Review of Outpatient Rehabilitation Services Provided by Americare Physical Therapy and Rehab Services for the Period January 1, 1997 Through December 31, 1997

This final report points out that Americare Physical Therapy and Rehab Services (Americare) claimed payment for outpatient rehabilitation services that did not meet the Medicare criteria for reimbursement. Specifically, we identified charges for outpatient rehabilitation services that were not reasonable and medically necessary for the beneficiary's condition, or were inadequately documented. Based on a statistical sample, we estimate that at least $190,399 was paid to Americare for unallowable charges. We also identified additional unallowable costs of $313,220 in unreasonable owner's compensation, contracted costs for which there was not sufficient documentation, and other miscellaneous unallowable expenses on Americare's 1997 Medicare cost report. Americare concurred with our recommendation that it strengthen its procedures to ensure that claims for services are reasonable, necessary, and properly documented and that nonreimbursable costs are eliminated from its Medicare cost reports. We are also providing the results of our audit to the fiscal intermediary so that it can make the appropriate financial adjustments.