Review of Outpatient Cardiac Rehabilitation Services - Northern Michigan Hospital, Petoskey, Michigan

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicare properly reimbursed Northern Michigan Hospital (Hospital) for outpatient cardiac rehabilitation services.  Our review disclosed the Hospital did not designate a physician to directly supervise the services provided by its cardiac rehabilitation program.  In addition, contrary to current Medicare requirements, we could not identify the physician professional services to which the cardiac rehabilitation services were provided “incident to.”  Also, the Hospital claimed and received Medicare reimbursement for outpatient cardiac rehabilitation services, amounting to approximately $3,738, which did not meet Medicare coverage requirements, which may not have been supported by medical record documentation, or which were otherwise unallowable.  We recommended a financial adjustment determination, and procedural and internal control improvements.