Mental Health Center of Florida Generally Met Medicare Billing Requirements for Some Psychotherapy Services

Why OIG Did This Audit

• During calendar year 2019, Medicare Part B paid approximately $1 billion for psychotherapy services.
• Prior Office of Inspector General (OIG) audits of psychotherapy providers identified a high number of improper payments and found that providers did not always comply with Medicare billing requirements.
• This audit examined whether Mental Health Center of Florida (MHCF) complied with Medicare requirements when billing for psychotherapy services.

What OIG Found

• For 1 of 100 sampled claim lines, MHCF billed an incorrect Current Procedural Terminology (CPT) code. The error occurred because the provider inadvertently billed the incorrect CPT code.
• Since our audit period ended, MHCF stated that it updated its internal controls, including additional quality assurance steps, to increase compliance with Medicare requirements.

What OIG Recommends

We recommend that Mental Health Center of Florida monitor and evaluate the effectiveness of its quality assurance program updates to ensure that documenting of time spent on psychotherapy services meets Medicare requirements.

MHCF did not indicate concurrence or nonconcurrence with our recommendation.