From: 23x11.5c@gmail.com   
      
   OIG: Mental Health Centers Need Scrutiny   
      
   By David Pittman, Washington Correspondent, MedPage Today   
   Published: August 22, 2012   
      
   WASHINGTON -- Most community mental health centers employ at least one   
   questionable billing practice, a government report has found.   
      
   More than half of community mental health centers (52%) were found to   
   have employed at least one of nine predetermined questionable billing   
   practices, the Department of Health and Human Services Office of   
   Inspector General (OIG) found in a report released Tuesday. About a   
   third of the 195 centers (35%) it reviewed exceeded thresholds for   
   unusually high billing in at least two of the nine areas.   
      
   The OIG report focused on the centers' practices in billing for   
   partial hospitalization programs. Medicare Part B reimburses community   
   mental health centers for providing such programs, which are intense,   
   structured outpatient mental health treatment programs.   
      
   To combat possible billing fraud, the OIG recommended that the Centers   
   for Medicare and Medicaid Services (CMS) increase monitoring of the   
   mental health centers' billing and fraud prevention, take appropriate   
   action against questionable billing, finalize proposed conditions of   
   participation, and enforce the requirement that certifying doctors be   
   listed on partial hospitalization program services claims.   
      
   Enforcing the requirement that physicians be listed on the claims   
   "provides additional information for CMS to use to verify whether the   
   [partial hospitalization program] services billed were medically   
   reasonable and necessary," the report stated.   
      
   CMS has already agreed with all of the OIG's recommendations, the   
   report said.   
      
   In 2010, 206 centers received $218.6 million for providing partial   
   hospitalization services to 25,000 Medicare beneficiaries. In 2011,   
   four community mental health center owners and managers were convicted   
   of fraudulently billing Medicare for roughly $200 million for   
   medically unnecessary partial hospitalization services from 2002 to   
   2010.   
      
   To find out more about the problem, the investigative wing of of HHS   
   developed nine questionable billing characteristics, then reviewed   
   2009 and 2010 Medicare claims to spot community mental health centers   
   with one of the characteristics to help identify areas of possible   
   waste.   
      
   Questionable characteristics included:   
      
   Beneficiaries who received only group psychotherapy during   
   participation   
   Beneficiaries who were not evaluated by physicians during   
   participation   
   Beneficiaries with no mental health diagnoses 1 year before   
   participation   
   Beneficiaries with cognitive disorders such as Alzheimer's disease   
   Beneficiaries who were readmitted to inpatient treatment   
   The OIG found that in 2010, eight of 11 metropolitan areas with at   
   least three mental health centers had a higher percentage of   
   questionable billing than the national average; areas with the highest   
   percentages of centers employing questionable practices included   
   Houston, Miami, and Baton Rouge, La.   
      
   In addition, 90% of centers with questionable billing were located in   
   states that don't require mental health centers to be licensed or   
   certified.   
      
   CMS expects to publish a final rule for conditions of participation   
   for community mental health centers in spring 2013.   
      
      
      
   http://www.medpagetoday.com/PublicHealthPolicy/Medicare/34322   
      
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