Overbilling for Partial Hospitalization Programs
Overpaying happens in many industries, but when it happens in the American medical industry, federal and state governments sit up and take notice. According to the United States Department of Health and Human Services (HHS), over half of community health medical centers (CHMC) ask for more money from Medicare than they should have. Many of these medical centers offer partial hospitalization programs (PHPs).
The HHS’ 2012 study only focused on the year 2010, but due to the time it takes to crunch numbers, it can be assumed that many medical centers with partial hospitalization programs are still asking Medicare for too much money. This can cause a potential legal disaster for the medical centers and for the psychiatric patients who rely on PHPs to get affordable mental health care.
The Department of Health and Human Services’ study determined that one of the most common causes of overbilling is patients are listed as getting more billable procedures than they actually received. Some examples include:
- Patients are listed as getting individual therapy and group therapy, but they really only receive group therapy
- Patients aren’t given checkups by their doctors during their time in PHP
- Patients who have cognitive disorders like Alzheimer’s Disease are listed as having mental illnesses that can be treated with PHP
- Patients are admitted to a PHP without the proper referrals
The HHS noted that the community health medical centers that were not required by state law to be licensed were the most likely facilities to overbill Medicare. In fact, about 90 percent of errors related to excess payments came from unlicensed community health medical centers. The CHMCs that overbilled the most were in metropolitan areas in Florida, Louisiana and Texas.
Penalties for Overbilling
Community health medical centers that do not return excess payments face many penalties. First off, they may be expelled from the Medicare program and lose all Medicare funding. In order to start receiving payments from Medicare, a CHMC must first agree to promptly give back any overpayments.
The next penalty is the CHMC must pay back all excess funds. If overbilling is a chronic practice in the community health medical center, then paying back what it owes could be enough to shut it down permanently.
All Medicare overpayments must be returned, according to federal law; it doesn’t matter if the overbilling was intentional or accidental. Keeping these payments opens the medical center to federal prosecution. If overbilling is discovered, the medical center or its PHP needs to contact a defense attorney who is familiar with federal crimes law or health care fraud law. Usually, a CHMC has only 60 days to report an overbilling problem once it has been discovered.
To learn more about Medicare overpayments for partial hospitalization programs, speak to Houston criminal lawyer James Alston at (713) 228-1400.