EKY mental health provider accused of billing fraud and workplace harassment
Three former employees of a Kentucky mental health system headquartered in Prestonsburg say the company coerced them to commit federal billing fraud and retaliated against them when they refused.
Former Mountain Comprehensive Care Center Chief Financial Officer Rebeckah Hall, Billing Coordinator Rachel Williams and Mental Health Director Kristy Stiltner have filed three separate workplace harassment lawsuits against the nonprofit healthcare provider and its underlying tax-exempt support corporation since January.
All three women said they were instructed to falsify healthcare bills and medical records to generate more revenue for the company.
MCCC operates 50 outpatient clinics across Kentucky, plus therapeutic foster care facilities, addiction service centers, nearly 20 primary-care clinics and several homeless shelters and transitional living facilities, according to its website. The company provides counseling and juvenile intervention services in several Eastern Kentucky school districts.
The company is also a publicly-funded community mental health center charged with providing services for Kentuckians struggling with mental health, developmental, intellectual disabilities or substance abuse through the Kentucky Cabinet for Health and Family Services. It receives a “significant portion” of its revenue from state and federal reimbursements, including Medicare and Medicaid, according to one lawsuit.
The location of some services were changed to appear as if they were provided at federally qualified low-income clinics to improve MCCC’s chances for federal grant funding, the three lawsuits said. Services were billed under licensed providers even when those providers weren’t involved to obtain higher Medicare and Medicaid reimbursement rates, the former employees allege in the lawsuits.
Employees were told to refrain from engaging with Medicaid or Medicare for inquiries or clarifications on billable charges, they added.
Two of the former employees said they were told not to correct billing codes for “audio only” services after the COVID-19 pandemic, and to ignore warnings from MCCC financial and billing departments that changing billing locations violated state law.
The three women said when they refused to engage in fraudulent billing practices, supervisors retaliated by creating a hostile work environment.
Hall and Williams said they were effectively forced to resign. Stiltner, who filed suit against the company earlier this month, said she remained with the company until she was fired. CEO Promod Bishnoi reportedly told her, “This just isn’t working out,” according to the lawsuit.
Hall and Williams included copies of their resignation letters in the employment dispute lawsuits they filed in Floyd Circuit Court in January and March, respectively, court records show.
Williams said three employees, including herself, sent a letter to the MCCC board of directors reporting fraudulent billing. She said she did not hear anything about the complaint after it was filed and was not contacted for “any questioning about the information I had.”
“I was placed in a situation where I was asked to engage in billing practices that were unethical and fraudulent,” she said. “Because these requests went against my personal and professional morals, I refused to participate.”
Hall said Bishnoi personally asked her to participate in fraudulent billing and “went through other Program directors and staff to make this happen” after she refused. She said she believes the company’s “current financial trajectory is unsustainable” and that several cost-cutting recommendations she gave Bishnoi were ignored.
“Unless there are significant changes, it is my professional opinion that MCCC will not be able to continue operating long term,” she wrote.
Williams said she advocated for increased pay for her staff, higher starting wages to attract qualified candidates and support to achieve adequate staffing levels, but no improvements were made. Persistent staffing shortages caused “billing processes to fall dangerously behind,” she said.
MCCC reported more than $132 million revenue in fiscal year 2024, according to the National Center for Charitable Statistics. The company netted just over $310,000 that year, the data shows. MCCC Inc. appears responsible for most program services, while a separate but related nonprofit called Mountain Plus Services Inc. dispenses most salaries and wages. MPS reported $81.5 million in FY 2024 revenue and a slight budget deficit.
The company has denied Hall and Williams’ allegations and has not yet responded to Stiltner’s. Bishnoi and Marketing Director Zach Watts didn’t immediately respond to a Herald-Leader request for comment Thursday, nor did the MCCC’s attorney.
The lawsuits mark the second time MCCC has been accused of bill fraud in court. A whistleblower case that was unsealed in 2023 claimed the company “engaged in a routine pattern and fraudulently submitted claims for payment to government healthcare programs.”
A former employee hired to work in the company’s Juvenile Intervention and Services program said MCCC billed for non-reimbursable services, routinely falsified time records, refused to discharge patients who lacked medical necessity and billed for services that weren’t provided.
The U.S. Justice Department declined to intervene on behalf of the whistleblower and the case was dismissed without prejudice in August 2023, meaning the allegations could be made again. Several emergency motions made by the government in the whistleblower case remain under seal.
MCCC is a separate company unaffiliated with Whitesburg-based Mountain Comprehensive Health Corp., which operates medical clinics across Eastern Kentucky and Southwestern Virginia.
