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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Outpatient Psychiatric Services Provided by College Hospital for the Calendar Year Ended December 31, 1998," (A-09-00-00067)

April 18, 2001


Complete Text of Report is available in PDF format (2.54 MB). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

This final report points out that a significant amount of College Hospital's outpatient psychiatric service claims did not meet the Medicare criteria for reimbursement. Specifically, many charges for psychiatric services were either unreasonable or unnecessary for the treatment of the patient's condition, or were not adequately supported by the underlying medical records. Based on a statistical sample, we estimate that for calendar year 1998 at least $567, 888 in outpatient psychiatric charges submitted by the Hospital were unallowable. In addition to a financial adjustment, we recommended that the Hospital strengthen its procedures to ensure that charges for outpatient psychiatric services are covered and properly documented in accordance with Medicare requirements.