OIG Continues to Fault Efforts to Prevent Medicare Fraud in Community Mental Health Centers

The OIG has examined CMS efforts to prevent fraud and abuse at community mental health centers (CMHCs), which provide partial hospitalization program services (structured outpatient mental health treatment programs) to qualifying Medicare beneficiaries. The OIG has previously reported that CMHCs may be particularly vulnerable to fraud, waste, and abuse involving PHP services, with approximately half of CMHCs exhibiting questionable billing in 2010. The OIG’s new report is entitled, Vulnerabilities in CMS's and Contractors' Activities to Detect and Deter Fraud in Community Mental Health Centers. The OIG found that most Medicare Administrative Contractor (MAC) and Zone Program Integrity Contractor (ZPIC) activities to detect and deter CMHC fraud in 2010 were actually performed in conjunction with the CMS-led South Florida High-Risk Provider Enrollment Project; other MACs and ZPICs performed minimal activities to detect and deter fraudulent CMHC billing despite having jurisdiction over fraud-prone areas. The OIG also found that Medicare paid noncompliant CMHCs after their revocations were effective and while their revocations were being approved. To address program vulnerabilities, the OIG recommends that CMS: implement additional CMHC fraud mitigation activities in fraud-prone areas; improve tracking of revocations; coordinate activities to deter CMHC fraud in Florida; and follow up on payments made to CMHCs after revocations.

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