EXECUTIVE SUMMARY:
The Silver Springs Health Center, a Community Mental Health Center (CMHC) located in Miami, Florida, received reimbursement for partial hospitalization program services provided to Medicare beneficiaries. Our audit showed that the Center did not meet the certification requirements for a CMHC, that none of the 20 patients in our sample were eligible for partial hospitalization services and that none of the services provided to the 20 beneficiaries were medically necessary and therefore allowable for reimbursement under Medicare coverage and reimbursement criteria. The services provided were social, recreational and diversionary rather than psychotherapeutic in nature.
Based on the audit, Medicare payments to the Center were suspended without notice. We also recommended that the Center's Medicare provider agreement be terminated and that the Health Care Financing Administration instruct the fiscal intermediary to recover the $2,281,731 of Medicare payments to the Center since the effective date of its participation in the program.