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A Southern 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), with offices located in Southern California, did not comply with Medicare requirements. Specifically, of the 100 beneficiary days in our random sample, the practice properly claimed Medicare reimbursement for 68 beneficiary days. However, the practice improperly claimed Medicare reimbursement for the remaining 32 beneficiary days, which had therapy services that were not medically necessary. On the basis of our sample results, we estimated that the practice improperly received at least $267,000 in Medicare reimbursement for outpatient physical therapy services that did not comply with Medicare requirements.

Filed under: Centers for Medicare and Medicaid Services