A state pilot program that uses GPS to track therapists who serve children on the autism spectrum is so fraught with problems that providers say they are having a hard time going to appointments and getting paid.
The program is one of many changes that state officials made after discovering Medicaid fraud among providers in the applied behavior analysis, or ABA, therapy field two years ago.
The state introduced the pilot program this month to provide GPS tracking – called electronic visit verification (EVV) -- of therapists to ensure they're providing the care they say they are.
The pilot program was supposed to roll out in September to nine South Florida and Treasure Coast counties, but it was pushed back each month until a soft launch happened Dec. 1.
The agency says they moved the soft launch of the EVV system to Dec. 1 "in order to conduct additional outreach, training and testing to ensure a smooth program introduction," said Patrick Manderfield, Deputy Communications Director for AHCA.
As of Dec. 17, 2019, AHCA says there are 29 group providers using the EVV system.
"The Agency has conducted extensive outreach and training with BA providers regarding the EVV system and has encouraged providers to contact the Agency or Tellus with any questions or concerns they may have," Manderfield said.
But participating behavior analysts and registered behavior technicians in the pilot program region say the software is riddled with issues and they fear the mandatory roll-out in just three months. That rollout will be mandatory only to the pilot counties: Broward, Miami-Dade, Monroe, Indian River, Okeechobee, St. Lucie, Martin, and Palm Beach counties
"Statewide roll-out is contingent on our evaluations of the pilot and future legislative approval," Manderfield said.
Karin Torsiello, a board-certified behavior analyst and president of Behavior Basics, based in Port St. Lucie, said her staff logged 16 errors in the three days they tested the program.
"We went through a big struggle to hopefully help many, many people, but I can tell you that they did experience some level of trauma response,” Torsiello said. “It was very stressful, and so they are hesitant to touch it again."
Torsiello said AHCA refused to address concerns via email and bounced staff members around on the phone. The company contracted to provide the tracking software, Tellus, LLC, has been largely unresponsive to calls and emails documenting the errors.
The errors included an inability to log locations because of poor cellular connectivity or lack of access to WiFi, despite assurances that the app works via satellite; inaccurate billing codes; not allowing appointments to be logged for more than an hour; Tellus saying client addresses were invalid; and appointments showing as completed for future dates that hadn’t happened yet.
ABA providers should be held accountable – and hold themselves accountable – for properly spending taxpayer money, Torsiello said. But she said she is frustrated that Tellus does not appear to be held to the same standards.
"If you're hired to do a job and it's a computer programming issue and you do it for other provider types, nine months into this, you should have learned what our provider type looks like by now and how we function,” Torsiello said.
Despite that, Torseillo said she’s hopeful AHCA and Tellus will work out the bugs, because when the tracking system becomes mandatory, providers will not get paid if they can’t file claims properly.
“At the end of the day, every business needs cash flow and order to make payroll, pay their rent, office supplies, etc.,” Torsiello said. “We need to get paid in order to keep our doors open to keep our staff employed so that they can service the kiddos. And in order to do that we have to be able to build our claims.”
The tracking system and other changes were supposed to cut back on Medicaid fraud. But hasty roll outs, and the agency backtracking after provider and parent feedback, led to many children losing services temporarily or permanently and providers not getting paid.
“And on other side of that coin, AHCA and Medicaid need to be able to verify that we were where we said we were, that for those three hours that they're going to reimburse us for we were really with Johnny at his home on 123 ABC Street, you see what I'm saying?” Torsiello said.
According to AHCA, the cost of Tellus’ contract will be $1.2 million annually. The costs are eligible for a 50% federal match, so only $600,000 is attributable to state funding under the Contracted Services portion of the Medicaid budget.
The appropriation was made during the 2019 Legislative Session for State Fiscal Year 2019-2020.
Andrew Houvouras, president of the Florida Association for Behavior Analysis, said earlier this year that the organization supported efforts to crack down on fraud and would happily comply with the pilot program to see how efficient it is.
"The Medicaid program must remain vigilant to guard against waste, fraud and abuse," Manderfield said. "Every dollar fraudulently billed is a dollar that can’t be used to effectively support critical resources for Medicaid members."
The state has not released information about how much money was lost due to fraud.