complex Care Program. The facility used a multi-page Behavior Frequency Documentation Data Sheet to track behaviors and interventions, but review of these sheets for two sampled residents showed entries with initials that could not be linked to any identifiable staff member. For one resident with schizophrenia, dementia, major depressive disorder, and generalized anxiety disorder, behavior sheets for two consecutive months contained multiple entries initialed as "AB" by an unverified staff member; a similar pattern of unverified initials appeared on another resident’s behavior sheets over two months. The behavior documentation for one of these residents included numerous interventions that were not part of the resident’s care plan and were not used by facility staff. These interventions were described as effective, successful, failed, or ineffective and included terms such as loss of privileges, time-out, detention, parent-teacher conferences, suspension, student-teacher conferences, expulsion, seclusion, calm-down corner, and corporal punishment. The Unit Manager stated that facility staff did not have access to the behavior data sheets, did not document on them, and had never used the listed interventions when addressing resident behaviors. The Administrator similarly reported that contracted behavioral health staff were solely responsible for completing the behavior documentation and submitting all related documents to Medicaid. Interviews with facility leadership and contracted vendor staff further showed that the contracted behavioral health staff, not facility staff, controlled the behavior documentation and submission process. The Assistant Administrator and Administrator confirmed that treatment and documentation for residents in the behaviorally complex care program were completed by the vendor’s behavioral health staff. A Lead Behavior Coordinator from the vendor acknowledged awareness that a Behavior Coordinator was using other initials to sign paperwork and that terms such as spanking and corporal punishment had appeared on the sheets. The vendor’s Chief Clinical Officer later determined that a single employee had documented interventions that were not actually implemented at the facility and that this employee had used an AI tool to generate interventions instead of obtaining real-time intervention information from facility staff, contrary to expectations and the consulting agreement that required accurate labeling and verification of patient data for claims submission.
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