According to a report issued by the Office of the Inspector General Spectrum Rehab LLC of New Jersey claimed Medicare reimbursement for outpatient physical and occupational therapy services that did not comply with certain Medicare requirements. The OIG random sample incuded 100 claims from a 2 year timeframe. According to the OIG report, Spectrum improperly claimed Medicare reimbursement for 83 of the 100 claims, with only 17 claims meeting criteria for reimbursement. Of these 83 claims that did not meet reimbursement criteria, 44 contained more than 1 deficiency.
The OIG recommended that Spectrum:
- refund $3,112,501 to the Federal Government;
- strengthen its policies and procedures to ensure that outpatient therapy services are provided and documented in accordance with Medicare requirements; and
- obtain a better understanding of the Medicare reimbursement requirements related to outpatient therapy services, through such means as attending provider outreach and education seminars.
Spectrum Rehab, through its attorney was not in agreement with the OIG recommendation to refund over $3.1 million, but was in agreement with the recommendations for Spectrum to strengthen its policies and procedures, as well as to obtain a better understanding of Medicare reimbursement via educational offerings.
This OIG case represents a sneak preview of what is likely to happen to therapy providers who have not complied fully with Medicare documentation requirements. Providers under probe review have found technical denials for the plan of care not being signed, or the minutes not supporting the number of codes that were billed. However in this review we are seeing a detailed insightful review of a therapy provider – a case study for every therapy practice.
Spectrum Rehab was able, through its legal representation, to successfully refute a number of deficiencies with which the OIG agreed.