Department of Health

Medicaid Overpayments for Mental Health Services

We analyzed the claims paid by Medicaid for mental health services over a 41-month period. On the basis of our analysis, we identified certain billing patterns and other circumstances in which there appeared to be a relatively high risk of overpayments. We accordingly selected a sample of these claims for detailed examination, focusing on the claims submitted by certain service providers. Our detailed examination identified more than $1.3 million in Medicaid overpayments, many of which were the result of providers billing Medicaid more than once for the same service.

About $436,000 in overpayments were made to a psychiatrist who admitted to not seeing certain patients. The patients were seen by an assistant instead (a social worker). However, the psychiatrist billed for the patients at the higher “psychiatrist” billing rate, sometimes billing for more than 24 hours of treatment in a single day. We referred this matter separately to the Office of the State Attorney General for further investigation. We recommended that the Department of Health investigate and recover the overpayments we identified, and strengthen its Medicaid claims processing controls to prevent such overpayments in the future.

For a complete copy of Report 2006-S-53 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.