Review of Inpatient Rehabilitation Facility Admissions at Catholic Medical Center for Calendar Year 2003

The objective of our review was to determine whether Catholic Medical Center (the Hospital) submitted inpatient rehabilitation facility (IRF) claims that met Medicare requirements. The Hospital submitted numerous IRF claims that did not meet Medicare requirements.  For 44 of the 100 claims in our sample, an IRF was not the appropriate setting for the beneficiaries.  Based on the sample results, we estimate that Medicare overpaid the Hospital approximately $1.7 million for IRF claims during 2003.

We recommended that the Hospital refund to the Medicare program the $1.7 million estimated overpayment for 2003; identify and refund any overpayments for subsequent years' IRF claims that did not meet Medicare requirements; and strengthen its preadmission screening procedures to provide reasonable assurance that beneficiaries who are admitted for IRF services require treatment at the IRF level of care, are capable of significant practical improvement, and are able to participate in intensive rehabilitation.  The Hospital strongly objected to our findings and recommendations.