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.
Don’t back down from your claims against Sweetser.
Agreed, and don’t stop blowing the whistle on waste.
I wonder why I haven’t read any articles about our esteemed Attorney General investigating this matter. If what Ms. Boardman claims is true then it sounds a lot like welfare fraud to me. It isn’t only poor people who defraud the welfare system in Maine. They are just the ones hauled into court. Isn’t that correct former Speaker Nutting?
Outgoing Speaker Nutting should be prison-going. He’s a crook and a liar.
Glad to read about this story for sure…seeing that I’m a client of Sweetser and been used by them for meany years for my Mainecare dollars….Hope the state of Maine investigate them good….!!..
Not only have you been used by Sweetser for your Maine Care dollars, I am willing to bet that during the years you have been a client of Sweetser, you have been mislead, misinformed, and generally been subject to untrained Sweetser Case Managers that have been ineffective in meeting your needs, particularly if you needed assistance in obtaining housing and meeting other daily living requirements. It is amazing the number of Sweetser employees that have no idea what they are doing and worse yet, don’t care if they misinform the client that is depending on their help.
Disgruntled employees wasting more state resources.You got fired for not doing your job. Get over it and get a gov’mint job where nothing will be expected of you.
Fired for not doing her job as in scalping Maine Care??
The only ones scalping mainecare are the droves of meth heads ,out of state welfare seekers ,no intention of ever getting a job freeloaders,generational welfare-rs and baby making machines.Sweetsers just a provider that only gets 30cents on the dollar from an over burden medicaid program thats being taken advantage of by those who do not care that others are going without so they can have.
You certainly send a very unique Christmas message.
Mainecare is saturated with fraud as you stated above but the meth heads, out of state welfare seekers, freeloaders, generational welfarers & baby making machines are not ‘the only ones” scalping Mainecare. Sweetser may get only 30 cents on the dollar from the “overburdened” system but if Sweetser cannot afford to be in business without fraudulent over-billing to compensate for the 30cents on the dollar, they need to revise how they do business, or decide whether they should even be in business.
You are not a very good businessman, or you would realize that Sweetse4r stealing your tax dollars is not good for your business.
Sweetser LIVES on tax dollars. if there was no government aid, there would be no Sweetser. ALSO, the programs at this taxpayer funded entity specialize in producing the droves of meth heads, freeloaders,generational welfare seekers and baby making machine you describe
So I take it you are in favor of providers such as Sweetsers charging Mainecare more for services then is necessary. That most certainly is an interesting concept. Do you also feel the State should overpay for other services as well?
Another agency forcing their workers to do unethical practices to fit their fscal needs. The demands on these mental health workers to meet impossible needs just contunues to get worse. I am very pleased someone is finally speaking out against it, it is not only Sweetser, it is happening everywhere
This is why I don’t trust not-for-profits! Start taxing them!
Good, I think they also give kickbacks to school guidande counselor’s for sending client their way. Was told by one that sweetster had the only program that could help my kid. When I asked why? No answer. This was also the answer when I asked why my kid needed this program. and GC would’nt even recommend 1 Pro in the Portland area. If you look in the yellowpages there are a least 100.
It has been my experience that many employers have ethics issues. An honest employee doesn’t have a chance.
but wait…..authorities say there really is very little fraud and abuse of the Mainecare/Medicare system. REALLY! There’s major abuse of the system which in turn hurts the people who really and truly need help. I never in the world would begrudge the person that honestly needs help.
This type of thing happened WAY WAY before Mainecare.
Back in 1978, I suggested the discharge of a youth from a facility where I worked. The youth had completed the program, and was ready to return to her family. It was well within my job description to access “readiness” to return to the sending community.
The director of the program called me into his office He said the “discharge” wasn’t going to happen. I inquired as to what issues we had left to address with this client? He responded “The issue of your pay.” He continued; “We get paid when the children are in program. we stop getting paid when they are discharged.”
That was about the same time that I began to believe that Maine had way too many “social service” programs