Review of Outpatient Psychiatric Services Provided by the Tomball Regional Hospital for Fiscal Year Ended June 30, 1998

This final audit report estimates, based on a statistical sample, that at least $1,098,553 in outpatient psychiatric services claimed by Tomball Regional Hospital did not meet Medicare reimbursement criteria. Specifically, charges for outpatient psychiatric services were not reasonable and necessary, or were provided to beneficiaries who were not eligible for such services. We noted an additional $219,114 for unallowable occupational therapy charges related to the above claims. Finally, we identified $45,059 in unallowable patient transportation costs, and were unable to determine the reasonableness of an additional $818,429 because the Hospital could not provide supporting documentation. In addition to financial adjustments, 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. We also recommended that the Hospital establish an effective procedure for excluding costs related to noncovered services from its Medicare cost reports.