A troubled Western Slope mental health care center falsified assessments of its patients’ conditions for at least nine years in an effort to make its treatment programs seem more effective and secure funding from the state, whistleblowers say.
Former workers describe a long practice by the Grand Junction-based Mind Springs Health of intentionally writing bogus patient evaluations. The three departments tasked with regulating Colorado’s mental health safety net system failed to notice the allegedly falsified reports during a recent multi-agency audit of the center, and over years of lax oversight.
“You’ve got to wonder how closely these so-called regulatory agencies are really looking,” said Sunny Sullivan, one of 29 current and former Mind Springs workers who came forward to tell the Colorado News Collaborative (COLab) what they see as legal and ethical breaches.
State officials say they offer considerable leeway in how forms are filled out, but Sullivan and five other former workers say their supervisors had them and their colleagues fill out mental health assessments of patients they knew little or nothing about and hadn’t actually evaluated. The whistleblowers, who were not trained in behavioral health care and had no clinical licenses or experience at the time they worked for Mind Springs, say their bosses also told them to:
Make up diagnoses for patients to justify treating them
Diagnose certain patients with disorders they did not have in order to qualify them for costly, Medicaid-funded treatment they did not need
Show progress among all patients they were assigned to assess – including those whose symptoms had not actually improved – because state funding for the center hinged partly on the success of its treatment
Mind Springs’ longtime CEO Sharon Raggio and two of its other top executives resigned following a Colorado News Collaborative investigation about access to and quality of the center’s care. Interim CEO Doug Pattison and the center’s spokeswoman had not returned multiple emails and phone calls over several months about these latest allegations before the deadline for this story.
The former workers’ accounts span from 2012 to 2021, suggesting that falsifying records wasn’t merely a one-off or occasional mistake.
“I’m no legal expert, but I’m pretty sure what we were doing was fraud,” says former case manager Amy Jensen, who estimates she took part in doctoring at least 1,000 patient assessments between 2014 and 2018. “I’ve wondered how long it could go on without anyone at the state bothering to do something about it.”
Mind Springs is one of 17 regional community mental health centers statewide that have long made up the core of Colorado’s safety-net system, serving people in 10 Western Slope counties.
The Behavioral Health Office long has required the centers and other mental health care providers complete evaluations called Colorado Client Assessment Records, or CCARs for short, for each person receiving Medicaid or other publicly funded care. One CCAR must be filled out upon intake for treatment and another when treatment has ended. Care providers must submit additional CCARs for clients in long-term therapy and for psychiatric patients who are medicated or hospitalized long-term.
From a policy perspective, the evaluations help state agencies track who’s getting state and federally funded mental health treatment and the extent to which it’s helping. The state also uses aggregated data from the reports to inform lawmakers about the efficacy of Colorado’s overall mental health safety-net system. The clarity of that picture depends on the accuracy – and truth – of the information providers like Mind Springs submit.
From a clinical standpoint, the mere mention of a CCAR form can trigger groans among care practitioners who often complain the assessment and other mandatory state paperwork take too long to complete. Because the need for publicly funded mental health care services far exceeds the number of clinicians available, the people most familiar with patients’ cases and who are most qualified to assess them often are slow to fill out the reports. That leaves backlogs of CCARs that need to be completed and submitted to the state in order for a provider to get paid.
At Mind Springs, whistleblowers say they were typically asked to fill out the CCAR after the patient was long gone from treatment or discharged from Mind Springs’ psychiatric hospital. And so they typically filled in clients’ diagnoses blindly, often guessing they had conditions such as general anxiety disorder, major depressive disorder, or schizoaffective disorder. Sullivan – then a team leader in the hospital admissions office – says her supervisor told her and her staff to write in “adjustment disorder” under the reasoning “that everyone has trouble adjusting to something, so nobody would be questioning that diagnosis.”
Mind Springs’ objective, as whistleblowers tell it, was speed, not accuracy.
“They said just put down your best guess, and fast,” says Sarah Mackie, who also worked in hospital admissions. “I had no sense of who these patients were. I had no clue how they would (have) answered these questions about themselves. And I had no idea what I was doing.”
“I had zero business – zero, zero, zero – diagnosing people,” adds Jennifer Hector, another former employee of the admissions office.
Each of the whistleblowers says she was encouraged to work on CCARs whenever she had downtime on a shift. Some were called in to work evenings or weekends to complete hundreds of the assessments in Mind Springs’ backlog. Supervisors referred to those occasions as “CCAR parties,” says Hector, who estimates she completed about 700 of the questionnaires in one year alone, 2015. “You just sat there, put your head down and did nothing but fill out those forms.”
The single mother of seven says she told her supervisors “I don’t want to do this” and “I’m not comfortable… messing with the state of Colorado and funding.”
To her many objections, she says they had the same response: “That I didn’t have a choice.”
Amy Jensen is a former case worker at Mind Springs who estimates she took part in falsifying at least 1,000 patient assessments.
Jensen, the former Mind Springs case manager, also struggled with signing her name to phony assessments of people. She says supervisors assured her the assignment was legal and urged her to stop raising objections.
“They had us flat-out making stuff up, then came down on us for asking if it was legal or even ethical,” she says. “I felt like I was in the Twilight Zone. Like, am I nuts? Why does everybody think this is OK?”
Four of the five whistleblowers say supervisors instructed them, when working on a client’s discharge evaluation, to answer all 25 questions about mental health symptoms at least one number lower in severity than the corresponding number on that client’s intake CCAR. Mind Springs’ goal, they say, was to document that clients had improved from its treatment, whether or not that was actually true.
“We’d ask can we go read their treatment plans or their charts, and they’d say no, just mark them better, just mark them a point or two lower on all the questions,” Hector says.
Mental health care records are protected under HIPAA, leading the state to refuse the Colorado News Collaborative’s requests for CCARs submitted by Mind Springs and for certain data gleaned from them.
“What this means to people who needed help really bothers me. I hate to think of how many people weren’t getting the right treatment because of that,” says Reggie Bicha, who ran the Human Services Department under former Gov. John Hickenlooper.
It was under Bicha’s leadership that the state started to hinge its exclusive contracts with community mental health centers partly on their performance. Bicha’s behavioral health staff worked with each center to set quality improvement goals it had to meet to receive its monthly reimbursements from the state and renew its annual contract.
In fiscal year 2016-2017, for example, “improvement of symptom severity” was one of Mind Springs main performance goals. The state was only able to monitor progress through CCAR data.
In fiscal year 2017-2018, Mind Springs stood to lose up to $257,000 in state funding if it failed to show that symptoms of its adult clients’ depression were becoming less severe in the first six months of treatment and that the severity of those symptoms eased by 50% within a year. CCARs were key in demonstrating progress.
The often cash-strapped center had other possible reasons to falsify client assessments, including a program that gave centers the opportunity to earn extra funding if they “exemplify(ied) extraordinary performance.” That statewide pot was small at first, at only $50,000 in fiscal year 2016-2017, but by fiscal year 2017-2018 had grown to $3.9 million.
As Bicha tells it, a program that had real potential of boosting Mind Springs’ cashflow may have backfired.
Mind Springs Health in Grand Junction, Colo., on Friday, March 18, 2022.
“The intention of our performance management was to understand problems, hold ourselves and our partners more accountable and to drive better results for the people of Colorado,” he says. “A system that has contractors gaming it flies in the face of all of those priorities.”
Whistleblowers point to other incentives at play.
Jensen, for example, recalls being assigned to evaluate clients serving parole with a community corrections company that partnered with Mind Springs. She says two of her supervisors and one member of upper management instructed her to diagnose every one of those parolees with a substance abuse disorder, regardless of whether they had a history of substance abuse. The diagnosis ensured that each parolee would qualify for a Medicaid-funded intensive outpatient program that brought in money for Mind Springs.
As a private nonprofit, Mind Springs is not required to disclose how much it made from its partnership with the company.
The Colorado News Collaborative’s investigation into Colorado’s mental health safety net focused not just on troubles at Mind Springs, but also more broadly on state agencies’ longtime failure to regulate community mental health centers.
Shortly after those stories appeared in at least 30 partner news outlets statewide, Gov. Jared Polis’s administration announced the state was conducting an audit of Mind Springs with three state departments would be involved.
The Colorado Department of Public Health & Environment found “zero deficiencies,” its records show.
The Department of Human Services found Mind Springs failed to report 40% of “critical incidents” such as botched prescriptions, violence, injuries, patient escapes and staff wrongdoing within the required 24 hours, and to provide patients being released from its hospital with the proper paperwork for continued treatment. It also found data submission errors, but falsified client evaluation was not among them.
The Department of Health Care Policy and Financing – which controls the Medicaid funding that makes up most of community mental health centers’ budgets – announced Thursday that it found Mind Springs has been using various auditing methods and statistics that allowed it to expand its government revenues without expanding its services. It also found a need for Mind Springs to simplify its complex corporate structure and to improve the quality of its care.
As part of the audit, nobody from the three state departments reached out to any of the 29 current and former Mind Springs workers who at that time started contacting the Colorado News Collaborative about practices at the center.
The whistleblowers hold little faith in state audits.
“Mind Springs Health was audited all the time. We saw auditors in and out of that place and they never seemed to see what we were seeing, or even ask us. It makes me wonder if they even took their jobs seriously or if they simply ignored possible issues of fraud,” Sullivan says.
Sunny Sullivan, a former team leader in the admissions department of Mind Springs’ psychiatric hospital, West Springs, blew the whistle on a long pattern of falsifying patient records. She says she has little faith in state agencies’ willingness to meaningfully inspect and regulate the troubled Grand Junction-based community mental health center.
For months this winter and spring, the Human Services Department downplayed the relevance of allegations about falsified CCARs, saying state law gives leeway in how mental health providers fill out state reports. A spokeswoman, who since has left the department, emailed in March that state policy “does not dictate the physical location in which CCARs must be filled out and in most cases does not specify who can fill out a CCAR.”
“OBH Rule does not require an assessment to be performed in person… or by a licensed individual,” Maria Livingston wrote. “OBH staff routinely review CCAR data in line with the CCAR Data Reporting Policy as part of regular licensed/designated-provider site visits and reviews. The review involves checking to see if CCAR data is incomplete or missing.”
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She would not say whether the reviews also look for accuracy.
Medicaid officials at Colorado’s Department of Health Care Policy and Financing also had little interest in whistleblowers’ accounts of falsifying CCARs at Mind Springs when the Colorado News Collaborative asked about them in the winter. Since then, Rocky Mountain Health Plans, the company the Department of Health Care Policy and Financing pays to manage Mind Springs’ Medicaid contract launched an investigation into possible waste, fraud and abuse.
Then the Department of Health Care Policy and Financing began its own internal review. Most recently, the Human Services Department said it also is launching an investigation into the accuracy of Mind Springs’ CCARs, among other things.
“I worry this is a disingenuous PR move,” says Jensen.
Adds Sullivan: “I hope this time they actually take their investigations seriously.”
This story is brought to you by COLab, the Colorado News Collaborative, a nonprofit coalition of more than 170 newsrooms across Colorado working together to better serve the public. Learn more at https://colabnews.co