Partnership Review of Psychotherapy Claims Submitted by Two Payees Under the Illinois Medicaid Program

The objective of this partnership review with the Inspector General, Illinois Department of Public Aid (IDPA) was to develop and validate a time dependent billing routine that would identify practitioners who submitted claims for more time than is feasible in a day.  The routine identified practitioners who billed for one or more 12-hour days for dates of service from July 1, 1998 to June 30, 2000.  Two organizations were identified as alternate payees for several physicians in the time dependent billing project.  The alternate payees claimed physician psychotherapy services and received payments on behalf of the physicians.  We concluded that the physicians did not provide the psychotherapy services claimed by the alternate payees.  Counselors employed by the alternate payees allegedly provided family counseling services, which were claimed, using the physicians' Medicaid provider number, as individual psychotherapy services provided by physicians.  None of the services billed by the two alternate payees, during the audit period, were performed by physicians; therefore, we recommended that IDPA recover the unallowable payments made to the two alternate payees totaling $7,581,693 (Federal share ($3,790,846).  The State agency concurred with our findings and recommendation.