AgeWell Physical Therapy & Wellness, P.C., Claimed Unallowable Medicare Part B Reimbursement for Outpatient Therapy Services

AgeWell Physical Therapy & Wellness, P.C. (AgeWell), claimed Medicare reimbursement for outpatient therapy services that did not comply with Medicare requirements. On the basis of our sample results, we estimated that AgeWell improperly received at least $1.4 million in Medicare reimbursement for outpatient therapy services that did not comply with certain Medicare requirements.

Of the 100 claims in our random sample, AgeWell properly claimed Medicare reimbursement for 38 claims. However, AgeWell improperly claimed Medicare reimbursement for the remaining 62 claims. Of these 62 claims, 29 contained more than 1 deficiency.

These deficiencies occurred because AgeWell did not have a thorough understanding of Medicare requirements related to claiming outpatient therapy services and did not have adequate policies and procedures to ensure that it billed for services in accordance with Medicare requirements.

We recommended that AgeWell (1) refund $1.4 million to the Federal Government, (2) strengthen its policies and procedures to ensure that outpatient therapy services are provided and documented in accordance with Medicare requirements, and (3) obtain a better understanding of Medicare requirements related to claiming outpatient therapy services through such means as attending provider outreach and education seminars. AgeWell, through its attorneys, generally disagreed with our first recommendation (financial disallowance) and agreed with our remaining recommendations.