Documentation errors and omissions for tele-mental health services accounted for $348 million.

More than half of the $1 billion in temporary pandemic-related psychotherapy services paid by Medicare in the first year of the public health emergency were incorrectly billed, federal auditors say.

The Department of Health and Human Services Office of the Inspector General examined the Centers for Medicare & Medicaid Services' mental health services records for both in-person and telehealth visits from March 2020 through February 2021 at the start of the public health emergency.

The audit covered approximately $1 billion in Part B payments for more than 13.5 million psychotherapy services during the period. The audit picked two random samples of psychotherapy services: one of 111 enrollee days for telehealth services, and the other of 105 enrollee days for in-person services.

For 128 of the sampled 216 enrollee days, providers did not properly document psychotherapy time or omitted other needed information. In 54 sampled enrollee days, providers' failed to sign their claims.

"Based on our sample results, we estimated that of the $1 billion that Medicare paid for psychotherapy services, providers received $580 million in improper payments for services that did not comply with Medicare requirements, consisting of $348 million for telehealth services and $232 million for non-telehealth services," OIG says. 

"The deficiencies we identified in our audit occurred because CMS's oversight was not adequate to prevent or detect payments for psychotherapy services, including telehealth services, that did not meet Medicare requirements and guidance," OIG says. "CMS's oversight was partially affected by the unprecedented challenges of the PHE because CMS's focus was to ensure that Medicare enrollees had access to health care."

"However, as CMS continues to reinstitute its program integrity measures and considers making other permanent changes to telehealth services, CMS should focus on implementing adequate oversight of providers to minimize the risk of paying for psychotherapy services, including those provided via telehealth, that do not meet Medicare requirements."

The bureau warns that a burgeoning medical credit card market could exacerbate medical debt woes for millions of people.

Americans put about $23 billion in healthcare expenses from 2018 to 2020 on high-interest medical credit cards and medical installment loans and paid about $1 billion in interest and other fees, a federal watchdog says.

And the Consumer Financial Protection Bureau in a new report, warns that the proliferation of these payment schemes "can create a significant financial burden for patients and deter them from seeking needed healthcare in the future."

The cards were used more than 17 million times in the three-year span to pay for everything from medications and lab work to emergency department visits for bills ranging from $35 to $40,000, the report says, warning that the proliferation in the marketing and use of medical credit cards, medical installment loans and other "high-cost specialty products" can easily and quickly saddle consumers with mountains of debt.  

Medical financing companies market their credit cards and payment schemes directly to hospitals and other care venues, and patients are often offered these credit cards in physicians’ offices, the report notes, "even when their insurance may cover the procedure, or they qualify for a hospital’s reduced or no-cost financial assistance program."

"Fintechs and other lending outfits are designing costly loan products to peddle to patients looking to make ends meet on their medical bills," CFPB Director Rohit Chopra says. "These new forms of medical debt can create financial ruin for individuals who get sick."

The report warns that financial terms and interest rates of many of the medical credit cards and medical installment loans are also "significantly higher than traditional consumer credit cards, 26.99% to 16%, respectively," and that the payment plans "often have deferred interest plans, with all accrued interest potentially becoming due at the end of a defined period, which can prove especially expensive and unaffordable for patients."

To bolster the use of medical credit cards, the CFPB says financial firms woo providers with a promise of quick payments, minimal financial risk and administrative ease. The report warns that after accepting these incentives, providers may be "disincentivized to explain legally mandated financial assistance programs or zero-interest repayment options before offering these products to patients."

The report also found that credit cards, installment loans and other deferred-interest payment plans are often sold to patients with little disclosure or explanation of the terms of the debt. Clinicians pushing the products on their patients often rely "solely on marketing materials and training that financing companies provide to them at no cost," the report says.

Worse still for consumers, financing medical debt on a credit card could increase patients’ risk of legal exposure if they’re in arears because creditors could use aggressive collecting tactics such as lawsuits that providers typically wouldn’t pursue.

Peach State clinicians who violate it risk censure from their respective professional credentialing boards.

Effective July 1, any clinician in Georgia who claims to be a medical specialist better have the credentials to back it up, under a new law signed this week by Gov. Brian P. Kemp.

Under Georgia Senate Bill 197, also known as the "Health Care Practitioners Truth and Transparency Act," a clinician's advertisements must include the clinician's names, and the specific license that the clinician holds for specific services.  

The law also bans the use of the title "doctor" by nonphysicians in clinical venues. Advanced practice nurses and physician assistants with doctorates who identify themselves as "doctors" must make it clear in their advertising that they are not a medical doctor or a physician.

Georgia clinicians who violate the new law risk disciplinary action from their respective professional credentialing boards.

Michael W. Champeau, MD, FAAP, FASA, president of the American Society of Anesthesiologists, strongly supports the new law, which he says "makes it clearer for patients to make informed decisions because they know the qualifications of the professional providing their care."

"Every patient deserves to be certain of exactly who is performing and responsible for their care during a procedure or surgery," Champeau says.

Auditors blame CMS for failing to establish a data-sharing agreement with the VA.

Medicare overpaid providers about $128 million over five years for medical care that the Veterans Administration had already paid for, federal watchdogs report.

The Department of Health and Human Services Office of the Inspector General determined that the "duplicate payments occurred because the Centers for Medicare & Medicaid Services did not implement controls to address duplicate payments for services provided to individuals with Medicare and VHA benefits."

"Specifically, CMS did not establish a data-sharing agreement with VHA for the ongoing sharing of data between the two agencies and did not develop an interagency process to include VHA enrollment, claims, and payment data in CMS's data repository," OIG says. "Inclusion of these data, which is required by federal law, would have allowed CMS to compare VHA claims data with existing Medicare claims data to identify duplicate claims paid for by both Medicare and VHA."

The audit covered $19.2 billion in Medicare Parts A and B payments for 36.3 million claims for Medicare and VHA benefits that received services from VA's community providers between January 2017 and December 2021. The auditors compared claims data from the VA and Medicare to match payments that had been claimed in both datasets.

"Because CMS did not develop an interagency process, CMS did not establish an internal process (such as claims processing system edits) to address duplicate payments for medical services authorized and paid for by VHA. Furthermore, CMS guidance to providers on VA’s responsibility to pay for medical services did not clarify that a provider should not bill Medicare for a medical service that was authorized by VHA," OIG says.

CMS Agrees

The OIG recommends that CMS: Create a data-sharing agreement with VHA; Build an interagency process to integrate VHA enrollment, claims, and payment data into the CMS Integrated Data Repository to identify pMedicare otential fraud, waste, and abuse under the Medicare; and establish an internal process to address duplicate payments made by Medicare for medical services authorized and paid for by VHA; and issue guidance to providers on not billing Medicare for a medical service that was authorized by VHA.

CMS agreed with the recommendations and said it was taking up the recommendations.