Review of the Outpatient Cardiac Rehabilitation Services - HealthSouth Sea Pines Rehabilitation Hospital

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicare properly reimbursed Health South Sea Pines Rehabilitation Hospital (Hospital) for outpatient cardiac rehabilitation services.  We could not identify the physician professional services to which the cardiac rehabilitation services were provided 'incident to.'  Also, from our claims review for 30 sampled beneficiaries who received outpatient cardiac rehabilitation services during calendar year 2001, we determined that the Hospital received Medicare payments of $26,279 for services provided to beneficiaries not allowable, and payments of $902 where medical documentation may not have supported Medicare covered diagnoses.  We recommended that the Hospital:  (1) work with its fiscal intermediary to ensure that its outpatient cardiac rehabilitation program is being conducted in accordance with the Medicare coverage requirements for direct physician supervision and for services provided 'incident to' a physician's professional service; (2) work with its fiscal intermediary to establish the amount of repayment liability for services where medical documentation may not have supported Medicare covered diagnoses; (3) refund the $26,279 overpayment; (4) conduct an internal review of all cardiac rehabilitation claims from August 1, 2000 to the present and report the overpayments to the fiscal intermediary and the Office of Inspector General; and, (5) implement controls to ensure only 1 unit of service per beneficiary is billed for each cardiac rehabilitation session.