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A Florida Physical Therapy Practice Claimed Unallowable Medicare Part B Reimbursement for Some Outpatient Therapy Services

A Florida physical therapy practice (the Therapy Practice), located in Boca Raton, Florida, properly claimed Medicare reimbursement on 87 of 100 beneficiary claim days that we sampled. However, the Therapy Practice improperly claimed Medicare reimbursement on the remaining 13 beneficiary claim days. These deficiencies occurred because the Therapy Practice did not have adequate policies and procedures in place to ensure that it billed for services that complied with Medicare requirements.

On the basis of our sample results, we estimated that the Therapy Practice improperly received at least $55,000 in Medicare reimbursement for outpatient physical therapy services that did not comply with certain Medicare requirements for calendar years 2012 and 2013.

Filed under: Center for Medicare and Medicaid Services