Good morning to all from Washington, DC. Today OIG posts a report and related podcast, announces an upcoming externship opportunity and provides news about enforcement actions. As always, you can use the links provided to go directly to the new material. ------------------------------------------------------------------------------ Questionable Billing by Community Mental Health Centers (OEI-04-11-00100) http://go.usa.gov/7mP WHY WE DID THIS STUDY During 2010, 206 community mental health centers (CMHC) received an estimated $218.6 million for providing partial hospitalization program (PHP) services to approximately 25,000 Medicare beneficiaries with mental disorders. Past OIG studies have found vulnerabilities in Medicare payments to CMHCs for PHPs. Additionally, in 2011, four CMHC owners and managers in Miami-Dade County, Florida, were convicted of fraudulently billing Medicare approximately $200 million for medically unnecessary PHP services from 2002 to 2010.
HOW WE DID THIS STUDY We developed nine questionable billing characteristics based on past OIG work and input from CMS staff. We used 2009 and 2010 Medicare claims from CMS’s National Claims History File to identify CMHCs that had unusually high billing for at least one of nine OIG questionable billing characteristics in 2010 and the metropolitan areas where these CMHCs were located. We also determined whether the percentage of CMHCs with questionable billing varied according to whether States had licensure or certification requirements.
WHAT WE FOUND In 2010, approximately half of CMHCs met or exceeded thresholds that indicated unusually high billing for at least one of nine questionable billing characteristics. Approximately one-third of these CMHCs had at least two of the characteristics. Additionally, approximately two-thirds of CMHCs with questionable billing were located in eight metropolitan areas. Finally, 90 percent of CMHCs with questionable billing were located in States that do not require CMHCs to be licensed or certified.
WHAT WE RECOMMEND We recommend that CMS: (1) Increase its monitoring of CMHCs’ Medicare billing and fraud prevention controls, (2) Enforce the requirement that certifying physicians be listed on the PHP claims submitted by CMHCs, (3) Finalize and implement the proposed conditions of participation for CMHCs, and (4) Review and take appropriate action against CMHCs with questionable billing that we identified. CMS concurred with all four recommendations. ------------------------------------------------------------------------------ Podcast Interview on Latest OIG Report Now Available http://go.usa.gov/7mV Latrice Rollins, a program analyst for the Office of Evaluation and Inspections in Atlanta, is interviewed by Jaime Durley, Deputy Regional Inspector General for the Office of Evaluation and Inspections ------------------------------------------------------------------------------ Spring 2013 Legal Extern Program Announced The HHS Office of Counsel to the Inspector General (OCIG) seeks two to three 2Ls or 3Ls for its 2013 Spring Semester Legal Extern Program. ------------------------------------------------------------------------------ August 20, 2012; U.S. Attorney; Southern District of Texas Houston Doctor Arrested on Charges of Health Care Fraud http://go.usa.gov/yWn ------------------------------------------------------------------------------ August 17, 2012; U.S. Attorney; Eastern District of Kentucky Local and Out of State Pain Clinic Owners and Doctors Charged in Prescription Drug Conspiracies http://go.usa.gov/yWn ------------------------------------------------------------------------------ State Enforcement Actions Updated http://go.usa.gov/pqp ------------------------------------------------------------------------------ That’s all we have for today. If we can be of any further assistance, please send an Email to public.affairs@oig.hhs.gov Make it a great day! Marc Wolfson – Office of External Affairs OIG’s privacy policy can be found at http://oig.hhs.gov/notices/privacy-notice.asp
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OIG Posts Report and Related Podcast, Externship Announcement and News about Enforcement Actions - 8/21
