Review of Outpatient Psychiatric Services Provided by Provena St. Joseph Hospital for the Period September 1, 1996 Through November 30, 1997

This final audit report points out that significant numbers of outpatient psychiatric claims by Provena St. Joseph Hospital for the 15-month period ending November 30, 1997 did not meet Medicare reimbursement requirements. Specifically, many outpatient psychiatric services were not medically necessary, not supported by medical records, or without any medical record. We estimate, based on a statistical sample, that unallowable charges totaled at least $1.9 million for the above period. We also identified another $97,494 in other unallowable costs for meals, patient transportation, and other costs which were not supported. We recommended financial adjustments. We also recommended that the hospital strengthen its controls and procedures to ensure that charges for outpatient psychiatric services are covered and documented in accordance with Medicare requirements. Finally, we recommended that the hospital develop procedures to exclude unallowable costs from its Medicare cost reports.