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October 2006
 Carrier Determination of Copayments for Medicare Mental Health
Services
The U.S. Office of the Inspector General (OIG) conducted this
investigation in 2003 to determine
the extent to which Medicare carriers correctly calculate copayments
for mental health
services. The investigation sought to determine if carriers:
-
Consistently calculated beneficiary copayments for mental health
services
-
Correctly calculated copayments for mental health services rendered
to beneficiaries
diagnosed with Alzheimer's disease or related disorders
The
OIG determined that during the investigation period in 2003 there
was variation in the
amount carriers calculated as copayments for mental health services.
Copayments ranged
from 20% of services billed to 50% of services. The variation
appeared to be geographical
and was primarily due to the carriers' incorrect application of a
formula used to
determine copayments. As a result, OIG estimated that nearly $27
million in Medicare
eligible costs were shifted to consumers in the form of excessive
copayment amounts.
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