Audit of the Medicare Partial Hospitalization Program at Mental Health Corporation of Denver

This final report points out that review of medical records performed by the intermediary's medical review staff and the Health Care Financing Administration's medical surveyors found that all of the 1,030 units of service included in 100 sampled claims made by the Mental Health Corporation of Denver (MHCD) did not meet Medicare requirements for partial hospitalization services (PHP). Based on the totality of the evidence, we have questioned the entire $4,447,607 charged for PHP services by MHCD during Fiscal Year 1996. During the course of our audit, MHCD discontinued billing Medicare for PHP services. In addition to a financial adjustment, we are recommending that the intermediary (Blue Cross Blue Shield of Texas) review PHP services provided by MHCD for other cost report periods. We are also recommending that MHCD take the necessary steps to ensure that any future billings for PHP services meet the Medicare requirements for such services.