HHS OIG Report Finds Medicare Mental Health Care Overbilling

A report released today by HHS' Office of the Inspector General cited about one-third of mental health services provided to Medicare beneficiaries in doctors' offices and mental health centers as "unnecessary, provided by unqualified staff or billed incorrectly," USA Today reports. According to the report, which is part of a series investigating Medicare mental health spending, the "inappropriate" care and "incorrect" bills cost taxpayers and patients more than $185 million a year. Some patients receive "too much" care -- 80-minute visits with psychotherapists when 50-minute sessions "would do" -- while other patients do not receive required medication, the study found. In addition, nurses, social workers and graduate students "sometimes" provide services "for which they are not qualified," the study reports. "Medicare is paying for a lot of unnecessary and inappropriate care, while some patients are not getting the care they need," George Grob, deputy inspector general, said. The OIG study examined funds spent in 1998 on psychotherapy, psychological testing and group therapy, "just a portion" of the $1.2 billion spent last year by Medicare on mental health services. "The Medicare error rate (the amount improperly paid) is just over 7% for the program as a whole," Grob said, adding, "With mental health services, the percentage is never below 33% and is sometimes 50%." However, mental health professionals blamed "flaws in the way billing and treatment were investigated," pointing out that OIG has questioned some "justified" treatments for patients suffering from Alzheimer's disease and dementia. Critics added that the agency "should be concerned with a host of research showing that many [elderly patients] aren't getting enough" treatment. "The real worry here is that under technicalities, such as a lack of good billing documentation, the message may get out that older people are overutilizing mental health services," Stephen Bartels of the American Association for Geriatric Psychiatry said, adding, "Nothing could be further from the truth. The right people aren't getting the right services, and there aren't enough qualified geriatric providers" (Appleby, USA Today, 6/4).