Apparently Medicare is comfortable with virtually any type of physician diagnosing mental illness and conducting psychotherapy sessions—even without training in psychiatry, psychology or social work. The worst cases have happened in Illinois, where, for example, Medicare paid an OB/GYN physician $207,980 for more than 10,000 mental health group visits for nursing home residents in 2012.
A recent analysis of federal data by investigative journalists at the nonprofit organization ProPublica found that many such doctors—obstetricians/gynecologists, thoracic surgeons, primary care physicians and others—are being reimbursed by Medicare for offering such services to those living in intermediate and long-term care facilities.
Several large billers are suspect because their area of specialty is not within behavioral health and because of the unusually high volume of claims. Medicare has always been an easy target for fraud.
Medicaid stopped paying for group psychotherapy for nursing home residents in 2012, but a representative of the Centers for Medicare & Medicaid Services told ProPublica that Medicare does not have a policy specifying which types of physicians may conduct group psychotherapy sessions.
To read the ProPublica article, click here.