Review of Outpatient Cardiac Rehabilitation Services at Washington Adventist Hospital, Takoma Park, Maryland

EXECUTIVE SUMMARY:

The objective of our review was to determine whether Medicare properly reimbursed Washington Adventist Hospital (WAH) for outpatient cardiac rehabilitation services.  WAH contracted with a physician to supervise the services provided by its cardiac rehabilitation program.  The physician's responsibilities included the approval of cardiac rehabilitation treatment plans and review of patients' medical records.  However, our review disclosed that the physician was not in the exercise area during regularly scheduled exercise sessions, nor did he personally see the patients.  In addition, from our claims review for 29 sampled beneficiaries who received outpatient cardiac rehabilitation services during calendar year 2001, we determined that WAH received Medicare payments of $15, 946 for services provided to beneficiaries where medical documentation may not have supported Medicare covered diagnoses and for services not otherwise allowable.