decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Mental Health Services / Fraud Alerts / 1996 Fraud Alert - Mental Health Services Billing Fraud
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Article Overview
This article summarizes an OIG fraud alert focused on Medicare Part A mental health services billing. It describes investigation findings involving community mental health centers, hospital-based services, and claims review concerns, and it highlights why the alert mattered to fiscal intermediaries, compliance staff, and auditors responsible for identifying suspicious billing activity.
Why This Topic Matters
It helps billing, compliance, audit, and reimbursement professionals recognize the kind of mental health services claim activity that prompted federal fraud scrutiny and understand the general oversight concerns raised by OIG.
Article Sections
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Investigations and billing patterns
Summarizes the OIG investigations that identified questionable mental health services billing activity in Medicare Part A settings and the general service patterns involved.
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OIG recommendations and review focus
Describes the broader review and oversight measures recommended for identifying unusual billing patterns in mental health claims.
What You Will Learn
- What prompted the fraud alert
- Which types of Medicare mental health billing activity were investigated
- What general claim review concerns were raised by OIG
- Why enhanced medical review was recommended for mental health services
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Auditors
- Revenue cycle professionals
- Healthcare administrators
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