Review of Outpatient Psychiatric Services Provided by Saint Vincent's Hospital for Calendar Year Ended December 31, 1997

EXECUTIVE SUMMARY:

This final report points out that many of the outpatient psychiatric services claimed by Saint Vincent Hospital did not meet the Medicare criteria for reimbursement. Specifically, charges for outpatient psychiatric services lacked sufficient patient treatment plans, lacked sufficient medical record documentation, and/or were not reasonable and necessary. We estimated, based on a statistical sample, that at least $2,261,155 in such charges for calendar year 1997 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 reasonable and necessary and properly documented in accordance with Medicare regulations and guidelines.