ProPublica report: outlier providers account for enormous numbers of group psychotherapy Medicare claims

by Ben Vernia | July 15th, 2014

ProPublica has issued an interesting report identifying numerous suspicious patterns of billing for group psychotherapy services under Medicare, including:

  • Four Illinois doctors (three obstetricians, one former thoracic surgeon) accounted for more claims than all providers in California, combined;
  • One Queens, N.Y., primary care physician had the highest rate of billings, comprising one of every six such claims in the state of New York;
  • A Detroit social worker billed 5000 claims for 26 patients – an average of 190 per patient;

The report described changes Illinois’ Medicaid program implemented to reduce abuse, which led to a drop in one year of two-thirds the amount of claims for group psychotherapy services.

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