The National Consumer Protection Technical Resource Center: The Center of Service & Information for SMPs

Health Care Fraud

From the Office of Inspector General (OIG), U.S. Department of Health & Human Services

Behavioral Health (Community Mental Health Centers)

Community mental health centers (CMHCs) treat mentally ill Medicare beneficiaries in outpatient centers. This type of treatment keeps beneficiaries out of the hospital and allows them to go home at night. CMHCs are mandated to provide intensive psychotherapy to their patients.

How the Scam Works

  • Instead of providing professional mental health services, fraudulent CMHCs provide nothing more than adult day care, where patients merely watch television all day and Medicare is billed for expensive mental health treatments.
  • Fraudulent CMHCs will also proactively recruit beneficiaries and offer spa treatments and vacations for the use of their Medicare card to bill Medicare for mental health care that was never rendered.
  • Another scheme includes billing for group therapy as individual therapy or van shopping trips to the mall that are billed as mental health care.

How to Fight Back

  • Reject offers of money or gifts in exchange for your Medicare number, Medicare card or statements containing your medical information and identity.
  • Don’t give out any of your personal information to these unscrupulous persons. The next victim of medical identity theft could be you.

Report Suspected Fraud

To report suspected fraud, click here.

 

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