Report Materials
EXECUTIVE SUMMARY:
The primary objective of the review was to evaluate the medical necessity of the care and services provided and the reasonableness of the charges and reimbursements made during the period from November 1, 1994 through December 31, 1995.
The Operation Restore Trust reviewers questioned $354,537 in charges reported for the 20 sample beneficiaries in our study. This amount is comprised of $349,835 related to physical, occupational and speech therapy services rendered; $16,064 of unallowable respiratory therapy services; $684 in unallowable pharmacy charges; $4,702 in inappropriate psychiatric services. Therefore, we are recommending an adjustment of the above charges. In addition, we request that a focused review of all rehab therapies and the physician orders for these therapies be conducted by the fiscal intermediary and State agency in order to recoup overpayments made to this skilled nursing facility and to implement corrective action by the facility.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.