OIG examines behavioral health billing
Data analytics plays a proactive role in detecting potential fraud, waste and abuse. In the second quarter of fiscal year 2021, the Investigations and Reviews Division further advanced the findings of a Fraud Detection Operation (FDO) initiated in November 2020.
Through a collaborative effort with OIG Fraud, Waste and Abuse Research and Analytics, the FDO team selected four behavioral health providers identified as outliers among their peers. Preliminary reviews of client and business records and extensive research was conducted on four providers located in San Antonio, Houston, Victoria and Brownsville.
Findings included instances of no client record or other documentation to support services rendered and clients reporting shorter sessions than providers billed, which results in a higher reimbursement rate to the provider. The OIG is evaluating the findings to determine next appropriate actions.