Routine Monitoring & Targeted Auditing for Improper Payments

Our program identifies improper payments, including overpayments due to mistakes, fraud, waste, and abuse.

Overpayment Protocol for Behavioral Health Federal Insurance Programs

To update the FY24-25 protocol (FY24-25), we reviewed the Medicaid and Medicare laws, regulations, contracts and agency manuals. In addition, we leveraged the feedback received from DHCS during their Acute Inpatient Psychiatric Hospital Triennial Review (December 2022/January 2023) SMHS Outpatient Triennial Review (February/March 2023).

To simply the protocol and process, we designed a flexible protocol that can be used for almost any funding stream (SMHS vs. DMC-ODS) and payer (Medicare vs. Medicaid).

We created a slide-deck presentation that describes the updated audit protocol and contextual. 

In addition, we posted a 30-minute video to the BHS Vimeo channel - - it walks you through the slide-deck presentation.


Last updated May 8, 2024