Summary report reviews five psychiatric and behavioral health teleservices providers

The OIG Audit and Inspections Division released a report that reviews 63,713 Texas Medicaid and Children's Health Insurance Program (CHIP) managed care teleservices claims from five providers. The report was generated from five audits conducted between 2022 and 2024, covering more than $5.8 million in paid claims.

Auditors found that all five reviewed providers, including The Center for Comprehensive Mental Health, Medcare Clinics PLLC, The PsyClinic, Baylor Scott & White Health and The Harris Center for Mental Health and Intellectual and Developmental Disabilities, complied with most requirements. However, each provider had at least one area where they were not compliant. Specifically:

•    All five providers had findings related to billing incorrect procedure codes.
•    One provider billed services delivered by providers not enrolled in Texas Medicaid.
•    One provider double-billed for services.
•    One provider billed for unallowable facility fees.
•    One provider did not always maintain complete records. 
•    Two providers did not always notify patients of privacy practices before the start of telemedicine evaluation or treatment.

Each provider was given individual recommendations to correct issues uncovered during the audits. A total reimbursement of more than $106,609 was also recommended to resolve improper payments made to all providers.