Outpatient Mental Health Care Fraud

Outpatient mental health care can be an important benefit to a beneficiary. Medicare covers outpatient mental health services in settings such as a doctor’s office or other health care provider’s office, a hospital outpatient department, or a community mental health center. Medicare only covers visits when they are provided by a health care provider who accepts assignment, which means that they agree to accept the Medicare-approved amount as full payment for any covered service provided.

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

  • You are picked up by a bus or van along with other beneficiaries and taken out for a meal and Medicare was billed for a psychiatric evaluation
  • You spend all day watching TV or playing games at a facility and Medicare was billed for group psychotherapy
  • You see on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) charges for:
    • Mental health services or time spent in excess of what was received
    • Mental health services that were not received
    • Mental health services that were not provided by a psychiatrist or other doctor, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, or physician assistant

To learn how to read your Medicare Summary Notice (MSN) and Explanation of Benefits (EOB), click here.

Report Suspected Fraud

To report suspected fraud, click here.

SMP Resources