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Medicare Compliance & Reimbursement

Mental Health:

'Incident To' Won't Fly Without Supervision

Published on Wed May 19, 2004

Though psychologist Dr. Richard Cook said he had no intention of defrauding the government, his alleged lack of oversight landed him smack in the middle of a false claims suit.
 
U.S. Attorney John Suthers announced April 21 that the Englewood, CO doctor agreed to settle allegations that he submitted fraudulent bills to Medicare and Medicaid by repaying $250,000 to the state and the federal government.

Charges revolved around claims for psychotherapy sessions Cook claimed he performed between 1998 and 2000, which were allegedly conducted by unlicensed employees not under his immediate supervision. Prosecutors say that Cook "knew or should have known" his way around incident-to billing regulations that would have allowed him to bill such services if supervision was properly documented. The lack of such documentation flagged his claims as fraudulent, even though the services provided to patients may have been adequate and medically necessary.

"False claims to Medicare and Medicaid, whether they are completely false, or, as here, seek an unjustified incremental increase in compensation for services which were actually provided, cost the taxpayers billions of dollars. We continue to pursue false claims at all levels of the health care profession to help ensure the long-term integrity of the Medicare and Medicaid programs."

Lesson Learned: Providers need to make sure services provided by unlicensed personnel are billed "incident-to" and meet all documentation requirements.

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