More than half of the $1 billion in Medicare psychotherapy provided from March 2020 to February 2021 "did not comply with Medicare requirements," according to an HHS inspector general's report released May 4.
The $580 million in improper payments included $348 million for telehealth and $232 million for non-telehealth services, the report said. Providers frequently failed to properly document the services they provided during the pandemic's first year.
The determination was based on a review of a random sample of 216 claims, extrapolated to reflect the 13.5 million total claims submitted in that period, the report said. Rates of improper billing were 61 percent for telehealth, and 57 percent for in-person treatment.
Those providing psychotherapy in-person failed to document treatment time more often than those providing telehealth, the report said. For telehealth psychotherapy providers, however, treatment plans were more often missing or incomplete.
HHS OIG recommended that CMS implement system edits for psychotherapy to prevent payments for incorrectly billed services, among other recommendations.