ALBANY, N.Y., December 17 – Medicaid was improperly billed for over $1.3 million by a psychiatrist, according to an audit released by New York State Comptroller Thomas P. DiNapoli. On eight separate occasions, the psychiatrist billed Medicaid for treatments lasting more than 24 hours in a single day and for patients that he never treated.

More $1.3 million in Medicaid overpayments for mental health services was identified by the auditors for the time period of August 1999 to October 2006.

Most doctors work hard, but it is difficult to imagine how anyone can put in more than 24 hours in one day on multiple occasions. This should have immediately raised red flags and the psychiatrist should never have been paid. Better systems must be put in place by the Department of Health to prevent these types of payments from being made in the first place, said DiNapoli.

The overpayment for mental health services could have been prevented with additional controls in the eMedNY Medicaid claims processing system, which is administered by the New York State Department of Health.

The primary findings of the audit were:

One mental health provider who was paid more then $436,000 billed Medicaid on eight separate occasions for more than 24 hours " and as high as 42 hours in one instance " of service in a single day. He admitted to auditors he did not see certain patients for which he billed Medicaid. Auditors also discovered his clinical social worker saw certain patients, but Medicaid was billed at the higher psychiatrists rate;

389 providers submitted more than 27,000 claims valued at $662,000 for mental health services and pharmacologic management provided on the same day. Under Medicaid rules, psychiatrists who provide mental health evaluation and management services for patients cannot bill the program for prescribing medication " known as pharmacologic management " on the same day;

106 clinic-based mental health practitioners received 21,132 payments totaling more than $381,000 from June 2002 through December 2005 for services for which the clinic also received payment. When services are provided at clinics, only the clinic, not the individual service provider, is permitted to bill Medicaid;

1,898 instances were identified in which 27 different clinics had billed Medicaid twice at different rates for the same services. From June 2001 through October 2006, the overpayments totaled $302,568.

Of the nine providers who double-billed Medicaid for mental health care services, eight claimed they were confused about the rules and misinterpreted the Department of Health policy. The Department of Health was recommended to add a control to their eMedNY system to block payment for pharmacologic management when it is billed in conjunction with other mental health services, as well as other improvements in order to block duplicate payments.

According to the Department of Health, it will respond to the audit by implementing recommended controls and utilizing other strategies to avoid many of the overpayments found by the auditors. The Department of Health will also seek to recover the funds paid to providers in error.