Rights panel to hear complaint against Sweetser on MaineCare billing

Posted Dec. 24, 2012, at 3:43 p.m.

AUGUSTA, Maine — A Brunswick woman who alleged she was fired for reporting “what she reasonably believed to be illegal work practice” for billing MaineCare has reasonable grounds to proceed with her claim, a Maine Human Rights Commission investigator has found.

The commission is expected to rule on the claim when it meets Jan. 14.

According to commission documents, Eileen Boardman claims her employer, the mental health nonprofit organization Sweetser, encouraged her to keep clients in her office for a full two hours so Sweetser could bill MaineCare for the time.

Sweetser disputes the claim.

A report filed by investigator Domini Pham notes that Boardman was told in April 2010 that “productivity requirements for intake clinicians would be reviewed more stringently” because time used completing paperwork could no longer be billed to MaineCare, the state version of Medicaid. Instead, clinicians could bill only for direct face-to-face time with clients.

After the change in practice, Boardman said Sweetser urged her “to retain clients unnecessarily for the maximum two hours in order to bill MaineCare for the full 120 minutes.” Later that year, Boardman claimed, her supervisor suggested she schedule short assessment meetings with clients “or look to keep client in the room for longer periods of time with discussion about what support might be needed…”

Boardman told the investigator she believed this was a directive to “either make clients keep two shorter appointments or for her to keep clients in a longer appointment … purely to bill for MaineCare hours.”

Boardman met with her supervisor and Sweetser’s vice president of programs about her concerns, according to the complaint, describing the new directive as “illegal and immoral” and in violation of her social work code of ethics.

She was terminated from the job in Sweetser’s Brunswick office in September 2010.

Sweetser told the investigator that it established productivity levels for its clinicians “to ensure that the business generates enough of their work week to performing billable work” and so the business “generates enough income to pay its clinicians.”

Beginning in January 2010, Boardman’s supervisor observed that she was “good at conducting assessments” but working below the expected level of billable hours. Subsequent meetings between supervisors and Boardman were scheduled to help her achieve the desired productivity, Sweetser officials told the investigator.

Sweetser also reported that Boardman “was resigned to her employment being terminated for failing to meet her productivity goals.”

Sweetser also told the investigator that Boardman was fired after a client complained about her.

Investigator Pham concluded there was at least an even chance that Boardman’s claim would prevail in court, which is the commission’s standard for reasonable grounds. Pham wrote that the “evidence indicates [Boardman] repeatedly objected to the proposed practice of unnecessarily detaining clients for intake to bill MaineCare for the allowable maximum time.”

Pham also noted that another employee who complained about the alleged directive to keep clients in the office longer eventually complied with that approach, and was not terminated.

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