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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Results of Review of America's Behavioral Health Center," (A-04-98-01192)

December 17, 1999

Complete Text of Report is available in PDF format (72 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


This report provides the results of the Review of America's Behavioral Health Center's (ABHC) Partial Hospitalization Program (PHP).

The objective of this review was to determine whether the partial hospitalization services claimed by ABHC between January 1, 1998 and July 31, 1998 for 30 beneficiaries were in accordance with Medicare eligibility and reimbursement requirements.

Our review showed that:

In our opinion, this occurred because the provider did not ensure that the beneficiaries admitted to the facility met the Medicare eligibility criteria for PHP services, or that the services billed met the Medicare reimbursement requirements. Based on the results of our review, we recommend that the Health Care Financing Administration (HCFA) direct the Fiscal Intermediary (FI) to: