News: Documentation partly to blame for $2.6 million in psychotherapy overpayments, OIG says

Oceanside Medical Group, a clinic providing mental health services in Santa Monica, California, is disputing an Office of Inspector General (OIG) report that estimated the group received $2.6 million in overpayments for psychotherapy services by failing to comply with Medicare billing and documentation requirements.

The OIG based its estimate off a sample of 100 beneficiary days, which included 103 individual psychotherapy services, Credentialing Resource Center reported. The OIG’s auditors determined that none of the 100 sampled services complied with Medicare’s requirements. Specifically, the auditors determined that:

• Psychotherapy was not provided for 52 services
• Psychotherapy time was not documented for 49 services
• Adequate supporting documentation was not provided for two services

The sampled services represented an overpayment of $5,317. Based on the sample, the OIG estimated Oceanside received at least $2.6 million in overpayments.

The OIG recommended that Oceanside repay a portion of the estimated $2.6 million overpayment for claims that are within the reopening period. For claims outside that period, the OIG recommended that Oceanside identify and return overpayments according to the 60-day overpayment rule. The agency also recommended that Oceanside implement policies and procedures and strengthen oversight to ensure that services are correctly provided, documented, and billed, according to Credentialing Resource Center.

Oceanside disagreed with the OIG’s findings and the agency’s first recommendation. Oceanside maintains that its documentation supported the provision of separately identifiable psychotherapy services. Oceanside also disagreed that psychotherapy time was not properly documented because it does not believe that providers are required to document specific start and stop times.

The OIG stands by the findings in its report.

Editor’s note: This article originally appeared in Credentialing Resource Center. To read the OIG report, click here. To read about how CDI can help improve documentation in this area, click here.