Arkansas Medical Board chairman suspended from state Medicaid program
The chairman of the Arkansas State Medical Board has been suspended from the Arkansas Medicaid Program and is under investigation for Medicaid and Medicare fraud.
State health officials suspended all Medicaid payments to Board Chairman Dr. Brian Hyatt on Friday after determining there was a “credible allegation of fraud,” according to a letter obtained in a public records request.
A search warrant for Hyatt’s phone records, also obtained by the Advocate under the Arkansas Freedom of Information Act, provides a list of allegations against the Northwest Arkansas psychiatrist being investigated by Attorney General Tim Griffin’s office.
Chiefly, the warrant affidavit states that Hyatt appeared to consistently bill Medicaid for the highest level of patient severity — and therefore the highest reimbursement rate — without seeing those patients face-to-face.
Investigators pointed to interviews with Hyatt’s staff at Northwest Medical Center in Springdale (His contract at the hospital was “abruptly terminated” in May, per state records) and a review of hundreds of hours of video footage of Hyatt’s movements through the hospital.
“The Affiant believes the information herein and the video provided to the court establishes reasonable cause to believe that Dr. Hyatt has committed Medicaid and Healthcare fraud,” reads the search warrant, which was approved by a Pulaski County circuit judge on Jan. 17.
Medicaid fraud is a felony if it results in an overpayment of more than $2,500, according to state law.
"That is to say that according to the claims submitted by Dr. Hyatt and the non-physician providers working under his supervision, no patient being treated in the behavioral unit located at Northwest Medical Center ever got better, at least not before the day of the patient’s release."
– Arkansas Attorney General Medicaid Fraud Control Unit Investigator Mary Bowen in a search warrant affidavit.
Hyatt hasn’t been criminally charged, and he has 30 days to appeal the inspector general’s decision to suspend Medicaid payments. The suspension will last until the legal proceedings related to the alleged fraud are complete.
Attempts to reach him on Tuesday weren’t successful. Attorneys representing him in a separate legal matter also didn’t respond to messages seeking comment.
A spokeswoman for Northwest Medical Center said the hospital is continuing to cooperate with the attorney general’s office investigation.
Former Gov. Asa Hutchinson appointed Hyatt to the Medical Board in 2019. He was elected vice chairman in January 2022 and more recently elected chairman.
He owns Pinnacle Premier Psychiatry in Rogers.
The attorney general’s office investigation began after a whistleblower complaint from the Northwest Medical Center’s behavioral health unit.
Investigators also identified several “red flags” after reviewing Hyatt’s Medicaid claims, records show.
From Jan. 1, 2019, to June 30, 2022, Hyatt billed Medicaid under the highest reimbursement code designating the need for subsequent hospital care more than any other psychiatrist in the state billed for all Medicaid patients under any of the three “subsequent hospital care” codes, according to the search warrant affidavit.
During that time period, 99.95% of the claims for subsequent hospital care Hyatt billed to Medicaid were reported to be for the highest level of severity. For comparison, Arkansas psychiatrists billed for the highest severity code 38.76% of the time on average, according to state data.
“That is to say that according to the claims submitted by Dr. Hyatt and the non-physician providers working under his supervision, no patient being treated in the behavioral unit located at Northwest Medical Center ever got better, at least not before the day of the patient’s release,” the search warrant affidavit reads.
Additionally, three non-physician providers working under Hyatt said that he instructed them to bill the three codes or the highest severity code on every patient, the affidavit said.
The whistleblower told investigators that Hyatt only spent a few minutes on the patient floor each day and had no contact with patients, per court records. Further, the informant said Hyatt didn’t want patients to know his name and instructed staff to mark through his name on patients’ armbands.
“These allegations raise numerous issues,” the warrant request reads. “The patients have a right to know their treating physician. If Dr. Hyatt was not their doctor, then who was? At least some of the patients on the unit were being held against their will and only a physician could make the decision to impose a 72 hour hold.”
To review Hyatt’s claims that he conducted daily, face-to-face evaluations of patients, investigators pulled roughly two months of video surveillance footage from the hospital, records indicate. While they hadn’t reviewed all of the video at the time the search warrant was issued, investigators wrote that after several days of review and hundreds of hours of video, they never observed Hyatt enter a patient’s room.
Instead, they said the video showed him pushing a computer cart down the hall, sometimes pausing to look in a patient’s room but never entering.
Investigators also decided to conduct a comprehensive audit of all the care provided to every patient in Hyatt’s unit on a random day — March 15, 2022.
The video showed Hyatt making similar walks down the halls of the three floors of the unit without entering patients’ rooms, the affidavit notes.
Of the roughly hour and a half he spent in the unit that day, the bulk was spent in his office with his rounds starting at 7:54 a.m. and ending at 8:17 a.m.
The affidavit states that 74 patients were under Hyatt’s care that day, meaning that he dedicated an average of less than 20 seconds per patient during his rounds.
The investigator notes that video review and interviews with witnesses indicate that Hyatt wasn’t communicating with his patients regularly, but each patient still had copious records. The affidavit states that Hyatt developed long templates for progress notes that cited voluminous laws, regulations and medical coding definitions “and even warnings to regulators not to challenge his findings.”
“This created volumes of records on each patient, most of which was completely void of information about how the patient was doing on a particular day,” the affidavit reads. “Nevertheless, Dr. Hyatt repeatedly certified the notes and added his own addendum asserting that he saw and evaluated the patient on the date of services and that this diagnosis and billing is based on a face-to-face with the patient.
“Dr. Hyatt may try to claim that all he had to do was see the patient, but he knows that is not enough to evaluate a patient’s current condition and diagnosis.”
A sample of the patient care note template from the search warrant affidavit.
The investigators said they hadn’t reviewed enough video to say with certainty that Hyatt never saw the patients, but they stated that he did not have meaningful conversations with them on at least three days last March.
The investigators wrote that they interviewed one patient who was in the unit on March 15, and he said he never met Hyatt.
“It appears that at the direction of Dr. Hyatt, all [digital billing codes] for the entire unit were automatically billed at the highest code and templated progress notes were used to support this progress,” the warrant affidavit said.
The affidavit concludes with the mention of several other irregularities that have been identified and are being investigated.
First, the investigators wrote that Hyatt appeared to have billed Medicaid for inpatient care for patients who were not in the hospital at the time of care.
Additionally, they said Hyatt appears to have turned over a Medicaid recipient to a collections agency after Medicaid did not fully pay for the services for which Hyatt billed.
It is Medicaid fraud to try to collect unpaid amounts from a Medicaid beneficiary, the warrant notes.
Asked for comment on Tuesday, Attorney General Tim Griffin in a statement said: “We have no additional details to provide at this time.”
Hyatt is also a defendant in three separate, civil lawsuits in Washington County filed by former patients or their family members.
Two of the cases are similar and involve patients who claim they were held at Northwest Medical Center against their will. Both suits accuse Hyatt and others of false imprisonment, batter and assault.
The suits include details that are mirrored in the attorney general’s office affidavit.
One patient said that she never met Hyatt during her time in the hospital under his care, despite his 45 pages of notes about the patient, according to the lawsuit.
Another patient said that a hospital staff member attempted to black-out Hyatt’s name on her wrist band, according to the complaint.
In both cases, the hospital refused to release both patients at the request of the patients themselves and their family members. And in both cases, the patients were only released after a judge ordered it.
The Advocate also identified a third case in which a patient was only released after a judge’s order.
In all three cases, Hyatt didn’t file petitions for involuntary commitment, which require judicial review and are required under state law to involuntarily hold someone with a behavioral health impairment beyond the 72-hour crisis intervention period, according to court records.
The third lawsuit accuses Hyatt of medical negligence after a patient died by suicide the day after he was discharged from Northwest Medical Center.
“We take very seriously our responsibility to provide a safe environment of care for our patients and for our team members,” Northwest Health spokeswoman Christina Bull said.
“While it is not our practice to comment on pending litigation matters, I am able to share that last spring we undertook a number of actions to ensure our patients’ safety, including replacing the providers responsible for the clinical care of our behavioral health patients in early May 2022.”