Improper Coding and Unnecessary Overtime at the Central Texas Veterans Health Care System

On January 31, 2018, the VA Office of Inspector General (OIG) received allegations that a psychologist at the Temple campus of the Central Texas Veterans Health Care System double-coded group therapy sessions and received improper overtime pay. Double coding refers to inappropriately entering duplicate codes to a patient encounter when only a single code would be appropriate. This audit substantiated that the psychologist improperly coded mental health services for about 66 percent of patient encounters for a 20-week period. The psychologist double-coded services, used codes not supported by the medical documentation, and entered codes not permitted for psychologists’ use. Also, the psychologist received about $7,700 in salary for clinic time not spent providing direct patient care and more than 243 hours in unnecessary overtime pay. During the review, the team developed concerns that other psychologists were also coding patient encounters improperly. The OIG found similar errors, except for double coding. The team estimated that other psychologists entered improper codes for about 29 percent of the encounters completed during the same period. The coding errors occurred because the chief of psychology failed to make sure that staff attended training or otherwise received proper instruction. The chief also failed to provide oversight by not reviewing the health care providers’ coding for accuracy. Furthermore, the chief of Health Information Management failed to perform mandatory annual coding reviews for each provider. The OIG recommended stronger oversight and that the director of the Central Texas Veterans Health Care System ensure all psychologists receive medical coding training. The OIG also recommended improving the review of overtime hours, ensuring facility hours are used to provide direct patient care, and confirming psychologists follow VHA’s scheduling policies and use approved systems.