Oceanside Medical Group Received Unallowable Medicare Payments for Psychotherapy Services

Submitting OIG:

Department of Health & Human Services OIG

Report Description:

Medicare paid about $1.9 billion for psychotherapy services provided to beneficiaries nation-wide from July 1, 2015, through June 30, 2017 (audit period). Prior OIG reviews found that Medicare had made millions in improper payments for mental health services, including psychotherapy services. After analyzing Medicare claim data, we selected for review Oceanside Medical Group (Oceanside). Our analysis indicated that providers from Oceanside billed Medicare an average of 33 individual services per day. In addition, two providers each billed for services on all but 5 days during our audit period.

Date Issued:

Wednesday, August 28, 2019

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-09-18-03004

Component, if applicable:

Centers for Medicare & Medicaid Services

External entity, if applicable:

Oceanside Medical Group

Location(s):

Santa Monica, CA

United States

Type of Report:

Audit

Questioned Costs:

$2,694,446

Number of Recommendations:

View Document:

Attachment	Size
91803004.pdf	4.93 MB

Additional Details Link:

https://oig.hhs.gov/oas/reports/region9/91803004.asp

Recommendation Number	Recommendation Status	Significant Recommendation
267340	Open	No
We recommended that Oceanside Medical Group refund to the Medicare program the portion of the estimated $2,694,446 overpayment for claims that are within the reopening period.
267341	Open	No
We recommended that Oceanside Medical Group, for the remaining portion of the estimated $2,694,446 overpayment for claims that are outside of the reopening period, exercise reasonable diligence to identify and return overpayments in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.
267342	Open	No
We recommended that Oceanside Medical Group exercise reasonable diligence to identify and return any additional similar overpayments outside of our audit period, in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

267340

Open

We recommended that Oceanside Medical Group refund to the Medicare program the portion of the estimated $2,694,446 overpayment for claims that are within the reopening period.

267341

Open

We recommended that Oceanside Medical Group, for the remaining portion of the estimated $2,694,446 overpayment for claims that are outside of the reopening period, exercise reasonable diligence to identify and return overpayments in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.

267342

Open