MEDICARE: Mental Health Centers Target Of Federal Probes

      Two federal probes of community mental health centers have revealed "one of the worst track records to date" of Medicare fraud and abuse, the Wall Street Journal/Florida edition reports. Nancy-Ann Min DeParle, head of the Health Care Financing Administration, said the probes are prompting her agency to take "very aggressive termination actions" that will affect "a very significant number" of the mental health centers. The Journal reports that HCFA might start "by kicking out the providers that offer the fewest of the required services, which could total 80 to 160 centers, according to one official estimate." At issue is whether the mental health centers receiving Medicare reimbursement for "partial hospitalization" services are doing so legally. This service was intended to be "intensive outpatient treatment for Medicare beneficiaries who are seriously mentally ill but aren't a threat to themselves or others." The number of these centers nearly quadrupled in the last few years, from 196 in 1993 to 769 in 1997. And the average cost per patient skyrocketed from $1,642 to $10,352 during this period. Last year Medicare was billed $349 million on the benefit, completely overshooting HCFA's $15 million projection. And investigators contend that in many instances Medicare is paying for nothing more than "adult day care." Mental health providers, on the other hand, contend that the feds are "exaggerating the situation" and are "out to kill the program" because it has grown so rapidly within recent years.

Baby With The Bath Water?
      One of the probes looked at billings in five states -- Florida, Texas, Colorado, Pennsylvania and Alabama -- and found that $199 million out of $252 million was spent on "unallowable" services. The audit found that 79% of the Medicare funds were "wasted on people who didn't need treatment, or on recreational activities such as drawing or watching television." The second probe found that 80% of centers investigated should not "even qualify as community mental health centers" because they do not fulfill all of HCFA's requirements for the designation, such as offering "24-hour emergency care, specialized screening and outpatient services." One of the studies concluded: "In view of the severity of the problems disclosed, we believe that HCFA should evaluate the propriety of allowing (the centers) to provide the benefit." But providers say HCFA is guilty of a "knee-jerk reaction" in response to the growing number of centers offering partial hospitalization services that Medicare must cover. In addition, the providers say many of HCFA's requirements are "unclear" and "subject to interpretation." Dr. Miguel Nunez, vice president of the Florida Association of Community Mental Health Centers, said, "It looks like a systematic effort to shut down the whole industry rather than target the select providers that are really causing problems." DeParle said, "In my view, there's no reason why (community mental health centers) can't provide the service legitimately. A lot just aren't" (McKinnon, 8/19).