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 January 1, 1994 through December 31, 1994.
The Operation Restore Trust reviewers questioned $202,780 in charges reported for the 26 sample beneficiaries in our study. This amount comprises $192,505 related to unnecessary physical, occupation, speech and respiratory services, and $10,275 of unallowable routine supply and drug services. We are recommending an adjustment of the above charges and for the Fiscal Intermediary to conduct a focused review of all occupational therapy services and supplies since the period of our review in order to recoup overpayments made to this skilled nursing facility.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.