About one-third of mental health services provided to Medicare patients in doctor's offices and mental health centers is unnecessary, provided by unqualified staff or billed incorrectly, a report Monday says.
   The inappropriate care and incorrect bills overcharge taxpayers and patients more than $185 million a year, says the Office of the Inspector General for the Department of Health and Human Services.
   Some patients get too much care -- 80-minute visits with psychotherapists when 50-minute sessions would do -- while other patients fail to get needed medication, the study says. Nurses, social workers and graduate students are sometimes providing services for which they are not qualified, the report says.
   "Medicare is paying for a lot of unnecessary and inappropriate care, while some patients are not getting the care they need," says George Grob, deputy inspector general.
   The study, one of a series, looked at money spent in 1998 on psychotherapy, psychological testing and group therapy -- just a portion of the mental health services on which Medicare spent $1.2 billion that year. Earlier reports by the inspector general also found billing problems with such services provided in nursing homes and community health centers.
   "The Medicare error rate (the amount improperly paid) is just over 7 percent for the program as a whole," says Grob. "With mental health services, the percentage is never below 33 percent and is sometimes 50 percent."
   But mental health professionals cite flaws in the way billing and treatment were investigated.
   For example, psychiatrists say treatment of patients with Alzheimer's and dementia is often justified, although the inspector general's office has questioned some services, saying the patients may be too ill to benefit from group therapy or psychiatric services.
   Rather than focusing on elderly patients getting too much treatment, critics say, the inspector general should be concerned with a host of research showing that many aren't getting enough.
   "The real worry here is that under technicalities, such as a lack of good billing documentation, the message may get out that older people are overutilizing mental health services," says Stephen Bartels, of the American Association for Geriatric Psychiatry.
   "Nothing could be further from the truth," he says. "The right people aren't getting the right services, and there aren't enough qualified geriatric providers."

Detroit News

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