A troubled multicounty clinic based in Delta that offered physical and mental health services to some of the most vulnerable people on the Western Slope closed its doors Friday.
Integrated Insight Community Care’s closure comes after insurer Rocky Mountain Health Plans ended its contract with the clinic Jan. 18, citing concerns about patient safety. The state Behavioral Health Administration is also investigating a “multitude” of allegations against the clinic, including claims it falsified treatment records and that its founder had an inappropriate romantic relationship with a client and gave center staff drugs and alcohol on the job, state records show.
Clinic founder Joel Watts has denied wrongdoing and said he would even welcome a criminal investigation.
“Had we been given a chance to prove all of these allegations false, instead of shutting off our contract or targeting us at the state level, we could have proven them wrong and we could have still been in operation,” Watts said in an interview Tuesday evening.
The clinic employed about 100 staff and cared for about 1,400 people, most covered by Medicaid, who live on the Western Slope where providers are scarce, especially those willing to take that kind of insurance.
The state Medicaid department said it supports the decision by Rocky Mountain Health Plans to stop reimbursing the clinic for services.
Over the last few weeks, Colorado’s Medicaid department, Rocky Mountain Health Plans and the state’s Behavioral Health Administration have received complaints about patient safety and the clinic’s financial and operational challenges, a spokesperson for the state Medicaid department said.
The state Medicaid department and UnitedHealthcare, which merged with Rocky Mountain Health Plans in 2017, would not give specific information about safety concerns.
The clinic filed for Chapter 11 bankruptcy reorganization in early September.
Permanent closure of the clinic may create a mental health crisis on the Western Slope, Watts said.
“You’re talking about 1,400 people that suddenly have to go and be absorbed by other clinicians and start all over,” he said in an earlier interview. “If this was about patient safety, at what point did they not step in?”
Ceasing mental health and substance use services
On Feb. 1, the Behavioral Health Administration served the clinic a summary suspension, which required it to immediately stop providing substance use disorder treatment and community-based mental health services.
On or around Dec. 11, the department became aware of allegations that Watts had an inappropriate relationship with a person who was both a client and an employee, according to the order of summary suspension.
On Jan. 18, investigators from the Behavioral Health Administration made an unannounced visit to the Integrated office in Delta and requested access to the clinic’s administrative records.
Watts did not provide them. The investigators returned later that day and requested the records again, according to the report. Watts provided access to paper files but told the investigators that personnel records were kept in electronic form and he did not provide access to those records.
Department personnel continued to request access to the files later that evening.
Watts gave the investigators some of the personnel records the following day but it appeared an unknown employee had deleted a file from the records the previous evening, the report says.
The investigators got full access to the electronic documents Jan. 22. But Watts soon revoked access without notice, according to the order.
On Jan. 26, Watts was asked a fourth time for access to the records, but he said he would not provide them for a week to 10 days, the report says.
While it had access to personnel files, the Behavioral Health Administration said it found misleading and falsified documents, including former employees’ signatures on treatment records after they no longer worked for the clinic and current employee signatures for therapeutic sessions that predated their employment.
During its investigation, the Behavioral Health Administration “received statements from witnesses detailing a multitude of unethical employment and professional practices,” the report states, “including the simultaneous employment and therapeutic treatment of its employees, coercive and intimidating behavior by Joel Watts, and the use of alcohol and drugs to exploit employees.”
Watts denied revoking access to the documents and said there has been no intimidation of his employees and that he has never given drugs to clients or employees.
“I’ve heard these rumors and they’re not true. This has been a rumor since April of 2022 — that I’m literally running drugs from Cuba and Mexico back to Delta County, that I’m giving drugs to clients or employees and I’m not,” he said Tuesday evening.
“There’s been no proof offered except to have some former disgruntled employees and other people in the community foster this allegation,” he said. “We simply don’t know what they’re talking about.”
Finding new service providers
The clinic provided services to vulnerable people including individuals fleeing domestic violence, others who are on probation and some clients who could end up in jail or homeless again now that their treatment has ended at Integrated.
Almost all of the clinic’s 1,400 patients were covered by a Rocky Mountain Health Plan. About 1,000 of them are clients who received primary care, behavioral health care and psychiatric services at Integrated. They will now have to find three new providers, Watts said.
Fourteen people were receiving inpatient care at Integrated.
Rocky Mountain Health Plans, which receives federal and state funding to reimburse the providers who care for patients covered by Medicaid, said last month it is working with the state, local providers and partner organizations to ensure the care for the clinic’s patients is not disrupted.
A Jan. 18 notice of termination sent to Watts by UnitedHealthcare states that the contract with Integrated can be ended with the clinic immediately if Rocky Mountain Health Plans determines the health, safety or welfare of people receiving services at the clinic may be in jeopardy.
The clinic had 30 days to appeal the insurer’s decision and did so the day it received the notice of termination.
The clinic typically received $150,000 to $160,000 from Rocky Mountain Health Plans for a 10-day period, court records show.
Soon after the insurer pulled the contract, Integrated shut down the clinic’s mobile crisis services, which helped people around the clock including those with suicidal feelings by offering peer support, case management and de-escalation services in Montrose, Ouray, Delta and San Miguel counties.
The clinic also laid off its crisis resolution team, which supported families of young people who have behavioral health challenges.
The clinic was one of few providers on the Western Slope offering specialized Parent-Child Interaction Therapy for young children with behavioral health problems.
And Integrated was also paying for a local primary care provider to attend school to become an endocrinologist. She was planning to begin working at the clinic this summer, seeing people with diabetes, advanced osteoporosis and other bone disorders.
“We were ghosted by our own employer”
There was confusion about whether the crisis resolution team was laid off or fired from Integrated on Jan. 18, said Daney Sullivan, a former case manager on the team.
That afternoon, the director of the team said she was laid off and that she wasn’t sure if she was supposed to tell the rest of her staff that they were laid off too, Sullivan said.
Five members of the crisis resolution team reached out to Watts and other organization leaders to ask if they were fired. The clinic’s then-president responded and said the team was laid off and that they should have been given more information such as how to apply for unemployment.
Soon after, team members realized they were locked out of their email accounts and the clinic’s electronic health record system, where they uploaded documents and wrote client notes.
“We were ghosted by our own employer,” said Sullivan who worked at Integrated for just over a year. “It was very small and pretty disorganized when I first started but it seemed like Joel had a really good vision.”
On Tuesday evening, Watts denied the allegation and said after the contract was pulled by the insurer, he directed part of his leadership staff to call each employee on the crisis resolution team to tell them they were laid off.
Staff were aware of many problems at Integrated, Sullivan said. Right before the clinic closed, employees started receiving paper checks and were told to pick them up weekly.
There was no onboarding process when Sullivan started in late 2022, and communication between clinic leaders was spotty, she said. When Watts sent internal emails, they were often long and confusing and Sullivan soon became skeptical of his management ability.
Watts hired friends and many others who didn’t have a health care background, Sullivan and four other former employees said.
There was confusion and secrecy about the kinds of contracts the clinic had entered with Rocky Mountain Health Plans. It was unclear if the clinic had a value-based contract, where the insurer gives the clinic a sum of money ahead of time if it promises to care for a certain number of people, or if the clinic had a fee-for-service contract that allowed it to file claims for reimbursement, Sullivan said.
Seeing the contract would have allowed department leaders to understand their own budgetary constraints, what goals they needed to meet and what data they should collect to ensure their contract remained in place, Sullivan said.
“There were two different contracts and two different ways of billing and I feel like he didn’t really understand that and he was hiring people who didn’t really understand that either,” Sullivan said of Watts. “I asked to see the contract. But I was never able to obtain it. I don’t even think my director got to see it.”
The clinic was almost always short staffed, she said. Many Integrated employees found themselves doing two or three jobs. And staff didn’t understand why the clinic wasn’t hiring people after it published job postings, Sullivan said.
The clinic often had problems managing its own payroll. People who worked part-time were accidentally paid full-time rates, for example.
“I’m confused how this was able to go on for so long,” Sullivan said. “I have an ethical obligation to speak for the people who have boots on the ground and the clients. I can’t just ignore that this has happened. I want the other side of the story told.”
Watts said the clinic was always hiring people. And he said payroll was handled by an outside company.
Watts denied the other allegations. The crisis resolution team, or CRT, was “quasi-independent,” he said Tuesday night. “They used our systems, we employed them but we had other people in charge of that and I rarely had anything to do with CRT.”
13 properties rented by Integrated
On Sept. 8, when Integrated declared Chapter 11 bankruptcy in the U.S. Bankruptcy Court for the Northern District of Iowa, the clinic said it owed just over $800,000 to 10 creditors for contracts, credit cards and loans.
The company’s assets equaled just over $71,000 at the time of the bankruptcy filing.
The company had emerged from bankruptcy with reorganized finances, Watts said in a Jan. 24 interview.
That same day, Watts said he stepped down as CEO.
Bankruptcy documents show the clinic rented at least 13 properties in Delta, Paonia, Norwood, Grand Junction, Montrose and Cortez when that case was filed.
Public records requests to police departments in those towns and cities from 2021 through 2024 show dozens of calls to some of the clinic’s properties, which is consistent with organizations that serve vulnerable clients.
In February 2022, an officer responded to the clinic’s Impact House — a residential facility for men involved in the criminal justice system — to assist an ambulance called there to help someone who overdosed on 15 prescription medications.
Watts said the man did not overdose.
In October that same year, a woman living across the street from Impact House — which became the Success House, a short-term transitional facility for women in child welfare cases and drug court — said she made a complaint to the Delta Health Department after she became concerned about illegal drug use and the health and safety of pregnant women living there.
“Men were coming and going, there was increased traffic after dark, residents were using neighbors’ driveways as pickup and dropoff spots and basic maintenance of the property was not being performed,” the woman wrote in an email to The Colorado Sun.
“These programs must be run with integrity by capable facilities,” she wrote.
Watts said Integrated staff decided to move that facility to another location to increase safety for those clients.
In March 2023, when Delta police responded to one of the clinic’s offices, Watts reported that a former employee had demanded $25,000 for Integrated to maintain access to its company domain and website, according to a police report. The former employee, who had created the website, was later charged with extortion, according to the police report.
A suspended license
In November 2022, the state Board of Licensed Counselor Examiners suspended Watts’ professional counselor license while it investigated three complaints against him, according to a Denver District Court complaint filed by Watts against the board, which outlines the allegations.
The first complaint was filed in September 2021 and alleged Watts had a romantic relationship with a client he treated at a residential treatment center. Watts denies the allegation in court papers.
That client was hired and began working at Integrated in July 2020. In court documents, Watts said she was hired based on her experience.
The second complaint filed against Watts in October 2021 alleged he failed to report a child sexual abuse case to the Delta County Child Welfare Hotline. He denied the allegation in court documents and said he did make the report.
The third complaint was filed by a corporate compliance officer at the Center for Mental Health in November 2021 and alleged Watts provided therapeutic services to three patients that should have been referred to providers who were qualified to offer more specialized care.
In court documents, Watts said the compliance officer filed the complaint after an administrative services organization asked Integrated to become the new mobile crisis provider for three counties, which could cause the Center for Mental Health to lose that contract and possibly others related to crisis services.
The allegation was an attack on Watts and his practice and an effort to weaponize the Department of Regulatory Agencies against him, he said in his court complaint.
On Tuesday evening, Watts said one of those clients got off his medication and that the clinic provided good services to him.
The board had reasonable grounds to believe that Watts had “a romantic relationship with a client, failed as a mandatory reporter, and failed to refer three high-acuity clients to proper providers,” according to a summary suspension order that was later vacated by the board.
Watts sued the board in Denver District Court in December 2022. At the time, the board filed a notice of charges with the Office of Administrative Courts, starting formal disciplinary actions against his license.
Watts settled the disciplinary case by agreeing to a public stipulation that states the board maintains that Watts did not file a report about the child sex abuse case with Child Protective Services in a timely manner. The discipline for that included practice monitoring.
In January 2023, Watts acknowledged only that he practiced below the standard of care for his profession. He withdrew the Denver District Court case against the board later that month.
Working at Integrated
Working at the clinic was like riding a roller coaster, said Laurie Devere, a former front desk coordinator and executive administrative assistant on the crisis resolution team.
“Changes were radical and ongoing, and there was not any planning done before pulling the trigger on new ideas,” she wrote in an email to The Colorado Sun in late January.
During her first few months on the job, Devere said the then-president of the clinic made hiring decisions that put the company in jeopardy.
When Integrated was hiring more staff for its Grand Junction office, the clinic’s president asked a licensed counselor candidate to interview prospective clinicians.
The president eventually hired those licensed counselors without doing any more vetting of them, Devere said.
“This led to a clinician being hired who had all the credentials but had not practiced in many years, showed incompetency immediately, and had multiple complaints against him by clients within months,” Devere wrote. “Despite his lacking ability and multiple complaints by patients, he was moved to work in the busier Delta office.”
Watts denied the allegation on Tuesday evening.
In another case, an off-duty peer intervened while a client was having a psychiatric crisis and personally transported the client against an emergency medical technician’s advice to Integrated’s Grand Junction outpatient office even though she needed to be hospitalized, Devere said.
“The peer left the client with me and one other clinician candidate because she was on her way to vacation,” Devere wrote. “We ended up feeding the client and taking her to the hospital to be admitted for care. The peer was eventually terminated, but not before multiple complaints from patients.”
The peer was actually a case manager and she was terminated swiftly, Watts said Tuesday evening. He agreed the incident was inappropriate.
Growing concerns
Scott Fritzsche, a former program manager of Impact House — the residential facility for men involved in the criminal justice system and deemed incompetent to continue with their court proceedings — and his wife, Mary Fritzsche, a former acting manager at Success House in Delta have made complaints to state leaders about the clinic.
Scott Fritzsche and his supervisor noticed that Integrated was not keeping or properly reporting data it needed to report to the Colorado Fines Committee, which provided grant funding for the Impact House program.
For at least a year, the clinic wasn’t collecting names or complete demographic data on the clients it served in the program, as required, and no one seemed to be keeping receipts or properly tracking grant money, he said.
“The numbers that Integrated was reporting to the Fines Committee, there was nothing concrete to back them up,” he said. “Joel (Watts) has been involved with the Impact program from day one and he’s well aware of all this because he was told by more than one person that it was problematic.”
When it came time for the clinic to reapply for another round of grant funds for the program, the data reporting was already overdue.
Mary Fritzsche and program leaders noticed the clinic reported that it had spent drastically different amounts of money each month on expenses.
“And when I went to Joel and said, ‘I don’t think these numbers are correct,’ he said, ‘Well, just make it look right,’ Mary Fritzsche said.
“That caused some issues between me and Joel,” she said. “I didn’t feel comfortable saying those numbers were accurate when they couldn’t produce any receipts for me.”
When the Fritzsches and their supervisor submitted the data to the Fines Committee they noted in the report that they were unsure about the accuracy of information collected before they started work at Impact House.
“They worked at the houses and they were the ones in charge of data collection, which is why we had to remove one of them out of the house because it was such a bad thing,” Watts said.
He would not say which Fritzsche was removed from the facility but said the person had multiple complaints against them from clients.
“When we would go ask the clients, there was this sense they didn’t want to tell us, so we removed this person from the house and had them work at another house,” Watts said. “We tried to be proactive and coach this person up. This person refused to be coached up and instead started unfounded rumors and allegations and flat-out lies and so we had to remove her from the house.”
The Fritzsches said they felt the clinic had many patient safety issues.
Staff were told they would not have to work with clients who had a violent history. But two clients had a long history of violence, Scott Fritzsche said.
One was aggressive and both made threats to staff and to other clients. One of those clients was the brother of someone Watts had a previous romantic relationship with and that client threatened to kill people working at the clinic, Scott Fritzsche said.
“Everybody knows about the clients that we would take in,” Watts said Tuesday evening. “So we did our best to give everybody a chance to say they couldn’t work with certain clients.”
Eventually, Watts decided to expand the Impact program and begin serving women, which the Fritzsches thought was a good idea at first.
The Fritzsches picked the first woman in the program up from the Cortez jail and dropped her off at the Success House.
She did not have her own bedroom and was sleeping in the dining room at the Success House, Mary Fritzsche said, adding the woman begged to go back to jail several times and was suicidal.
Watts said the woman had a bedroom and that if she slept in the dining room, it was because of her psychosis.
A second female Success House client came shortly after. She had hallucinations and needed a higher level of care, Mary Fritzsche said.
Instead of getting her the care that she needed, she was excluded from group therapy courses and her individual therapists no longer wanted to meet with her.
Still, the client received multiple certificates of completion for therapeutic courses that she had not completed, Scott Fritzsche said. “And they asked her to leave because they couldn’t handle working with her.”
Watts denied that the woman was given certificates of completion without completing therapy.
Both Fritzsches finally quit Aug. 1. “I needed to get myself out of there and report to the proper agencies,” Scott Fritzsche said.
Most of the people Watts hired were not qualified for their jobs, Scott Fritzsche said.
In fact, Scott and Mary Fritzsche said they were not qualified when they began running the residential programs. They had been friends with Watts for 10 years in Ohio.
The couple did research, learned how to write manuals and watched academics explain how these facilities should be run. “We didn’t get any training,” Mary Fritzsche said.
When people were hired, if they were apprehensive about their qualifications or asked for training, Watts would persuade them that they already had what they needed to do the job, Scott Fritzsche said.
If staff made grave mistakes, Watts would pull the employee from where they were working and employ them in a different part of the company, Scott Fritzsche said.
Watts said he provided additional training to staff members who needed it and if they worked better in another department, he supported placing them in a more appropriate role.
“I think the Impact program could be a great benefit, especially on the Western Slope, where there’s not a lot of facilities,” Scott Fritzsche said. “But it was never run like it was supposed to be and when we tried to run it like it was supposed to be, there was interference, specifically by Joel.”
“We were working to solve all of these problems,” Scott Fritzsche said, “but there were so many.”
MORE: Rocky Mountain Health Plans established a call center, at 970-255-5660 and an email address, at RMHPCareManagementReferrals@uhc.com, to help patients who are affected and their caregivers.The Behavioral Health Administration said it’s coordinating with Health Care Policy & Financing and Rocky Mountain Health Partners to ensure the continuity of services. A dedicated call center has been set up and can be contacted at 720-947-5076 to assist anyone needing support or care; an email is also available to Coloradans bha_carecoordination@state.co.us.