Texas department alleges telehealth provider overbilled Medicaid claims

AUSTIN (KXAN) — Auditors with the Texas Health and Human Services' Office of Inspector General determined a behavioral health services provider allegedly incorrectly billed the state for add-on psychotherapy sessions, OIG officials said in a Tuesday release. Those alleged incorrect billings include using providers who weren't enrolled in Medicaid, the release added.

The OIG audited PsyClinic between June 1 and Dec. 31, 2021. During that period, the OIG claimed PsyClinic received more than $381,000 for over 4,300 claims. Those service claims included psychiatric evaluations, maintenance and add-on services, the OIG release said.

OIG officials said that while PsyClinic is enrolled in Texas' Medicaid program, four out of the 11 healthcare providers that consulted with patients hadn't been authorized to work with Medicaid clients, per the release. The OIG evaluated 60 claims and found that 16 allegedly involved non-enrolled providers, leading to $1,450 in "erroneous billing."

"OIG auditors used this amount to extrapolate an error rate in PsyClinic billing of $54,087, which should be returned to the state," the release said in part. "The use of providers not enrolled in Medicaid presents unnecessary risks to patients, including a lack of pre-enrollment screening by the state and the possibility that the provider is not approved to provide the specific service."

OIG officials claimed PsyClinic didn't identify specific services covered in 57 out of the 60 reviewed claims; instead, OIG officials alleged PsyClinic "lumped all services provided into a single visit measured by the total time spent with client." That process can make it difficult to code and evaluate proper repayment for visits, OIG officials said.

KXAN reached out to PsyClinic for a statement regarding these claims. We'll update this story if a response is received.