Review of Good Shepherd Medical Center Outpatient Rehabilitation Services

EXECUTIVE SUMMARY:

The objective of our review was to determine whether Medicare properly reimbursed Good Shepherd Medical Center (GSMC) for outpatient cardiac rehabilitation services.  We determined that GSMC met the Medicare cardiac rehabilitation coverage requirements for direct physician supervision and 'incident to' services.  Our claims review of 30 of the 93 Medicare beneficiaries who received outpatient cardiac rehabilitation services during CY 2001, revealed that GSMC claimed and received Medicare reimbursement for 12 beneficiaries' services, amounting to $3,737, which may not have met Medicare coverage requirements or which were otherwise unallowable.  We attributed these errors to weaknesses in GSMC's internal controls and oversight procedures.