Review of Rehabilitation Services at Gulf Health Care, Texas City, Texas

EXECUTIVE SUMMARY:

The objective of this review was to determine whether the services on rehabilitation claims paid to Gulf Health Care Center (Gulf) of Texas City, Texas, were medically necessary and adequately supported by medical documentation.  Of the 100 claims sampled, Gulf submitted 69 claims that did not meet Medicare requirements.  Based on our sample results, we estimate Medicare overpaid Gulf at least $671,456 for services that did not meet Medicare requirements. We recommended that Gulf refund to the Medicare program $671,456 in overpayments for improperly paid rehabilitation claims, ensure that future rehabilitation claims comply with Medicare requirements on medical necessity, strengthen its procedures to ensure that all Medicare claims are supported by adequate medical documentation, and work with the fiscal intermediary to determine the amount of overpayments made subsequent to our audit period. Gulf disagreed with our findings.