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

Claims for outpatient physical therapy services provided by a physical therapy practice (the practice), located in Yuba City, California, did not comply with Medicare requirements. Specifically, of the 100 beneficiary days in our random sample, the practice properly claimed Medicare reimbursement for 36 beneficiary days. However, the practice improperly claimed Medicare reimbursement for the remaining 64 beneficiary days, consisting of 62 beneficiary days that had therapy services that were not medically necessary and 2 beneficiary days that did not meet Medicare documentation requirements. On the basis of our sample results, we estimated that the practice received at least $583,000 in unallowable Medicare reimbursement for outpatient physical therapy services that did not comply with Medicare requirements.

Filed under: Centers for Medicare and Medicaid Services