A recent HHS Office of Inspector General (OIG) report assesses the extent of questionable billing by community mental health centers (CMHC) for partial hospitalization programs (PHP). The OIG identified nine questionable billing characteristics of CMHCs, such as high levels of CMHC beneficiaries who received only group psychotherapy during their PHP participation; who were not evaluated by physicians during their PHP participation; who had no mental health diagnoses a year prior to participating in PHPs; or who participated in PHPs at CMHCs outside of their communities (defined as more than 102 miles away). According to the OIG, about half of CMHCs had unusually high billing in 2010 for at least one of the nine questionable billing characteristics. Approximately two-thirds of CMHCs with questionable billing were located in eight metropolitan areas in three states: Florida, Louisiana, and Texas (with one CMHC in Florida billing for a beneficiary who lived in Hawaii and its other beneficiaries residing an average of nearly 550 miles away). The OIG also found that 90% of CMHCs with questionable billing were located in states that do not require CMHCs to be licensed or certified. Based on its findings, the OIG recommends that CMS: (1) increase monitoring of CMHCs’ Medicare billing and fraud prevention controls; (2) enforce the requirement that certifying physicians be listed on CMHC PHP claims; (3) finalize and implement proposed conditions of participation for CMHCs; and (4) take appropriate action against CMHCs with questionable billing identified by the OIG. CMS concurred with the recommendations.
Trackbacks (0) Links to blogs that reference this article Trackback URL