Review of Outpatient Rehabilitation Services Provided by South Jersey Rehabilitation Associates, Inc. for Calendar Year Ended December 31, 1997

EXECUTIVE SUMMARY:

This final report points out that South Jersey Rehabilitation Associates, Inc. (SJR) claimed payment for outpatient services that did not meet the Medicare criteria for reimbursement. Specifically, we identified charges for outpatient rehabilitation services which were not reasonable and necessary, lacked sufficient patient treatment plans, and/or were not properly supported by medical record documentation. Based on a statistical sample, we estimate that at least $241,774 was paid to SJR for unallowable charges. We also identified additional unallowable costs of $56,034 in owner's compensation and miscellaneous unsupported costs on SJR's 1997 Medicare cost report. During our audit, SJR voluntarily left the Medicare program. We are providing the results of our review to the fiscal intermediary so that it can make the appropriate financial adjustments.