OIG tags California medical group for erroneous billing

Santa Monica, Calif.-based Oceanside Medical Group failed to comply with Medicare requirements when billing for psychotherapy services, according to a report from HHS' Office of Inspector General.

The OIG said none of the 100 sampled beneficiary days, consisting of 103 psychotherapy services, complied with Medicare requirements. In the majority of cases, psychotherapy either was not provided or psychotherapy time was not documented, according to the OIG.

The claims that did not comply with Medicare billing requirements resulted in the medical group receiving $5,317 in combined overpayments during the audit period of July 1, 2015, through June 30, 2017, according to the OIG.

Extrapolating from the sample results, the OIG estimated Oceanside Medical Group received at least $2.6 million in overpayments from Medicare during the audit period.

"These overpayments occurred because Oceanside did not have policies and procedures or effective management oversight to ensure that psychotherapy services billed to Medicare were actually provided, adequately documented, and correctly billed," the OIG said.

Based on its findings, the OIG recommended the medical group refund Medicare the portion of the estimated $2.6 million overpayment for claims that are within the reopening period, exercise reasonable diligence to identify and return any additional overpayments outside of the audit period and strengthen controls to ensure full compliance with Medicare requirements.

In written comments on the draft report, Oceanside Medical Group agreed with the OIG's findings but disagreed with some of the agency's recommendations. The medical group disputed that is was "in violation of any overpayment," according to the OIG.

After reviewing the medical groups' comments, the OIG maintained its findings and recommendations.

The medical group will have the opportunity to appeal the results of the audit.

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