Lawmakers Question Screening of Fraudulent Medicare Mental Health Claims

WASHINGTON, DC - Citing growing fraud, U.S. Sens. Bill Nelson (D-FL) and Mary Landrieu (D-LA) have asked the inspector general of the Department of Health and Human Services (HHS-OIG) to examine whether federal health regulators are adequately screening for fraudulent Medicare mental health claims.

The lawmakers' request comes in the wake of the recent sentencing of Armando Gonzalez, the former owner of a Miami-based company, Health Care Solutions Network (HCSN).  Gonzalez was sentenced to 168 months in prison for submitting more than $63 million in false claims to Medicare and Florida Medicaid.   According to prosecutors, HCSN employees routinely submitted fraudulent billings for mental illness therapies that often consisted of nothing more than patients watching movies, playing bingo and having barbeques.  Before defrauding Medicare, Gonzalez spent five years in prison for cocaine trafficking.

Law enforcement officials say Gonzalez is among an increasing number of career criminals who've entered the lucrative Medicare mental health racket.

In August, an HHS inspector general report cited Florida, Louisiana and Texas as hotbeds for Medicare community mental health center fraud schemes.  As many as two-thirds of the centers with questionable billings were located in the three states,  according to the report's findings.  A separate audit conducted by the inspector general in January found that efforts by private contractors hired by Medicare to detect and deter fraudulent billing by community mental health centers were ineffective.

Nelson and Landrieu say the findings and Gonzalez's conviction warrant a broader investigation into how Medicare continually verifies the legitimacy of all mental health providers that bill for services.  Specifically, the lawmakers have asked the HHS inspector general to review how the program ensures mental health providers meet state and federal standards required for participation in the program.

"Clearly, the system isn't working if millions of dollars in fraudulent claims keep falling through the cracks, " said Nelson, who chairs the Senate Special Committee on Aging.   "We need to find out how it's happening and what needs to done to fix the problem."   
                                                                                  
"Both taxpayers and Medicare beneficiaries are hurt by those who take advantage of some of our most vulnerable citizens for their own profit," Landrieu said.  "We need to do more to stop fraudulent Medicare mental health claims and ensure that these funds go to the people who need support."

Click Here to view the lawmakers' letter to the HHS inspector general.