Audit finds psychiatric services provider overbilled for telemedicine visits

The OIG conducted an audit of claims submitted by Medcare Clinics for psychiatric services to ensure the provider billed Medicaid and the Children’s Health Insurance Program correctly for telemedicine services.

The audit determined the Houston-based provider had delivered psychiatric services to clients via telemedicine. Auditors also determined the type of service was at times improperly coded based on the time providers spent providing evaluation and management and add-on psychotherapy services. As a result, Medcare was overpaid and must return $2,437 to the state.

Telemedicine is a health care service that is (a) delivered by a physician licensed in Texas, or a health care professional acting under the delegation and supervision of a physician licensed in Texas, acting within the scope of the physician’s or health care professional’s license, (b) provided to a patient at a different physical location than the physician or health care professional, and (c) provided using telecommunications or information technology.

Following the COVID-19 pandemic, more providers began using telemedicine to connect with their patients. To make the transition to technology-delivered care easier, Texas officials adopted waivers and changes expanding the number of Medicaid services available through telemedicine.

OIG auditors recommended that the center implement processes to ensure that claims for services billed as time-based CPT codes are based on the actual length of services provided and that medical records include documentation to support the CPT codes billed. For the full audit, click here