Magazine article Behavioral Healthcare Executive

Be Aware of Fraud Regulations or Risk Exposure to Penalties

Magazine article Behavioral Healthcare Executive

Be Aware of Fraud Regulations or Risk Exposure to Penalties

Article excerpt

Encourage your staff to come forward with concerns about potential fraud so that deficiencies can be resolved through self disclosure rather than a costly audit

One strength of the behavioral health field is the great lengths to which providers will go to ensure that patients have access to medically necessary treatment. However, providers must be cautious about how they accept new clients and bill for the services provided to those clients in order to reduce the risk of suspected Medicare or Medicaid fraud.

The federal government and individual states have been increasing their focus on addressing fraud in healthcare in general, and in the behavioral health field in particular. In May, a Medicare Fraud Strike Force operation resulted in charges against 90 individuals, including 27 medical professionals, for their alleged participation in fraud schemes involving mental health and psychotherapy services, which amounted to approximately $260 million in Medicare false claims.

Laura E. Ashpole, J.D., an associate at the law firm Popovits and Robinson in Frankfort, 111., advises providers to be familiar with the Medicare enrollment and claims submission requirements under federal law. The rules can be complex, so it's important for providers to consult their legal teams on these issues.

"Many substance use disorder treatment providers do not see a great deal of Medicare patients and for that reason are not Medicare-certified or enrolled," Ashpole tells Behavioral Healthcare. "However, as implementation of the Medicare-Medicaid Alignment Initiative continues to ramp up in states, substance use disorder treatment providers are seeing more and more Medicare beneficiaries and dual-eligibles. They need to be aware of the regulatory issues associated with that and ensure that they are appropriately billing for services rendered."

According to Ashpole, behavioral health providers are becoming more open about the issues they are facing in Medicare billing and reimbursement. This is positive progress, as states and the federal government need to know where the issues lie and where the systems break down. She also advises organizations to encourage their staff members to come forward with concerns about potential fraud and abuse within the organization so that deficiencies can be addressed immediately and resolved through self-disclosure, as appropriate. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.