Englewood Hospital and Medical Center Claimed Unallowable Medicare Part B Reimbursement for Outpatient Cardiac and Pulmonary Rehabilitation Services

Englewood Hospital and Medical Center (the Hospital) (operating in New Jersey) claimed Medicare reimbursement for outpatient cardiac and pulmonary rehabilitation services that did not comply with Medicare reimbursement requirements. For 46 of the 100 claims in our random sample, the Hospital improperly claimed Medicare reimbursement. On the basis of our sample results, we estimated that the Hospital improperly received at least $115,000 in Medicare reimbursement for services that did not comply with Medicare requirements. We recommended that the Hospital (1) refund $115,000 to the Federal Government and (2) implement written policies and procedures to ensure that outpatient cardiac and pulmonary rehabilitation services are provided and documented in accordance with Medicare requirements.