Deeper Than the Headlines: Psychiatrist, Clinic Pay $900K in Fraud Allegation Settlement

Hi, everyone. I'm CJ Wolf with Healthicity. Welcome to another deeper than the headlines video.

Today, we're talking about a, psychiatrist and the mental health clinic in Philadelphia, Pennsylvania that recently paid nine hundred thousand dollars to resolve allegations that they, committed Medicaid billing fraud. Now the allegations were very specific. A lot of you know that in psychiatry, psychiatrists will often do what's called med checks. So they might a patient who has depression or is receiving psychotherapy services might be receiving those services by a social worker or a psychologist who may or may not be able to prescribe medication, and so the medication management is done by a psychiatrist, for example. Well, that code in medic for Medicaid in this state, in this particular case, the state required that that pharmacologic management code be at least fifteen minutes worth of, kind of checking with the patient and making sure that the medication is the proper medication.

It was even alleged that this psychiatrist and clinic had been audited, many years prior and told specifically that their visits that were documented as six to twelve minutes were not long enough.

Also, the doctor allegedly was documenting clock time that overlapped with clock time of seeing other patients. So, you know, in order to document fifteen minutes, of clock time for this medication management, you have to write down the the time and hours of the day that you spent. Not just I spent fifteen minutes, but actually record the clock time from one twelve, you know, PM to, one thirty or whatever the time may have been.

And it was alleged that the clinician was essentially falsifying records because they were overlapping times. It's impossible to be doing medication management for two patients at the same time, and also in separate clinics. So that was, a really interesting one. Hope you enjoy these types of things. We're gonna include the link, so that you can read more about this case. Thanks for watching.

Reference link: https://www.justice.gov/usao-edpa/pr/philadelphia-mental-health-clinic-and-its-psychiatrist-owner-agree-pay-900000-resolve

 

 

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