Outpatient Mental Health Care Fraud

Medicare Part B covers outpatient mental health services in places such as a doctor’s office or other health care provider’s office, a hospital outpatient office, or a community mental health center. Medicare only covers visits when provided by a health care provider who accepts the Medicare-approved amount as full payment for any covered service provided.

Report potential outpatient mental health care fraud, errors, or abuse if you:

• Were picked up by a bus or van along with other beneficiaries and taken out for a meal and Medicare is billed for a mental health evaluation
• Spent all day watching TV or playing games at a facility and Medicare is billed for group therapy
• See on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) charges for mental health services:
  • With time spent listed as more than what you received
  • That you did not receive
  • That were not provided in a health care office or by a licensed professional such as a psychiatrist, psychologist, social worker, nurse specialist, or nurse practitioner

Caregivers and family members, be on the lookout for:

• Someone picking up your loved one in a bus or van to go to a facility, where they report they watched TV or played games with others
• Charges for therapy your loved one never received

Watch this video to learn how to read your Medicare Summary Notice (MSN) and Explanation of Benefits (EOB).

Note: Need mental health care? Go to the 988 Lifeline, or call 988. They provide free and confidential support to people in suicidal crisis or emotional pain 24 hours a day, seven days a week, across the United States and its territories.

Report Suspected Fraud

To report suspected fraud, click here.