Health care fraud is a big industry, and the federal government has increased its efforts in recent years to battle the problem. While some states take the problem very seriously, others pay less attention to the problem.
According to a federal report released this week, at least 90 percent of over $200 in “questionable billing” issues discovered at Medicare outpatient community mental health centers took place in states that do not stress oversight of such programs to prevent such fraud.
Community health centers are intended to save Medicare money by keeping beneficiaries out of inpatient hospital care, but some providers look for loopholes to game the system.
Florida, Texas and Louisiana were reportedly the top three states for questionable billing practices. None of the states has licensing or certification requirements for the mental health programs. In Louisiana, 57 clinics had a total of $60 million in questionable bills.
The types of practices range from patients living thousands of miles from the clinics; patients who were unable to benefit from treatments; unusually high billing; and patients who were never seen by a doctor, and so on.
The report recommends better monitoring of the centers, enforcing physician certification of patients and improving reviews on questionable billing.
Despite the prevalence of Medicare fraud and other forms of health care fraud, it is important for each and every person accused of these crimes to take the steps to protect themselves and claim their rights. Failing to do so can lead to a false or inaccurate conviction and a future of having to deal with the consequences of conviction.
Source: USA Today, “Report examines Medicare billing at mental health centers,” Kelly Kennedy, August 21, 2012.