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 1994 through December 31, 1995.
The Operation Restore Trust reviewers questioned $220,483 in charges reported for 30 of the 32 beneficiaries in our sample. This amount comprises $218,000 related to physical, occupational, respiratory and speech therapy; $1,355 in laboratory charges; and $1,138 for pharmacy and x-ray charges. Therefore, we are recommending an adjustment of the above charges. In addition, we request that a focused review of occupational therapies and the use of standing orders for all rehab 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.