Reports

Department of Health & Human Services OIG

Montana Generally Complied With Requirements for Telehealth Services During the COVID-19 Pandemic

Full Details: Oversight.gov Report Page

Audit | 5/17/2023

Department of Justice OIG

Inmate Perceptions of the Federal Bureau of Prisons’ Management of the Coronavirus Disease 2019 Pandemic

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Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

Medicare Improperly Paid Providers for Some Psychotherapy Services, Including Those Provided via Telehealth, During the First Year of the COVID-19 Public Health Emergency

Full Details: Oversight.gov Report Page

Audit | 5/02/2023

23-A-09-068.01 - Open

We recommend that the Centers for Medicare & Medicaid Services work with the MACs to recover $35,560 in improper payments made to providers for the 128 sampled enrollee days that did not meet Medicare requirements.

23-A-09-068.02 - Closed

We recommend that the Centers for Medicare & Medicaid Services work with the MACs to based upon the results of this audit, notify appropriate providers (i.e., those for whom CMS determines this audit constitutes credible information of potential overpayments) so that the providers can exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.

23-A-09-068.03 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Conduct medical reviews of psychotherapy services, including services provided via telehealth, to verify that the services are documented and billed in accordance with Medicare requirements.

23-A-09-068.04 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Implement system edits for psychotherapy services, including services provided via telehealth, to prevent payments for services that were billed incorrectly.

23-A-09-068.05 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Strengthen educational efforts to make providers aware of educational materials on how to meet Medicare requirements and guidance for psychotherapy services, including services provided via telehealth.

23-A-09-068.06 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS work with the MACs to take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Review MAC jurisdictions' LCD requirements for psychotherapy services to identify which provisions effectively promote program integrity, and consider additional steps that CMS could undertake to ensure appropriate coverage and payment for psychotherapy services across all jurisdictions.