Operation Restore Trust Review of the Jerome Feldnan Community Mental Health Center, Orlando, Florida

EXECUTIVE SUMMARY:

The Jerome Feldman Community Mental Health Center, located in Orlando, Florida, received reimbursement for partial hospitalization services provided to Medicare beneficiaries. Our audit showed that the center did not meet the certification requirements established under Sections 1916(c)(4) of the Public Health Service Act and 1861 of the Social Security Act. We also found that 16 of the 20 beneficiaries in our sample were not eligible to receive partial hospitalization services, while no documentation could be located for the other 4 beneficiaries, and that many of the services provided in Calendar Year 1996 failed to meet Medicare coverage and reimbursement criteria. The center was unable to produce sufficient financial records to support claimed reimbursement for administrative costs, which included inappropriate claims for transactions with related parties and payments to facilities from which patient referrals were received. We also noted that the center was located in an abandoned warehouse that had been previously condemned by local authorities due to a variety of unsafe and unsanitary conditions.

Based on the audit, the $2,554,314 paid to the center during its participation in the Medicare program was disallowed, Medicare payments to the center were suspended with notice and the center's Medicare agreement was canceled. The results of the audit were also referred for consideration of criminal prosecution.