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Audit (A-05-13-00010)

08-20-2014
An Illinois Physical Therapist Claimed Unallowable Medicare Part B Reimbursement for Outpatient Therapy Services

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Summary

A therapist claimed Medicare reimbursement for outpatient physical therapy claims that did not meet Medicare reimbursement requirements. Specifically, of the 100 claims in our random sample, the therapist improperly claimed Medicare reimbursement on 99 claims, all of which contained more than 1 deficiency. The therapist properly claimed Medicare reimbursement on the remaining claim.

These deficiencies occurred because the therapist did not have adequate policies and procedures in place to ensure that the therapist billed services that met certain Medicare requirements.

On the basis of our sample results, we estimated that the therapist improperly received at least $630,000 in Medicare reimbursement for outpatient physical therapy services that did not comply with certain Medicare requirements.

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