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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Operation Restore Trust Skilled Nursing Facility Review Conducted at Palm Gardens of Pinellas, a Skilled Nursing Facility in Largo, Florida," (A-04-96-01118)

September 25, 1996


Complete Text of Report is available in PDF format (1.26 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

The primary objective of the review was to evaluate the medical necessity of the care and services provided and the reasonableness of the charges and reimbursements made during the period from November 1, 1994 through December 31, 1995.

The Operation Restore Trust reviewers questioned $47,229 in charges reported for the 28 sample beneficiaries in our study. This amount included $32,420 related to physical, occupational, and speech therapy services not rendered; $10,180 of unallowable respiratory therapy services; $270 in unallowable pharmacy charges; $310 in inappropriate physician payments; $441 in undocumented x-ray charges; and $3,598 in inappropriate psychiatric services. Therefore, we are recommending an adjustment of the above charges. In addition, we request that a focused review of all rehab therapies and the use of standing orders for these therapies be conducted by the Fiscal Intermediary and State agency in order to recoup overpayments made to this skilled nursing facility and to implement corrective action by the facility.