Federal Audit Reveals $30 Million in Improper Medicare Payments Fox Rehabilitation, based in Cherry Hill, New Jersey, received at least $29.9 million from Medicare for outpatient therapy services that did not meet Medicare requirements, according to a federal audit report. The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services found that 85 of ... News in Brief
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News in Brief  |   November 01, 2017
Federal Audit Reveals $30 Million in Improper Medicare Payments
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Practice Management / News in Brief
News in Brief   |   November 01, 2017
Federal Audit Reveals $30 Million in Improper Medicare Payments
The ASHA Leader, November 2017, Vol. 22, 10. doi:10.1044/leader.NIB1.22112017.10
The ASHA Leader, November 2017, Vol. 22, 10. doi:10.1044/leader.NIB1.22112017.10
Fox Rehabilitation, based in Cherry Hill, New Jersey, received at least $29.9 million from Medicare for outpatient therapy services that did not meet Medicare requirements, according to a federal audit report.
The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services found that 85 of 100 claims in its random sample contained services that were not medically necessary. Overall, privately owned Fox submitted 400,221 claims during the audit period—July 2013 to June 2015—for 15,287 Medicare beneficiaries in New Jersey, with $39.7 million in total reimbursement.
The $29.9 million figure in improper payment is extrapolated from the sample results.
“For nearly all of these claims, the amount, frequency, and duration of services were not reasonable and consistent with acceptable standards of practice,” the OIG report said. “Further, some services did not require the skills of a licensed therapist or were not an effective treatment for the Medicare beneficiary’s condition.”
The auditors recommend that Fox refund $29.9 million to the federal government and ensure that outpatient therapy services are provided and documented in accordance with Medicare requirements.
Fox, described in the OIG report as one of the nation’s largest providers of outpatient occupational, physical and speech therapy, disagreed with the findings and the repayment recommendation, and plans to appeal all of the denied claims. The case has been referred to the Center for Medicare and Medicaid Services, which will review OIG’s audit and any additional information provided by Fox.
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November 2017
Volume 22, Issue 11